Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy

Ammar M. Killu, Jae Yoon Park, Jaskanwal D. Sara, David O. Hodge, Bernard J. Gersh, Rick A. Nishimura, Samuel J Asirvatham, Christopher J. McLeod

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

A dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM. The Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF)<50% and CRT. Control subjects were identified in 1:1 manner. Clinical outcomes were determined. Of 2073 patients with HCM, 9 (8 male) had EF<50% and received CRT. The average age at CRT-D implant was 44.8±14.8 years, an average of 17.3±10.3 years after HCM diagnosis. The indication for CRT was based on New York Heart Association class≥II symptoms (mean 2.7±0.4) and EF<50% in all patients (EF 34.7±7.1% at implant), with electrocardiographic evidence of abnormal ventricular conduction. At 6-month, 12-month, and long-term follow-up, EF was 39.9±8.4%, 37.9±9.8%, and 33.3±7.6%, respectively (P>0.05 for all). There was no difference in the combined end-point of left ventricular assist device (LVAD), cardiac transplant, or death between groups (P=0.90). At last follow-up [mean duration 12.9±8.3 (median 10.7) years], 8 (89%) in the CRT group were alive. Three and 2 patients underwent LVAD implantation and cardiac heart transplantation, respectively, 15.0±10.1 years from HCM diagnosis and 2.660.9 years from CRT implant. In the control group, 4 (44.4%) patients were alive at last followup [mean duration 12.0±7.1 (median 12.7) years]. One patient each had LVAD and cardiac transplant. CRT in patients with dilated/end-stage HCM does not appear to confer a salutary effect on ventricular function. In medium-term follow-up, however, left ventricular function did not appear to deteriorate further, yet advanced heart failure therapy was common in this group.

Original languageEnglish (US)
Pages (from-to)82-88
Number of pages7
JournalEuropace
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Cardiac Resynchronization Therapy
Hypertrophic Cardiomyopathy
Heart-Assist Devices
Heart Transplantation
Transplants
Ventricular Function
Left Ventricular Function
Heart Failure
Databases
Control Groups

Keywords

  • Biventricular pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Killu, A. M., Park, J. Y., Sara, J. D., Hodge, D. O., Gersh, B. J., Nishimura, R. A., ... McLeod, C. J. (2018). Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy. Europace, 20(1), 82-88. https://doi.org/10.1093/europace/euw327

Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy. / Killu, Ammar M.; Park, Jae Yoon; Sara, Jaskanwal D.; Hodge, David O.; Gersh, Bernard J.; Nishimura, Rick A.; Asirvatham, Samuel J; McLeod, Christopher J.

In: Europace, Vol. 20, No. 1, 01.01.2018, p. 82-88.

Research output: Contribution to journalArticle

Killu, AM, Park, JY, Sara, JD, Hodge, DO, Gersh, BJ, Nishimura, RA, Asirvatham, SJ & McLeod, CJ 2018, 'Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy', Europace, vol. 20, no. 1, pp. 82-88. https://doi.org/10.1093/europace/euw327
Killu AM, Park JY, Sara JD, Hodge DO, Gersh BJ, Nishimura RA et al. Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy. Europace. 2018 Jan 1;20(1):82-88. https://doi.org/10.1093/europace/euw327
Killu, Ammar M. ; Park, Jae Yoon ; Sara, Jaskanwal D. ; Hodge, David O. ; Gersh, Bernard J. ; Nishimura, Rick A. ; Asirvatham, Samuel J ; McLeod, Christopher J. / Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy. In: Europace. 2018 ; Vol. 20, No. 1. pp. 82-88.
@article{3bfdbc99c28a4dda966ee0f554b0d48c,
title = "Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy",
abstract = "A dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM. The Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF)<50{\%} and CRT. Control subjects were identified in 1:1 manner. Clinical outcomes were determined. Of 2073 patients with HCM, 9 (8 male) had EF<50{\%} and received CRT. The average age at CRT-D implant was 44.8±14.8 years, an average of 17.3±10.3 years after HCM diagnosis. The indication for CRT was based on New York Heart Association class≥II symptoms (mean 2.7±0.4) and EF<50{\%} in all patients (EF 34.7±7.1{\%} at implant), with electrocardiographic evidence of abnormal ventricular conduction. At 6-month, 12-month, and long-term follow-up, EF was 39.9±8.4{\%}, 37.9±9.8{\%}, and 33.3±7.6{\%}, respectively (P>0.05 for all). There was no difference in the combined end-point of left ventricular assist device (LVAD), cardiac transplant, or death between groups (P=0.90). At last follow-up [mean duration 12.9±8.3 (median 10.7) years], 8 (89{\%}) in the CRT group were alive. Three and 2 patients underwent LVAD implantation and cardiac heart transplantation, respectively, 15.0±10.1 years from HCM diagnosis and 2.660.9 years from CRT implant. In the control group, 4 (44.4{\%}) patients were alive at last followup [mean duration 12.0±7.1 (median 12.7) years]. One patient each had LVAD and cardiac transplant. CRT in patients with dilated/end-stage HCM does not appear to confer a salutary effect on ventricular function. In medium-term follow-up, however, left ventricular function did not appear to deteriorate further, yet advanced heart failure therapy was common in this group.",
keywords = "Biventricular pacing",
author = "Killu, {Ammar M.} and Park, {Jae Yoon} and Sara, {Jaskanwal D.} and Hodge, {David O.} and Gersh, {Bernard J.} and Nishimura, {Rick A.} and Asirvatham, {Samuel J} and McLeod, {Christopher J.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1093/europace/euw327",
language = "English (US)",
volume = "20",
pages = "82--88",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy

