{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:18:10Z","timestamp":1787897890598,"version":"build-2784847793"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease, and the subsequent major adverse cardiovascular events (MACE) pose a serious threat to the health of patients. This investigation was intended to explore the association between gamma-glutamyl transferase (GGT) levels and MACE risk in patients with HCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from patients (\u2265 18 years old) diagnosed with HCM at a hospital were enrolled in this retrospective cohort study. The association between GGT levels and the risk of MACE was assessed using Cox regression models. Subgroup analyses were conducted according to HCM subtypes (non-obstructive, resting obstructive, latent obstructive) and New York Heart Association (NYHA) grades (I\/II, III\/IV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis cohort consisted of 437 patients with HCM, of whom 163 (37.30%) patients experienced MACE, while 274 (62.70%) remained MACE-free. GGT levels of 20\u201357 U\/L [HR\u2009=\u20091.72 (95%CI: 1.13\u20132.62)] and \u226557 U\/L [HR\u2009=\u20092.29 (95%CI: 1.30\u20134.03)] were both associated with a higher risk of MACE than those with GGT &amp;lt;20 U\/L. Subgroup analysis found that GGT levels of 20\u201357 U\/L [HR\u2009=\u20092.25 (95%CI: 1.15\u20134.37)] and \u226557 U\/L [HR\u2009=\u20093.66 (95%CI: 1.44\u20139.28)] were both linked to an increased risk of MACE in those with non-obstructive HCM, whereas no significant association was detected in those with resting obstructive HCM and latent obstructive HCM. Moreover, GGT levels of 20\u201357 U\/L [HR\u2009=\u20091.78 (95%CI: 1.07\u20132.97)] and \u226557 U\/L [HR\u2009=\u20092.97 (95%CI: 1.51\u20135.83)] were both linked to an elevated risk of MACE in patients with NYHA grade I\/II.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated GGT levels were associated with a higher risk of MACE among patients with HCM. GGT may serve as a clinical red flag for MACE risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1900684","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:35:57Z","timestamp":1787895357000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between gamma-glutamyl transferase and risk of major adverse cardiovascular events in patients with hypertrophic cardiomyopathy: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Meng","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyin","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cunying","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinqiao","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.jchf.2018.02.010","article-title":"Hypertrophic cardiomyopathy: clinical update","volume":"6","author":"Geske","year":"2018","journal-title":"JACC Heart Fail"},{"key":"B2","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1038\/s41572-025-00643-0","article-title":"Hypertrophic cardiomyopathy","volume":"11","author":"Argir\u00f2","year":"2025","journal-title":"Nat Rev Dis Primers"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1016\/s0140-6736(16)31321-6","article-title":"Hypertrophic obstructive cardiomyopathy","volume":"389","author":"Veselka","year":"2017","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1093\/ehjqcco\/qcaa075","article-title":"Prospective follow-up in various subtypes of cardiomyopathies: insights from the ESC EORP cardiomyopathy registry","volume":"7","author":"Gimeno","year":"2021","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"B5","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1016\/j.jcmg.2024.04.013","article-title":"Machine learning in hypertrophic cardiomyopathy: nonlinear model from clinical and CMR features predicting cardiovascular events","volume":"17","author":"Zhao","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1161\/circulationaha.117.033200","article-title":"Genotype and lifetime burden of disease in hypertrophic cardiomyopathy: insights from the sarcomeric human cardiomyopathy registry (SHaRe)","volume":"138","author":"Ho","year":"2018","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"557","DOI":"10.3390\/antiox14050557","article-title":"The key role and mechanism of oxidative stress in hypertrophic cardiomyopathy: a systematic exploration based on multi-omics analysis and experimental validation","volume":"14","author":"Zhang","year":"2025","journal-title":"Antioxidants (Basel"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1007\/s10741-023-10307-4","article-title":"Inflammation across the spectrum of hypertrophic cardiac phenotypes","volume":"28","author":"Lillo","year":"2023","journal-title":"Heart Fail Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1038\/s44161-022-00057-1","article-title":"Metabolic characterization of hypertrophic cardiomyopathy in human heart","volume":"1","author":"Wang","year":"2022","journal-title":"Nat