Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Prognostic and Safety Implications of Renin-Angiotensin-Aldosterone System Inhibitors in Hypertrophic Cardiomyopathy: A Real-World Observation Over 2,000 Patients

  • Chan Soon Park (Cardiovascular Center, Seoul National University Hospital) ;
  • Tae-Min Rhee (Cardiovascular Center, Seoul National University Hospital) ;
  • Hyun Jung Lee (Cardiovascular Center, Seoul National University Hospital) ;
  • Yeonyee E. Yoon (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jun-Bean Park (Cardiovascular Center, Seoul National University Hospital) ;
  • Seung-Pyo Lee (Cardiovascular Center, Seoul National University Hospital) ;
  • Yong-Jin Kim (Cardiovascular Center, Seoul National University Hospital) ;
  • Goo-Yeong Cho (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • In-Chang Hwang (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Hyung-Kwan Kim (Cardiovascular Center, Seoul National University Hospital)
  • Received : 2023.02.16
  • Accepted : 2023.05.17
  • Published : 2023.09.01
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Abstract

Background and Objectives: The prognostic or safety implication of renin-angiotensin-aldosterone system inhibitors (RASi) in hypertrophic cardiomyopathy (HCM) are not well established, mainly due to concerns regarding left ventricular outflow tract (LVOT) obstruction aggravation. We investigated the implications of RASi in a sizable number of HCM patients. Methods: We enrolled 2,104 consecutive patients diagnosed with HCM in 2 tertiary university hospitals and followed up for five years. RASi use was defined as the administration of RASi after diagnostic confirmation of HCM. The primary and secondary outcomes were all-cause mortality and hospitalization for heart failure (HHF). Results: RASi were prescribed to 762 patients (36.2%). During a median follow-up of 48.1 months, 112 patients (5.3%) died, and 94 patients (4.5%) experienced HHF. Patients using RASi had less favorable baseline characteristics than those not using RASi, such as older age, more frequent history of comorbidities, and lower ejection fraction. Nonetheless, there was no difference in clinical outcomes between patients with and without RASi use (log-rank p=0.368 for all-cause mortality and log-rank p=0.443 for HHF). In multivariable analysis, patients taking RASi showed a comparable risk of all-cause mortality (hazard ratio [HR], 0.70, 95% confidence interval [CI], 0.43-1.14, p=0.150) and HHF (HR, 1.03, 95% CI, 0.63-1.70, p=0.900). In the subgroup analysis, there was no significant interaction of RASi use between subgroups stratified by LVOT obstruction, left ventricular (LV) ejection fraction, or maximal LV wall thickness. Conclusions: RASi use was not associated with worse clinical outcomes. It might be safely administered in patients with HCM if clinically indicated.

Keywords

Acknowledgement

This project is an investigator-initiated trial. This research was funded by a grant from HK inno.N (Seoul, Korea) (Grant number: 06-2022-4110). This research was partly funded by Seoul National University (Grant number: 800-20210548). These funding sources did not have any role in the study design, execution, analyses, interpretation of the data, or decision to submit results.

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