CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Iacopo Olivotto, MD*,
Martin S. Maron, MD,
Franco Cecchi, MD and
Barry J. Maron, MD
* Referral Center for Cardiomyopathies, University Hospital of Careggi, Viale Pieraccini 1, Florence 50132, Italy (Email: olivottoi{at}ao-careggi.toscana.it).
We are grateful to Dr. Song for his interest in our work (1). He poses questions regarding the choice of the end point for our study and the definition of the causes of death. With regard with the first question, Dr. Song is correct in pointing out that the only end point assessed in our study was cardiovascular mortality. This choice was unavoidable, given the relatively short duration of follow-up available, consequent to the recent introduction of cardiovascular magnetic resonance to clinical cardiology and hypertrophic cardiomyopathy (HCM). Symptom progression to New York Heart Association functional class III to IV is a slowly evolving process in HCM and can be meaningfully assessed only over the course of several years or even decades. For example, our other study cited by Dr. Song (2), in which a combined end point was in fact employed, had a mean follow-up of 12 years, compared with 2.6 years in the present study (1).
With regard to the definition of causes of death and with all due respect, we believe that we have provided the relevant information in the Results section of the report (1). Over a 2.6- ± 0.7-year follow-up, there were 10 HCM-related events: 5 sudden death events (including 1 resuscitated cardiac arrest and 2 appropriate implanted cardioverter-defibrillator discharges for life-threatening, sustained ventricular arrhythmias), 3 deaths due to progressive heart failure, and 2 after surgical septal myectomy. The causes of death in our HCM patients were classified according to standard definitions that we have consistently employed in prior studies (2–5).
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References
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1. Olivotto I, Maron MS, Autore C, et al. Assessment and significance of left ventricular mass by cardiovascular magnetic resonance in hypertrophic cardiomyopathy J Am Coll Cardiol 2008;52:559-566.[Abstract/Free Full Text]2. Olivotto I, Gistri R, Petrone P, et al. Maximum left ventricular thickness and risk of sudden death in patients with hypertrophic cardiomyopathy J Am Coll Cardiol 2003;41:315-321.[Abstract/Free Full Text] 3. Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy N Engl J Med 2003;348:295-303.[Abstract/Free Full Text] 4. Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy N Engl J Med 2003;349:1027-1035.[Abstract/Free Full Text] 5. Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non–referral-based patient population Circulation 2000;102:858-864.[Abstract/Free Full Text]
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