, Chunli Shao 2
, Wenyao Wang 2
, Xiangbin Meng 3
, Kuo Zhang 2
, Jingjia Wang 2
, Mingqi Zheng 4
, Yi-Da Tang 5
2Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing-China
3Department of Cardiology, Peking University Third Hospital; Beijing-China;Central China Fuwai Hospital; Central China Branch of the National Cardiovascular Center; Department of Cardiology, Zhengzhou University People's Hospital; Henan Provincial People's Hospital; Zhengzhou-China
4Heart Center, The First Hospital of Hebei Medical University; Shijiazhuang-China
5Department of Cardiology, Peking University Third Hospital; Beijing-China
Abstract
Objective: Presently, an effective model to predict long-term cardiac mortality in patients with hypertrophic obstructive cardiomyopathy (HOCM) is lacking. Therefore, the objective of this study was to evaluate the predictive value of the modified Age, Creatinine clearance, and Ejection Fraction (mACEF) score for long-term cardiac mortality in patients with HOCM.
Materials and Methods: Two hundred and ninety two patients with HOCM treated non-invasively were enrolled in this study, all of whom had intact medical information.
Results: Over a median follow-up period of 41.9 months, 28 cardiac deaths occurred. In univariate Cox regression analysis, the mACEF score was associated with long-term cardiac death [hazard ratio (HR)=1.795, 95% confidence interval (CI) 1.518–2.124, p<0.001]. Multiple Cox regression analysis identified the mACEF score as an independent risk factor for long-term cardiac death (adjusted HR=1.372, 95% CI 1.076-1.749, p=0.011). Analysis of the receiver operating characteristic (ROC) for long-term cardiac death showed that the mACEF score had a considerable predictive value (area under ROC 0.844, sensitivity 89.29%, specificity 75.00%) with an optimum cut-off value of 0.96. The study population was divided into high-risk (mACEF score ≥0.96, n=91) and low-risk (mACEF score <0.96, n=201) groups according to the optimum cut-off value. Kaplan-Meier survival analysis was performed and showed a dramatic higher rate of long-term cardiac mortality in the high-risk group than in the low-risk group (27.4% vs. 1.7%, p<0.001 by log-rank test).
Conclusion: The mACEF score has a considerable predictive value for long-term cardiac mortality in patients with HOCM treated non-invasively. A mACEF score ≥0.96 could be considered as a sign of poor prognosis in patients with HOCM.