Orthostatic blood pressure test for risk stratification in patients with hypertrophic cardiomyopathy
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Orthostatic blood pressure test for risk stratification in patients with hypertrophic cardiomyopathy. / Münch, Julia; Aydin, Ali; Suling, Anna; Voigt, Christian; Blankenberg, Stefan; Patten, Monica.
in: PLOS ONE, Jahrgang 10, Nr. 6, 24.06.2015, S. e0131044.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Orthostatic blood pressure test for risk stratification in patients with hypertrophic cardiomyopathy
AU - Münch, Julia
AU - Aydin, Ali
AU - Suling, Anna
AU - Voigt, Christian
AU - Blankenberg, Stefan
AU - Patten, Monica
PY - 2015/6/24
Y1 - 2015/6/24
N2 - BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in young adults, mainly ascribed to ventricular tachycardia (VT). Assuming that VT is the major cause of (pre-) syncope in HCM patients, its occurrence is essential for SCD risk stratification and primarily preventive ICD-implantation. However, evidence of VT during syncope is often missing. As the differentiation of potential lethal causes for syncope such as VT from more harmless reasons is crucial, HCM patients were screened for orthostatic dysregulation by using a simple orthostatic blood pressure test.METHODS: Over 15 months (IQR [9;20]) 100 HCM patients (55.8±16.2 yrs, 61% male) were evaluated for (pre-)syncope and VT (24h-ECGs, device-memories) within the last five years. Eighty patients underwent an orthostatic blood pressure test. Logistic regression models were used for statistical analysis.RESULTS: In older patients (>40 yrs) a positive orthostatic test result increased the chance of (pre-) syncope by a factor of 63 (95%-CI [8.8; 447.9], p<0.001; 93% sensitivity, 95%-CI [76; 99]; 74% specificity, 95%-CI [58; 86]). No correlation with VT was shown. A prolonged QTc interval also increased the chance of (pre-) syncope by a factor of 6.6 (95%-CI [2.0; 21.7]; p=0.002).CONCLUSIONS: The orthostatic blood pressure test is highly valuable for evaluation of syncope and presyncope especially in older HCM patients, suggesting that orthostatic syncope might be more relevant than previously assumed. Considering the high complication rates due to ICD therapies, this test may provide useful information for the evaluation of syncope in individual risk stratification and may help to prevent unnecessary device implantations, especially in older HCM patients.
AB - BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in young adults, mainly ascribed to ventricular tachycardia (VT). Assuming that VT is the major cause of (pre-) syncope in HCM patients, its occurrence is essential for SCD risk stratification and primarily preventive ICD-implantation. However, evidence of VT during syncope is often missing. As the differentiation of potential lethal causes for syncope such as VT from more harmless reasons is crucial, HCM patients were screened for orthostatic dysregulation by using a simple orthostatic blood pressure test.METHODS: Over 15 months (IQR [9;20]) 100 HCM patients (55.8±16.2 yrs, 61% male) were evaluated for (pre-)syncope and VT (24h-ECGs, device-memories) within the last five years. Eighty patients underwent an orthostatic blood pressure test. Logistic regression models were used for statistical analysis.RESULTS: In older patients (>40 yrs) a positive orthostatic test result increased the chance of (pre-) syncope by a factor of 63 (95%-CI [8.8; 447.9], p<0.001; 93% sensitivity, 95%-CI [76; 99]; 74% specificity, 95%-CI [58; 86]). No correlation with VT was shown. A prolonged QTc interval also increased the chance of (pre-) syncope by a factor of 6.6 (95%-CI [2.0; 21.7]; p=0.002).CONCLUSIONS: The orthostatic blood pressure test is highly valuable for evaluation of syncope and presyncope especially in older HCM patients, suggesting that orthostatic syncope might be more relevant than previously assumed. Considering the high complication rates due to ICD therapies, this test may provide useful information for the evaluation of syncope in individual risk stratification and may help to prevent unnecessary device implantations, especially in older HCM patients.
KW - Adult
KW - Age Factors
KW - Aged
KW - Blood Pressure
KW - Blood Pressure Determination
KW - Cardiomyopathy, Hypertrophic
KW - Death, Sudden, Cardiac
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Risk Assessment
KW - Journal Article
U2 - 10.1371/journal.pone.0131044
DO - 10.1371/journal.pone.0131044
M3 - SCORING: Journal article
C2 - 26107635
VL - 10
SP - e0131044
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 6
ER -