Association of elevated pulmonary artery systolic pressure with stroke and systemic embolic events in patients with hypertrophic cardiomyopathy

Background Echocardiographically estimated pulmonary artery systolic pressure (PASP) is a non-invasive widely available method that is used to estimate pulmonary arterial pressure. Although elevated PASP predicts mortality in patients with hypertrophic cardiomyopathy (HCM), the relationship between PASP and embolic events is unclear. This study aimed to determine whether elevated PASP is associated with stroke and systemic embolic events in a tertiary referral HCM cohort. Methods This study included 374 clinically diagnosed patients with HCM. PASP was estimated from tricuspid regurgitant jet velocity using the modified Bernoulli equation. Results The median (interquartile range) PASP was 33 (28–37) mm Hg, and elevated PASP (>40 mm Hg) was observed in 66 (17.6%) patients. Seventeen of the 66 (25.8%) patients with elevated PASP and 24 of the 308 (7.8%) patients without elevated PASP experienced stroke and systemic embolic events during the 10.3 ± 7.4 years of follow-up (log-rank P < 0.001). Multivariable analysis showed that age at diagnosis, atrial fibrillation, and PASP >40 mm Hg (adjusted hazard ratio, 2.59; 95% confidence interval, 1.31–5.12; P = 0.006) were independently associated with embolic events. Conclusions In addition to age and atrial fibrillation, PASP estimated by Doppler echocardiography could help embolic risk stratification in patients with HCM.