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

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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.

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Abbreviations

ACEs:

Adverse cardiovascular events

AF:

Atrial fibrillation

APCs:

Adverse plaque characteristics

AUC:

Area under the curves

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CI:

Confidence interval

ECG:

Electrocardiography

EF:

Ejection fraction

HCM:

Hypertrophic cardiomyopathy

HR:

Hazard ratio

HU:

Hounsfield units

ICD:

Implantable cardioverter-defibrillator

LV:

Left ventricle

MI:

Myocardial infarction

ROC:

Receiver-operator characteristic

UA:

Unstable angina

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Funding

This work was supported by the National Research Foundation grant NRF-2015R1D1A1A01059717 funded by the Korea government (MEST).

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Yoon Joo Shin & Eun Ju Chun

  2. Department of Radiology, National Cancer Center Hospital, Goyang, Gyeonggi-do, South Korea

    Jae Hwan Lee

  3. Department of Radiology, Chungbuk National University Hospital, Cheongju, South Korea

    Jin Young Yoo

  4. Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South Korea

    Jeong A. Kim

  5. Department of Applied Statistics, College of Commerce and Economics, Yonsei University, Seoul, South Korea

    Yongho Jeon

  6. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea

    Yeonyee E. Yoon

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  1. Yoon Joo Shin
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Corresponding author

Correspondence to Eun Ju Chun.

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The scientific guarantor of this publication is Kyung Won Lee.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yongho Jeon, PhD (Department of Applied statistics, College of Commerce and Economics, Yonsei University), one of the authors, has contributed to the statistical analysis.

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Written informed consent was waived by the Institutional Review Board.

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Shin, Y.J., Lee, J.H., Yoo, J.Y. et al. Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain. Eur Radiol 29, 4593–4602 (2019). https://doi.org/10.1007/s00330-018-5951-8

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