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Left Ventricular Outflow Tract Obstruction And Sudden Cardiac Death In Hypertrophic Cardiomyopathy: A Tunisian Experience
Mohamed Fares Mezni, Abdeddayem Haggui,
Wafa Fehri, Imen Hamdi, Houaida Mahfoudhi, Badii Jdaida, Mehdi Ghommidh, Nizar Ben Mansour, Dhaker Lahidheb, Nadhem Hajlaoui, Habib Haouala.
Military Hospital of Tunis, Tunis, Tunisia.

Objective: The effect of left ventricular outflow tract obstruction (LVOTO) at rest on the incidence of sudden death (SD) in patients with hypertrophic cardiomyopathy (HCM) remains unresolved. The aim of the present study was the evaluation of LVOTO at rest as a new potential risk factor for SD in HCM. Methods: We hereby report a retrospective study about 48 patients with HCM followed between 1997 and 2013. Primary endpoint was life-threatening ventricular arrhythmias including SD, resuscitated SD and appropriate implantable cardioverter defibrillator therapy. The mean follow-up period was 5 years. Results: The 48 patients were predominantly young at diagnosis with a mean age of 37 ± 16 years and most of them were male (65%). At initial examination, 11 patients (23%) had peak instantaneous LVOTO gradients of ≥ 30 mm Hg at rest. During the follow-up period, 12 patients (25%) had life-threatening ventricular arrhythmias. The annual rate of life-threatening ventricular arrhythmias was 5%. In our study, the overall probability of SD was not significantly greater among patients with outflow tract obstruction than among those without obstruction (p=0.251) .A multivariate analysis based on the Cox regression confirmed that LVOTO was not independently associated with an increased risk of life-threatening ventricular arrhythmias in our cohort study. Conclusion: Our cohort study results do not support LVOTO as an independent risk factor for SD in patients with HCM.

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