Cardiovasc Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1111\/liv.13221","article-title":"Gamma-glutamyltransferase-friend or foe within?","volume":"36","author":"Kunutsor","year":"2016","journal-title":"Liver Int"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2078","DOI":"10.1161\/circulationaha.105.571919","article-title":"Gamma-glutamyltransferase, atherosclerosis, and cardiovascular disease: triggering oxidative stress within the plaque","volume":"112","author":"Emdin","year":"2005","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1016\/j.freeradbiomed.2023.09.020","article-title":"Targeting gamma-glutamyl transpeptidase: a pleiotropic enzyme involved in glutathione metabolism and in the control of redox homeostasis","volume":"208","author":"Mitri\u0107","year":"2023","journal-title":"Free Radic Biol Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"4464","DOI":"10.1093\/eurheartj\/ehae590","article-title":"Cardiac biomarkers and effects of aficamten in obstructive hypertrophic cardiomyopathy: the SEQUOIA-HCM trial","volume":"45","author":"Coats","year":"2024","journal-title":"Eur Heart J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"101435","DOI":"10.1016\/j.eclinm.2022.101435","article-title":"Association of gamma-glutamyltransferase levels with total mortality, liver-related and cardiovascular outcomes: a prospective cohort study in the UK Biobank","volume":"48","author":"Ho","year":"2022","journal-title":"eClinicalMed"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e13720","DOI":"10.1111\/eci.13720","article-title":"Gamma-glutamyl transferase and cardiovascular events in patients with congenital heart disease","volume":"52","author":"Mart\u00ednez-Quintana","year":"2022","journal-title":"Eur J Clin Invest"},{"key":"B16","doi-asserted-by":"publisher","first-page":"106380","DOI":"10.1016\/j.ejim.2025.06.009","article-title":"Gamma-glutamyltransferase independently predicts mortality and heart failure hospitalization in cardiac transthyretin amyloidosis","volume":"140","author":"Aimo","year":"2025","journal-title":"Eur J Intern Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1016\/j.amjcard.2016.02.004","article-title":"Relation of gamma-glutamyl transferase to cardiovascular events in patients with acute coronary syndromes","volume":"117","author":"Ndrepepa","year":"2016","journal-title":"Am J Cardiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"17994","DOI":"10.1038\/s41598-020-75078-6","article-title":"Association of gamma-glutamyl transferase with subclinical coronary atherosclerosis and cardiac outcomes in non-alcoholics","volume":"10","author":"Kim","year":"2020","journal-title":"Sci Rep"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1136\/heartjnl-2019-316271","article-title":"Gamma-glutamyl transferase variability and the risk of hospitalisation for heart failure","volume":"106","author":"Hong","year":"2020","journal-title":"Heart"},{"key":"B20","doi-asserted-by":"publisher","first-page":"65","DOI":"10.18433\/jpps30923","article-title":"Gamma glutamyl transferase - an underestimated marker for cardiovascular disease and the metabolic syndrome","volume":"23","author":"Neuman","year":"2020","journal-title":"J Pharm Pharm Sci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"19234","DOI":"10.1038\/s41598-024-70396-5","article-title":"The different associations of serum gamma-glutamyl transferase and alanine aminotransferase with insulin secretion, \u03b2-cell function, and insulin resistance in non-obese Japanese","volume":"14","author":"Minato-Inokawa","year":"2024","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1016\/s0195-668x(03)00479-2","article-title":"American College of Cardiology\/European Society of Cardiology Clinical Expert Consensus Document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines","volume":"24","author":"Maron","year":"2003","journal-title":"Eur Heart J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2703","DOI":"10.1016\/j.jacc.2011.10.825","article-title":"2011 ACCF\/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"58","author":"Gersh","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1093\/eurheartj\/eht439","article-title":"A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD)","volume":"35","author":"O'Mahony","year":"2014","journal-title":"Eur Heart J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3022","DOI":"10.1016\/j.jacc.2020.08.044","article-title":"2020 AHA\/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"76","author":"Ommen","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2232","DOI":"10.1161\/circulationaha.106.644682","article-title":"Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction","volume":"114","author":"Maron","year":"2006","journal-title":"Circulation"},{"key":"B27","doi-asserted-by":"publisher","first-page":"107003","DOI":"10.1016\/j.vph.2022.107003","article-title":"Novel