Hypertrophic Cardiomyopathy with Left Ventricular Systolic Dysfunction: Clinical Outcome after Implantable Continuous-Flow Left Ventricular Assist Device Implantation

Purpose Various patterns of disease progression have been reported in patients with hypertrophic cardiomyopathy (HCM). HCM with left ventricular systolic dysfunction (HCM-LVSD) has been recognized as unfavorable patterns of disease progression that a certain proportion of patients with HCM-LVSD finally requires heart transplantation (HTx) or implantable continuous-flow left ventricular assist device (iLVAD) implantation. Compared with dilated cardiomyopathy (DCM), HCM-LVSD has reported to demonstrate worse prognosis. However, long-term prognosis of patients with HCM-LVSD after iLVAD implantation has not been fully elucidated. This study aimed to clarify the long-term clinical outcome of patients with HCM-LVSD after iLVAD implantation in comparison with those with DCM. Methods The medical records of both patient with HCM-LVSD and idiopathic DCM as control group who underwent iLVAD implantation from 2011 to 2020 in our institution were reviewed. Results 96 patients with DCM (mean age 43.5 years, 73 males,) and 24 patients with HCM-LVSD (mean age 48.3 years, 16 males) had received iLVAD implantation (DCM: 25 centrifugal-flow and 71 axial-flow LVAD, HCM-LVSD: 10 centrifugal-flow and 14 axial-flow LVAD) with average LVAD support period of 1080 and 928 days, respectively. Although, there was no significant difference in brain natriuretic peptide (BNP) at pre LVAD implantation between both groups, BNP at 3 months post LVAD implantation in DCM group was significantly higher than that in HCM-LVSD group [88 vs 256 pg/ml, p Conclusion Despite inferior survival without LVAD, HCM-LVSD demonstrated equivalent overall survival compared with that of DCM after LVAD implantation. However, BNP at 3 months after LVAD implantation in HCM-LVSD group demonstrated higher value than that of DCM group which imply existence of persistent and progressive myocardial damage or subclinical right ventricular failure in HCM-LVSD even after LVAD implantation.