The online version of this article (doi:10.1186/1476-7120-7-37) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
GKE, CP, GG and EDP conceived the original paper, collected the data, reviewed literature and wrote the manuscript. SH, IHS and GP revised the article for important intellectual content and edited the final version. GKE, DP and CK performed the ultrasounds and participated in the analysis and interpretation of data. SG and VK performed the exercise tests and participated in the interpretation of data. All authors read and approved the final manuscript.
The percentage of hypertrophic cardiomyopathy (HCM) patients who are in high risk for Sudden Death (SD) constitutes only a minority of all HCM population but the incidence of SD in this subset is high (at least 5% annually). The identification of this small but important proportion of high risk HCM patients has been the clue in the clinical evaluation of these patients.
Our study cohort consisted from 123 patients with HCM who are currently followed up in our Institution. Five clinical risk factors were assessed: a family history of premature SD, unexplained syncope, Non Sustained Ventricular Tachycardia (NSVT) on 24-h ECG monitoring, Abnormal Blood Pressure Response (ABPR) during upright exercise testing and Maximum left ventricular Wall Thickness (MWT) ≥30 mm. The purpose of our study was the identification of high risk HCM patients coming from Northern Greece.
Fifteen patients (12.2%) of the whole cohort had MWT ≥ 30 mm, 30 patients (24.4%) had an ABPR to exercise, 17 patients (13.8%) had episodes of NSVT in 24-h Holter monitoring, 17 patients (13.8%) suffered from syncope, and 8 patients (6.5%) had a positive family history of premature SD. Data analysis revealed that 74 patients (60.1%) had none risk factor. Twenty four patients (19.5%) had 1 risk factor, 17 patients (13.8%) had 2 risk factors, 4 patients (3.25%) had 3 risk factors, and 4 patients (3.25%) had 4 risk factors, while none patient had 5 risk factors. Twenty five patients (20.3%) had 2 or more risk factors.
This study for the first time confirms that, although a 60% of patients with HCM coming from a regional Greek population are in low risk for SD, a substantial proportion (almost 20%) carries a high risk for SD justifying prophylactic therapy with amiodaron or ICD implantation.
Maron BJ: Hypertrophic cardiomyopathy: a systematic review. JAMA 2002, 287: 1308-1320. PubMed
Maron BJ, Shen W-K, Link MS, Epstein AE, Almquist AK, Daubert JP, Bardy GH, Favale S, Rea RF, Boriani G, Estes NA 3rd, Spirito P: Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med 2000, 342: 365-373. CrossRefPubMed
- Identification of high risk patients with hypertrophic cardiomyopathy in a northern Greek population
Georgios K Efthimiadis
Efstathios D Pagourelias
Despina G Parcharidou
Ioannis H Styliadis
- BioMed Central
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