molecular insights and potential approaches for targeting hypertrophic cardiomyopathy: focus on coronary modulators","volume":"145","author":"Pasqua","year":"2022","journal-title":"Vascul Pharmacol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2102","DOI":"10.1016\/s0140-6736(21)01205-8","article-title":"Hypertrophic cardiomyopathy: a practical approach to guideline directed management","volume":"398","author":"Ommen","year":"2021","journal-title":"Lancet"},{"key":"B29","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3109\/00365513.2014.954141","article-title":"Gamma glutamyl transferase activity is independently associated with oxidative stress rather than SYNTAX score","volume":"75","author":"U\u00e7ar","year":"2015","journal-title":"Scand J Clin Lab Invest"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e002858","DOI":"10.1161\/jaha.115.002858","article-title":"\u03b3-Glutamyltransferase and risk of sudden cardiac death in middle-aged finnish men: a new prospective cohort study","volume":"5","author":"Kunutsor","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"B31","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.cca.2017.11.026","article-title":"Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease","volume":"476","author":"Ndrepepa","year":"2018","journal-title":"Clin Chim Acta"},{"key":"B32","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.jtcvs.2011.10.059","article-title":"Expanding the indications for septal myectomy in patients with hypertrophic cardiomyopathy: results of operation in patients with latent obstruction","volume":"143","author":"Schaff","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jjcc.2021.09.002","article-title":"Hypertrophic cardiomyopathy with latent obstruction: clinical characteristics and surgical results","volume":"79","author":"Ji","year":"2022","journal-title":"J Cardiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.atherosclerosis.2008.03.023","article-title":"Gamma-glutamyltransferase activity in human atherosclerotic plaques\u2013biochemical similarities with the circulating enzyme","volume":"202","author":"Franzini","year":"2009","journal-title":"Atherosclerosis"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2555","DOI":"10.1093\/eurheartj\/ehv305","article-title":"Pathophysiological role of oxidative stress in systolic and diastolic heart failure and its therapeutic implications","volume":"36","author":"M\u00fcnzel","year":"2015","journal-title":"Eur Heart J"},{"key":"B36","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.atherosclerosis.2014.09.028","article-title":"b-Gamma-glutamyltransferase activity in human vulnerable carotid plaques","volume":"237","author":"Pucci","year":"2014","journal-title":"Atherosclerosis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"355","DOI":"10.5551\/jat.no414","article-title":"Serum gamma-glutamyl transferase levels are associated with metabolic syndrome in community-dwelling individuals","volume":"16","author":"Kawamoto","year":"2009","journal-title":"J Atheroscler Thromb"},{"key":"B38","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.jchf.2015.10.007","article-title":"Myocardial microvascular inflammatory endothelial activation in heart failure with preserved ejection fraction","volume":"4","author":"Franssen","year":"2016","journal-title":"JACC Heart Fail"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1016\/j.jacc.2010.05.043","article-title":"Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study","volume":"56","author":"Laukkanen","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1177\/2047487316644086","article-title":"Baseline and long-term gamma-glutamyltransferase, heart failure and cardiac arrhythmias in middle-aged Finnish men: prospective study and pooled analysis of published evidence","volume":"23","author":"Kunutsor","year":"2016","journal-title":"Eur J Prev Cardiol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"770","DOI":"10.3803\/EnM.2023.1726","article-title":"Long-term cumulative exposure to high \u03b3-glutamyl transferase levels and the risk of cardiovascular disease: a nationwide population-based cohort study","volume":"38","author":"Baek","year":"2023","journal-title":"Endocrinol Metab (Seoul"},{"key":"B42","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1038\/s41569-018-0064-2","article-title":"Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty","volume":"15","author":"Ferrucci","year":"2018","journal-title":"Nat Rev Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1900684\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:35:58Z","timestamp":1787895358000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1900684\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":42,"alternative-id":["10.3389\/fcvm.2026.1900684"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1900684","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1900684"}}