Reverse septal curvature is related to more severe left ventricular remodelling and presence of ventricular arrhythmias in patients with hypertrophic cardiomyopathy

Introduction: The pattern of ventricular septal hyper-trophy in patients with hypertrophic cardiomyopathy (HCM) is variable and can broadly be divided into the following morphological subtypes: reverse curvature, sigmoid, apical and neutral. It is known that rever-se septal curvature (RSC) is a strong predictor of ge-notype-positive status. However, the relation of RSC to the magnitude of cardiac remodelling and to the ar-rhythmic risk is less well established.
Objective: The aim of our study is to assess the magni-tude of cardiac remodelling and the prevalence of ven-tricular arrhythmias in HCM pts with RSC.
Methods: We have prospectively enrolled 140 patients (52 ±16 years, 61 men) with HCM. A comprehensive echocardiogram was performed in all, including the careful assessment of septal hypertrophy pattern, and measurements of maximal LV and RV wall thickness (WT) and indexed left atrial volume (LAVi). LV filling pressures were assessed using the E/average e’ ratio. Global longitudinal LV strain (LVight ventricular strain (RVg a 6 segments model), and LA strain (LAere assessed by speckle tracking echocardio-graphy. Ambulatory ECG monitoring was used to detect the presence of nonsustain ventricular tachycardia (NSVT). HCM Risk-SCD Score was calculated based on the ESC 2014 guidelines on HCM.
Results: Forty-six patients had RSC. Ninety-four pa-tients had other patterns of ventricular septal hyper-trophy (nonRCS): 62 patients with sigmoid septum, 18 patients with apical hypertrophy, and 14 patients with neutral septum. There were no significant diffe-rences between patients with and without RSC regar-ding: RVWT, RVAVi, LAverage e’ (p>0.05 for all). RSC patients were younger (47±18 vs. 55±15 years, p=0.008), had higher values for LVWT (24.8±5.9 vs. 19.4±3.9 mm, p<0.001) and lower values for LV (-13.2±3.2 vs -14.5±3.5%, p=0.03) compared to non-RSC patients. RSC patients had a higher prevalence of NSVT (34.7 vs.13.8%, p=0.006). HCM Risk-SCD Score was significantly higher in pts with RSC than in pati-ents with nonRSC (4.4±3.4 vs. 3.1±1.8, p=0.005). In multivariable analysis, RSC pattern (OR=2.71, 95% CI 1.12 to 6.55, p=0.02) and LVR=1.17, 95% CI 1.02 to 1.34, p=0.01) were correlated with the presence of VA independently of age and LVWT.
Conclusions: HCM patients with reverse septal curva-ture have more severe LV remodelling, higher preva-lence of VA and increased HCM Risk-SCD. The pattern of reverse septal curvature is independently correlated with the presence of NSVT. The assessment of ventri-cular septal hypertrophy patterns could be helpful in risk stratification of patients with HCM.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)