AU - Killu, Ammar M.

AU - Park, Jae Yoon

AU - Sara, Jaskanwal D.

AU - Hodge, David O.

AU - Gersh, Bernard J.

AU - Nishimura, Rick A.

AU - Asirvatham, Samuel J

AU - McLeod, Christopher J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - A dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM. The Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF)<50% and CRT. Control subjects were identified in 1:1 manner. Clinical outcomes were determined. Of 2073 patients with HCM, 9 (8 male) had EF<50% and received CRT. The average age at CRT-D implant was 44.8±14.8 years, an average of 17.3±10.3 years after HCM diagnosis. The indication for CRT was based on New York Heart Association class≥II symptoms (mean 2.7±0.4) and EF<50% in all patients (EF 34.7±7.1% at implant), with electrocardiographic evidence of abnormal ventricular conduction. At 6-month, 12-month, and long-term follow-up, EF was 39.9±8.4%, 37.9±9.8%, and 33.3±7.6%, respectively (P>0.05 for all). There was no difference in the combined end-point of left ventricular assist device (LVAD), cardiac transplant, or death between groups (P=0.90). At last follow-up [mean duration 12.9±8.3 (median 10.7) years], 8 (89%) in the CRT group were alive. Three and 2 patients underwent LVAD implantation and cardiac heart transplantation, respectively, 15.0±10.1 years from HCM diagnosis and 2.660.9 years from CRT implant. In the control group, 4 (44.4%) patients were alive at last followup [mean duration 12.0±7.1 (median 12.7) years]. One patient each had LVAD and cardiac transplant. CRT in patients with dilated/end-stage HCM does not appear to confer a salutary effect on ventricular function. In medium-term follow-up, however, left ventricular function did not appear to deteriorate further, yet advanced heart failure therapy was common in this group.

AB - A dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM. The Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF)<50% and CRT. Control subjects were identified in 1:1 manner. Clinical outcomes were determined. Of 2073 patients with HCM, 9 (8 male) had EF<50% and received CRT. The average age at CRT-D implant was 44.8±14.8 years, an average of 17.3±10.3 years after HCM diagnosis. The indication for CRT was based on New York Heart Association class≥II symptoms (mean 2.7±0.4) and EF<50% in all patients (EF 34.7±7.1% at implant), with electrocardiographic evidence of abnormal ventricular conduction. At 6-month, 12-month, and long-term follow-up, EF was 39.9±8.4%, 37.9±9.8%, and 33.3±7.6%, respectively (P>0.05 for all). There was no difference in the combined end-point of left ventricular assist device (LVAD), cardiac transplant, or death between groups (P=0.90). At last follow-up [mean duration 12.9±8.3 (median 10.7) years], 8 (89%) in the CRT group were alive. Three and 2 patients underwent LVAD implantation and cardiac heart transplantation, respectively, 15.0±10.1 years from HCM diagnosis and 2.660.9 years from CRT implant. In the control group, 4 (44.4%) patients were alive at last followup [mean duration 12.0±7.1 (median 12.7) years]. One patient each had LVAD and cardiac transplant. CRT in patients with dilated/end-stage HCM does not appear to confer a salutary effect on ventricular function. In medium-term follow-up, however, left ventricular function did not appear to deteriorate further, yet advanced heart failure therapy was common in this group.

KW - Biventricular pacing

UR - http://www.scopus.com/inward/record.url?scp=85040776259&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040776259&partnerID=8YFLogxK

U2 - 10.1093/europace/euw327

DO - 10.1093/europace/euw327

M3 - Article

C2 - 29315424

AN - SCOPUS:85040776259

VL - 20

SP - 82

EP - 88

JO - Europace

JF - Europace

SN - 1099-5129

IS - 1

ER -