Clinical outcome of cardiac resynchronization therapy in dilated-phase hypertrophic cardiomyopathy

Min GU; Han JIN; Wei HUA; Xiao-Han FAN; Hong-Xia NIU; Tao TIAN; Li-Gang DING; Jing WANG; Cong XUE; Shu ZHANG

doi:10.11909/j.issn.1671-5411.2017.04.002

摘要：Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy (CRT) is effective in patients with "non-is-chemic cardiomyopathy".However,patients with dilated-phase hypertrophic cardiomyopathy (DHCM) have been generally excluded from such trials.We aimed to compare the clinical outcome of CRT in patients with DHCM,idiopathic dilated cardiomyopathy (IDCM),or ischemic cardiomyopathy (ICM).Methods A total of 312 consecutive patients (DHCM:n =16;IDCM:n =231;ICM:n =65) undergoing CRT in Fuwai hospital were studied respectively.Response to CRT was defined as reduction in left ventricular end-systolic volume (LVESV) ＞ 15％ at 6-month follow-up.Results Compared with DHCM,IDCM was associated with a lower total mortality (HR:0.35,95％ CI:0.13-0.90),cardiac mortality (HR:0.29;95％ CI:0.11-0.77),and total mortality or heart failure (HF) hospitalizations (HR:0.34,95％ CI:0.17-0.69),independent of known confounders.Compared with DHCM,the total mortality,cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant (HR:0.59,95％ CI:0.22-1.61;HR:0.59,95％ CI:0.21-1.63;HR:0.54,95％ CI:0.26-1.15;respectively).Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn't reach statistical significance.Conclusions Compared with IDCM,DHCM was associated with a worse outcome after CRT.The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that ofICM patients.These indicate that DHCM behaves very differently after CRT.