Different clinical characteristics and outcomes of hypertrophic cardiomyopathy with and without hypertension:seeking the truth

OBJECTIVE To determine the different clinical characteristics and outcomes of hypertrophic cardiomyopathy(HCM)patients with and without hypertension(HT).METHODS A total of 696 HCM patients were included in this study and all HCM diagnoses were confirmed by the genetic test.Patients were analyzed separately in the septal reduction therapy(SRT)cohort and the non-SRT cohort.The primary endpoint was cardiovascular death and the secondary endpoint was all-cause death.Outcome analyses were conducted to evaluate the associations between HT and outcomes in HCM.Medications before enrollment and at discharge were collected in the post-hoc analyses.RESULTS HCM patients without HT were younger,had a lower body mass index,were more likely to have a family history of HCM,and had a smaller left ventricular(LV)end-diastolic diameter than those with HT in both cohorts.A thicker LV wall,a higher level of N-terminal pro-B-type natriuretic peptide,and a higher extent of LV late gadolinium enhancement were additionally observed in patients without HT in the non-SRT cohort.The presence of HT did not alter the distribution pattern of late gadolinium enhancement,as well as the constituent ratio of eight disease-causing sarcomeric gene variants in both cohorts.Outcome analyses showed that in the non-SRT cohort,patients without HT had higher risks of cardiovascular death(HR=2.537,P=0.032)and all-cause death(HR=3.309,P=0.032).While such prognostic divergence was not observed in the SRT cohort.Further post-hoc analyses in the non-SRT cohort found that patients without HT received fewer non-dihydropyridine calcium channel blockers and angiotensinconverting enzyme inhibitors/angiotensin receptor blockers before enrollment and at discharge.CONCLUSIONS HCM patients without HT had worse clinical conditions and higher mortality than patients with HT overall,which may result from active medical therapy in HT patients.Active SRT may have a substantial de-risking effect on patients meeting the indications.

Characteristics, Management, and Outcomes of Acute Heart Failure in the Emergency Department： A Multicenter Registry Study with 1-year Follow-up in a Chinese Cohort in Beijing

Background： The emergency department （ED） has a pivotal influence on the management of acute heart failure （AHF）, but dataconcerning current ED management are scarce. This Beijing AHF Registry Study investigated the characteristics. ED management, and short- and long-term clinical outcomes of AHF. Methods： This prospective, multicenter, observational study consecutively enrolled 3335 AHF patients who visited 14 EDs in Beijing from January 1, 2011, to September 23, 2012. Baseline data on characteristics and management were collected in the EDs. Follow-up data on death and readmissions were collected until November 31, 2013, with a response rate of 92.80%. The data were reported as median （interquartile range） for the continuous variables, or as number （percentage） for the categorical variables. Results： The median age of the enrolled patients was 71 （58 79） years, and 46.84% wvere women. In patients with AHH coronary heart disease （43.27%） was the most common etiology, andmyocardium ischemia （30.22%） was the main precipitant. Most of the patients in the ED received intravenous treatments, including diuretics （79.28%） and vasodilators （74.90%）. Fewer patients in the ED received neurohormonal antagonists, and 25.94%, 31.12%, and 33.73% of patients received angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and spironolactone, respectively. The proportions of patients who were admitted, discharged, left against medical advice, and died were 55.53%, 33.58%, 7.08%, and 3.81%, respectively. All-cause mortalities at 30 days and 1 year were 15.30% and 32.27%, respectively. Conclusions： Substantial details on characteristics and ED management of AHF were investigated. The clinical outcomes of AHF patients were dismal. Thus, further investigations of ED-based therapeutic approaches for AHF are needed.

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing:a multicenter cohort study with a 5-year follow-up

Background:Acute heart failure(AHF)is the most common disease in emergency departments(EDs).However,clinical data exploring the outcomes of patients presenting AHF in EDs are limited,especially the long-term outcomes.The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective,multicenter,cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1,2011 and September 23,2012.Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4%and 49.6%,respectively.The median overall survival was 34 months.Independent predictors of 5-year mortality were patient age(hazard ratio[HR]:1.027,95 confidence interval[CI]:1.023-1.030),body mass index(BMI)(HR:0.971,95%CI:0.958-0.983),fatigue(HR:1.127,95%CI:1.009-1.258),ascites(HR:1.190,95%CI:1.057-1.340),hepatic jugular reflux(HR:1.339,95%CI:1.140-1.572),New York Heart Association(NYHA)class III to IV(HR:1.511,95%CI:1.291-1.769),heart rate(HR:1.003,95%CI:1.001-1.005),diastolic blood pressure(DBP)(HR:0.996,95%CI:0.993-0.999),blood urea nitrogen(BUN)(HR:1.014,95%CI:1.008-1.020),B-type natriuretic peptide(BNP)/N-terminal pro-B-type natriuretic peptide(NT-proBNP)level in the third(HR:1.426,95%CI:1.220-1.668)or fourth quartile(HR:1.437,95%CI:1.223-1.690),serum sodium(HR:0.980,95%CI:0.972-0.988),serum albumin(HR:0.981,95%CI:0.971-0.992),ischemic heart diseases(HR:1.195,95%CI:1.073-1.331),primary cardiomyopathy(HR:1.382,95%CI:1.183-1.614),diabetes(HR:1.118,95%CI:1.010-1.237),stroke(HR:1.252,95%CI:1.121-1.397),and the use of diuretics(HR:0.714,95%CI:0.626-0.814),(3-blockers(HR:0.673,95%CI:0.588-0.769),angiotensin-converting enzyme inhibitors(ACEIs)(HR:0.714,95%CI:0.604-0.845),angiotensin-II receptor blockers(ARBs)(HR:0.790,95%CI:0.646-0.965),spironolactone(HR:0.814,95%CI:0.663-0.999),calcium antagonists(HR:0.624,95%CI:0.531-0.733),nitrates(HR:0.715,95%CI:0.631-0.811),and digoxin(HR:0.579,95%CI:0.465-0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF.Age,BMI,fatigue,ascites,hepatic jugular reflux,NYHA class III to IV,heart rate,DBP,BUN,BNP/NT-proBNP level in the third or fourth quartile,serum sodium,serum albumin,ischemic heart diseases,primary cardiomyopathy,diabetes,stroke,and the use of diuretics,P-blockers,ACEIs,ARBs,spironolactone,calcium antagonists,nitrates,and digoxin were independently associated with 5-year all-cause mortality.

Influence of administrative intervention on the availability,utilization, and competency for the use of defibrillators in primary hospitals

To the Editor:Sudden cardiac death is a major public health issue across the world.[1] Timely cardiopulmonary resuscitation (CPR) and defibrillation helps improve prognosis and avert the neurological sequelae of ventricular fibrillation.[2] However,there is low availability and utilization of defibrillators in China.[3] Hence,we investigated the availability and utilization of defibrillators during two consecutive years (before and after an administrative intervention) at all primary (public and private) hospitals in Suzhou city (Jiangsu province,China) to assess the effect of administrative intervention.