Risk stratification in patients with hypertrophic cardiomyopathy - Looking beyond the left side myocardial function

Q: What problem does the study address in hypertrophic cardiomyopathy risk stratification?

HCM outcomes are heterogeneous, and traditional risk stratification mainly uses left-sided myocardial function. The study examines whether right ventricular (RV) function improves prognostic prediction.

Q: What methods were used to evaluate ventricular function in the cohort?

The study used conventional echocardiographic parameters such as LVEF, TAPSE, and fractional area change, and analyzed longitudinal strain using speckle tracking echocardiography.

Q: Which RV-related measures remained independent predictors of the primary endpoint?

After adjusting for age, sex, and LVEF, TAPSE and RV free wall strain remained independent prognostic predictors for the composite endpoint.

Sep 29, 2026

Uploaded by Sarah

Background: Patients with hypertrophic cardiomyopathy (HCM) show heterogeneous outcomes, and risk stratification traditionally emphasizes left ventricular myocardial function. This study evaluates whether right ventricular (RV) function adds prognostic information in HCM. Methods: A retrospective cohort analyzed conventional ventricular functional parameters and RV/left-sided strain by speckle tracking echocardiography. The primary endpoint combined heart failure hospitalization, sustained ventricular tachycardia, and all-cause death. Results: Over ~30 months, RV measures predicted events independently beyond age, sex, and LVEF. Conclusion: RV assessment by TAPSE and RV free wall strain supports more comprehensive HCM risk stratification.

LanguageEnglish

CategoryHealthcare

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INTRODUCTION

Study rationale for beyond-left RV assessment

Abstract

Background

Methods

Results

Conclusion

J Chin MedAssoc Original article Risk stratification in patients with hypertrophic cardiomyopathy: Looking beyond the left side myocardial function Hao-Chih Changa,b, Hao-Min Chengc,d,e,f, Ling Kuob,e,g, Dan-Ying Leeb, Shih-Hsien Sungb,d,e, Chen-Huan Chene,f,h, Wen-Chung Yub,e,* aDepartment of Medicine, Taipei Veterans General Hospital Yuanshan and Suao Branch, Yilan, Taiwan, ROC; bDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cCenter for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dInstitute of Public Health, Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; eDepartment of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; fDepartment of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; gDepartment of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; hCollege of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract Background: Patients with hypertrophic cardiomyopathy (HCM) have heterogeneous outcomes. As risk stratification mostly focuses on left-side myocardial function, we sought to investigate the prognostic value of right ventricular (RV) function in patients with HCM. Methods: This retrospective cohort study included patients with HCM. Conventional ventricular functional parameters, including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and fractional area change were obtained. The longitudinal strain was analyzed using the speckle tracking method. The primary endpoint was defined as a composite of hospitalization for heart failure, sustained ventricular tachycardia, or all-cause death. Results: A total of 56 patients with HCM (aged 58.0 ± 14.9 years, 64.3% male) were included. After a mean follow-up duration of 30.1 ± 17.4 months, primary endpoints developed in 10 (20%) of 50 patients who were treated medically. Patients with cardiovascular events had a more reduced LV thickest segmental strain, worse TAPSE, and more impaired RV free wall strain. After adjusting for age, sex, and LVEF, TAPSE (hazard ratio [HR], 95% confidence intervals [CIs]: 0.24, 0.06-0.93) and RV free wall strain (HR, 95% CIs:1 . 12, 1.03-1.21) remained independent prognostic predictors. Incorporating either TAPSE or RV free wall strain provides incremental prognostic value to the LV strain alone (net reclassification improvement by 31 .4% and 34. 1%, respectively, both p < 0 .05) . Conclusion: RV function assessed by TAPSE or RV free wall strain is predictive of subsequent cardiac events, suggesting that a comprehensive evaluation of RV function is useful for risk stratification in patients with HCM. Keywords: Hypertrophic cardiomyopathy; Longitudinal strain; Right ventricular function; Risk stratification; Speckle tracking echocardiography 1. INTRODUCTION Hypertrophic cardiomyopathy (HCM) is a common inherited disorder defined as marked left ventricular hypertrophy (LVH) in the absence of secondary causes.1,2 HCM is characterized by * Address correspondence. Dr. Wen-Chung Yu, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: yu.wenchung@gmail.com](ROC. E-mail address: yu.wenchung@gmail.com) (W.-C. Yu). Author Contributions: Dr. Hao-Chih Chang and Dr. Hao-Min Cheng contributed equally to this work. Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 19-25. Received June 14, 2022; accepted September 2, 2022. doi: 10. 1097/JCMA.0000000000000825. Copyright © 2022, t

FAQs

What problem does the study address in hypertrophic cardiomyopathy risk stratification?

HCM outcomes are heterogeneous, and traditional risk stratification mainly uses left-sided myocardial function. The study examines whether right ventricular (RV) function improves prognostic prediction.

What methods were used to evaluate ventricular function in the cohort?

The study used conventional echocardiographic parameters such as LVEF, TAPSE, and fractional area change, and analyzed longitudinal strain using speckle tracking echocardiography.

Which RV-related measures remained independent predictors of the primary endpoint?

After adjusting for age, sex, and LVEF, TAPSE and RV free wall strain remained independent prognostic predictors for the composite endpoint.

Sep 29, 2026

Uploaded by Sarah