Circulation. Heart failure · 2026
Prognostic Implications of Mitral Regurgitation Across Hypertrophic Cardiomyopathy Subtypes: A Report From REVEAL-HCM Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Obayashi Yuki, Kato Takao, Shiomi Hiroki, Nakatsuka Kiyomasa, Kitaoka Hiroaki, Sakata Yasushi, Dohi Kaoru, Tokita Yukichi, Matsushima Shouji, Amano Masashi, Furukawa Yutaka, Tamura Toshihiro, Hayashida Akihiro, Abe Haruhiko, Ando Kenji, Yuda Satoshi, Inoko Moriaki, Ono Koh, Nishimura Kunihiro, Izumi Chisato, REVEAL-HCM Investigators
Аннотация
BACKGROUND: Mitral regurgitation (MR) is a frequent comorbidity in patients with hypertrophic cardiomyopathy (HCM), which includes distinct subtypes with various characteristics. However, data on the long-term prognostic impact of MR and its progression or regression over time remain limited, particularly across individual HCM subtypes.
METHODS: Patients with HCM were retrospectively included from a Japanese multicenter registry and compared by MR severity (moderate or greater versus mild or less) within each subtype: hypertrophic obstructive cardiomyopathy (HOCM), end-stage HCM (ES-HCM), and other HCM (including nonobstructive, midventricular obstruction, and apical HCM).
RESULTS: Among 3602 patients (HOCM: n=837; ES-HCM: n=275; other HCM: n=2490), the prevalence of moderate or greater MR was highest in HOCM (36.3%), followed by ES-HCM (21.5%) and other HCM (8.5%). During a median follow-up of 5.3 (interquartile range, 2.1-9.3) years, the cumulative 5-year incidence of all-cause death or heart failure hospitalization was not significantly different between the moderate or greater MR and mild or less MR groups in HOCM (14.6% versus 12.4%; P=0.35) or ES-HCM (60.7% versus 54.7%; P=0.84). After adjustment for clinical covariates, no significant association was observed in either subtype (HOCM: hazard ratio, 1.13 [95% CI, 0.79-1.60], P=0.51; ES-HCM: hazard ratio, 0.84 [95% CI, 0.55-1.28], P=0.42). In contrast, in other HCM, moderate or greater MR was significantly associated with the higher 5-year cumulative incidence of all-cause death or heart failure hospitalization (34.2% versus 13.9%, P<0.001), which remained significant after adjustment, with a significant interaction (hazard ratio, 1.45 [95% CI, 1.09-1.91], P=0.01; Pinteraction=0.02). MR severity improved over time in HOCM, showed no clear change in ES-HCM, and worsened in other HCM (P<0.001, 0.46, and <0.001, respectively; Pinteraction <0.001).
CONCLUSIONS: In patients with HCM, moderate or greater MR was not associated with worse outcomes in HOCM or ES-HCM, but had significant prognostic implications in other HCM subtypes, suggesting the need for HCM subtype-specific MR management.
METHODS: Patients with HCM were retrospectively included from a Japanese multicenter registry and compared by MR severity (moderate or greater versus mild or less) within each subtype: hypertrophic obstructive cardiomyopathy (HOCM), end-stage HCM (ES-HCM), and other HCM (including nonobstructive, midventricular obstruction, and apical HCM).
RESULTS: Among 3602 patients (HOCM: n=837; ES-HCM: n=275; other HCM: n=2490), the prevalence of moderate or greater MR was highest in HOCM (36.3%), followed by ES-HCM (21.5%) and other HCM (8.5%). During a median follow-up of 5.3 (interquartile range, 2.1-9.3) years, the cumulative 5-year incidence of all-cause death or heart failure hospitalization was not significantly different between the moderate or greater MR and mild or less MR groups in HOCM (14.6% versus 12.4%; P=0.35) or ES-HCM (60.7% versus 54.7%; P=0.84). After adjustment for clinical covariates, no significant association was observed in either subtype (HOCM: hazard ratio, 1.13 [95% CI, 0.79-1.60], P=0.51; ES-HCM: hazard ratio, 0.84 [95% CI, 0.55-1.28], P=0.42). In contrast, in other HCM, moderate or greater MR was significantly associated with the higher 5-year cumulative incidence of all-cause death or heart failure hospitalization (34.2% versus 13.9%, P<0.001), which remained significant after adjustment, with a significant interaction (hazard ratio, 1.45 [95% CI, 1.09-1.91], P=0.01; Pinteraction=0.02). MR severity improved over time in HOCM, showed no clear change in ES-HCM, and worsened in other HCM (P<0.001, 0.46, and <0.001, respectively; Pinteraction <0.001).
CONCLUSIONS: In patients with HCM, moderate or greater MR was not associated with worse outcomes in HOCM or ES-HCM, but had significant prognostic implications in other HCM subtypes, suggesting the need for HCM subtype-specific MR management.