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Shin YJ, Lee JH, Yoo JY, et al. Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain. Eur Radiol. 2019;29(9):4593-4602doi: 10.1007/s00330-018-5951-8.
Shin, Y. J., Lee, J. H., Yoo, J. Y., Kim, J. A., Jeon, Y., Yoon, Y. E., & Chun, E. J. (2019). Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain. European radiology, 29(9), 4593-4602. https://doi.org/10.1007/s00330-018-5951-8
Shin, Yoon Joo, et al. "Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain." European radiology vol. 29,9 (2019): 4593-4602. doi: https://doi.org/10.1007/s00330-018-5951-8
Shin YJ, Lee JH, Yoo JY, Kim JA, Jeon Y, Yoon YE, Chun EJ. Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain. Eur Radiol. 2019 Sep;29(9):4593-4602. doi: 10.1007/s00330-018-5951-8. Epub 2019 Feb 22. PMID: 30796567.
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Eur Radiol. 2019 Sep;29(9):4593-4602. doi: 10.1007/s00330-018-5951-8. Epub 2019 Feb 22.

Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain.

European radiology

Yoon Joo Shin, Jae Hwan Lee, Jin Young Yoo, Jeong A Kim, Yongho Jeon, Yeonyee E Yoon, Eun Ju Chun

Affiliations

  1. Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
  2. Department of Radiology, National Cancer Center Hospital, Goyang, Gyeonggi-do, South Korea.
  3. Department of Radiology, Chungbuk National University Hospital, Cheongju, South Korea.
  4. Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South Korea.
  5. Department of Applied Statistics, College of Commerce and Economics, Yonsei University, Seoul, South Korea.
  6. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.
  7. Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea. [email protected].

PMID: 30796567 DOI: 10.1007/s00330-018-5951-8

Abstract

OBJECTIVE: Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up.

METHODS: In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables.

RESULTS: The prevalence of obstructive CAD (≥ 50% in luminal stenosis) and APC was 14.7% and 18.9%, respectively. During the follow-up period (median, 37 months; range, 2-108 months), there were 31 occurrences of ACEs (13.0%). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001).

CONCLUSIONS: Using CCTA, about 20% of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients.

KEY POINTS: • Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.

Keywords: Cardiomyopathy, hypertrophic; Chest pain; Computed tomography angiography; Coronary artery disease

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