Clinical and pathological impact of tissue fibrosis on lethal arrhythmic events in hypertrophic cardiomyopathy patients with impaired systolic function

Yuko Wada, Takeshi Aiba, Taka Aki Matsuyama, Ikutaro Nakajima, Kohei Ishibashi, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Yoshiaki Morita, Hideaki Kanzaki, Kengo Kusano, Toshihisa Anzai, Shiro Kamakura, Hatsue Ishibashi-Ueda, Wataru Shimizu, Minoru Horie, Satoshi Yasuda, Hisao Ogawa

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

Background: The natural history of hypertrophic cardiomyopathy (HCM) varies from an asymptomatic benign course to a poor prognosis. Myocardial fibrosis may play a critical role in ventricular tachyarrhythmias (VT/VF); however, the clinical significance of tissue fibrosis by right ventricular (RV) biopsy in the long-term prognosis of HCM patients remains unclear. Methods and Results: We enrolled 185 HCM patients (mean age, 57±14 years). The amount of fibrosis (%area) was quantified using a digital microscope. Hemodynamic, echocardiographic, and electrophysiologic parameters were also evaluated. Patients with severe fibrosis had longer QRS duration and positive late potential (LP) on signalaveraged ECG, resulting in a higher incidence of VT/VF. At the 5±4 year follow-up, VT/VF occurred in 31 (17%) patients. Multivariate Cox regression analysis revealed that tissue fibrosis (hazard ratio (HR): 1.65; P=0.003 per 10% increase), lower left ventricular ejection fraction (HR: 0.64; P=0.001 per 10% increase), and positive SAECG (HR: 3.14; P=0.04) led to a greater risk of VT/VF. The combination of tissue fibrosis severity and lower left ventricular ejection fraction could be used to stratify the risk of lethal arrhythmic events in HCM patients. Conclusions: Myocardial fibrosis in RV biopsy samples may contribute to abnormal conduction delay and spontaneous VT/VF, leading to a poor prognosis in HCM patients.

Original languageEnglish
Pages (from-to)1733-1741
Number of pages9
JournalCirculation Journal
Volume79
Issue number8
DOIs
Publication statusPublished - 2015 Jul 24
Externally publishedYes

Keywords

  • Arrhythmias
  • Fibrosis
  • Histopathology
  • Hypertrophic cardiomyopathy
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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