Korean Circ J.  2023 Sep;53(9):606-618. 10.4070/kcj.2023.0035.

Prognostic and Safety Implications of Renin-Angiotensin-Aldosterone System Inhibitors in Hypertrophic Cardiomyopathy: A Real-World Observation Over 2,000 Patients

• Park CS
• Rhee TM
• Lee HJ
• Yoon YE
• Park JB
• Lee SP
• Kim YJ
• Cho GY
• Hwang IC
• Kim HK

• KMID: 2545954
• DOI: http://doi.org/10.4070/kcj.2023.0035

Abstract

Background and Objectives
The prognostic or safety implication of renin-angiotensinaldosterone 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.

Keyword

Hypertrophic cardiomyopathy; Mortality; Prognosis; Renin-angiotensin system

Figure

• 

  Figure 1 Clinical outcomes according to the use of RASi in the original cohort. Multivariable-adjusted survival curves demonstrating the difference in all-cause mortality (A) and HHF (B) according to the use of RASi are illustrated.HHF = hospitalization for heart failure; HR = hazard ratio; RASi = renin-angiotensin-aldosterone system inhibitors.

• 

  Figure 2 Clinical outcomes according to the use of RASi in the propensity score matching cohort. Multivariable-adjusted survival curves for all-cause mortality (A) and HHF (B) according to the use of RASi were illustrated.HHF = hospitalization for heart failure; HR = hazard ratio; RASi, renin-angiotensin-aldosterone system inhibitors.

• 

  Figure 3 Impact of RASi according to LVOT obstruction. Patients without LVOT obstruction (A) and with LVOT obstruction (B) were categorized according to the use of RASi. Multivariable-adjusted survival curves demonstrating the difference in each group are illustrated.HHF = hospitalization for heart failure; HR = hazard ratio; LVOT = left ventricular outflow tract; RASi = renin-angiotensin-aldosterone system inhibitors.

• 

  Figure 4 Association between all-cause mortality and use of RASi. The effects of RASi on all-cause mortality in exploratory subgroups were analyzed.CI = confidence interval; HCM = hypertrophic cardiomyopathy; HR = hazard ratio; LV = left ventricular; LVOT = left ventricular outflow tract; RASi = renin-angiotensin-aldosterone system inhibitors.

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