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Valeur seuil optimale de la fraction d’éjection ventriculaire gauche pour la prédiction de la mortalité dans la cardiomyopathie hypertrophique avec dysfonction systolique

Year: 2025
Type: dissertation
Study design: Observational Study
Abstract: Introduction: End-stage HCM is a distinct and advanced form of HCM, defined by LVEF <50%. However, relying on a single cut-off may limit prognostic discrimination within this heterogeneous population. Aim: To determine the optimal LVEF cut-off value for predicting long-term all-cause mortality in end-stage HCM patients. Methods: All patients referred for cardiovascular magnetic resonance assessment of HCM at three French university hospitals between 2008 and 2024 were retrospectively screened. Patients with a LVEF <50% were included. The primary endpoint was all-cause mortality. A conditional inference tree (C-Tree) and Youden index method were used to identify the optimal LVEF cut-off. Propensity score matching was applied to strengthen our findings. Results: Among 2,875 eligible patients with HCM, 691 with a LVEF <50% were included (mean age 53 ±7 years, 54% male). The optimal LVEF cut-off was 40%. Patients with LVEF <40% had more dilated left ventricles (indexed end diastolic volume: 99 ±11 vs 83 ±7 mL/m², p<0.001), a greater extent of late gadolinium enhancement (2.4 ±1.9 vs 0.6± 1.2 segments; p<0.001) and more heart failure symptoms (70.4% vs 13.8%, p<0.001). After a median follow-up of 9 years (IQR 6–11), 226 patients died (32%). After adjustment for traditional prognostic factors, a LVEF value <40% was strongly associated with mortality even after propensity score matching (HR: 23.6 [95% CI: 14.6–38.1]; p<0.001 and HR: 20.5 [95% CI: 12.4-33.9], p<0.001 respectively). Conclusions: In this large multicenter cohort of end-stage HCM patients, a LVEF cut-off of 40% identified a subgroup with significantly higher mortality.
Source: HAL
Language: French
Field: Medicine
Open Access status: green
OpenAlex ID: W7225447720
Cites: 3
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Related to: 10