{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T22:22:20Z","timestamp":1783117340693,"version":"3.54.6"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,1,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">In patients with obstructive hypertrophic cardiomyopathy, surgical myectomy (SM) is indicated for severe symptoms. We sought to compare long\u2010term outcomes of patients with obstructive hypertrophic cardiomyopathy where SM was based on guideline\u2010recommended Class I indication (Functional Class or FC \u22653 or angina\/exertional syncope despite maximal medical therapy) versus earlier (FC 2 and\/or impaired exercise capacity on exercise echocardiography with severe obstruction).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We studied 2268 consecutive patients (excluding &lt;18\u00a0years, \u2265 moderate aortic stenosis and subaortic membrane, 56\u00b114\u00a0years, 55% men), who underwent SM at our center between June 2002 and March 2018. Clinical data, including left ventricular outflow tract gradient, were recorded. Death and\/or appropriate internal defibrillator discharge were primary composite end points. One thousand three hundred eighteen (58%) patients met Class I indication and 950 (42%) underwent earlier surgery; 222 (10%) had a history of obstructive coronary artery disease. Basal septal thickness, and resting and maximal left ventricular outflow tract gradient were 2.0\u00b10.3\u00a0cm, 61\u00b144\u00a0mm\u00a0Hg, and 100\u00b131\u00a0mm\u00a0Hg, respectively. At 6.2\u00b14\u00a0years after SM, 248 (11%) had composite events (13 [0.6%] in\u2010hospital deaths). Age (hazard ratio [HR], 1.61; 95% CI, 1.26\u20131.91), obstructive coronary artery disease (HR, 1.46; 95% CI, 1.06\u20131.91), and Class I versus earlier SM (HR, 1.61; 95% CI, 1.14\u20132.12) were associated with higher primary composite events (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Earlier surgery had better longer\u2010term survival (similar to age\u2010sex\u2010matched normal population) versus surgery for Class I indication (76 [8%] versus 193 [15%],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In patients with obstructive hypertrophic cardiomyopathy, earlier versus surgery for Class I indication had a better long\u2010term survival, similar to the age\u2010sex\u2010matched US population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.016210","type":"journal-article","created":{"date-parts":[[2020,12,21]],"date-time":"2020-12-21T10:01:29Z","timestamp":1608544889000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Outcomes in Guideline\u2010Based Class I Indication Versus Earlier Referral for Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy"],"prefix":"10.1161","volume":"10","author":[{"given":"Alaa","family":"Alashi","sequence":"first","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G.","family":"Smedira","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Hodges","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoran B.","family":"Popovic","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5692-2299","authenticated-orcid":false,"given":"Maran","family":"Thamilarasan","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Wierup","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry M.","family":"Lever","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0010-9797","authenticated-orcid":false,"given":"Milind Y.","family":"Desai","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland 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