Comparison of Long-Term Outcome between Apical and Asymmetric Septal Hypertrophic Cardiomyopathy

Abstract

Objectives: As reported, diagnostic age, gender and presence of outflow tract obstruction have an impact on prognosis in patients with hypertrophic cardiomyopathy. The aim of this study was to compare the long-term outcome between apical hypertrophic cardiomyopathy (ApHCM) and asymmetric septal hypertrophic cardiomyopathy (ASHCM) after the exclusion of these factors. Methods: A total of 540 patients (270 with ApHCM and 270 with ASHCM) identified in a consecutive single-center cohort were retrospectively studied. The two groups were matched by diagnostic age, gender and the presence of outflow tract obstruction. Clinical characteristics and long-term outcomes were compared. Results: The mean follow-up duration in ASHCM and ApHCM were 6.6 ± 5.5 and 7.6 ± 4.1 years, respectively. During follow-up, 16 patients experienced cardiovascular death in the ASHCM group, while 2 patients experienced cardiovascular death in the ApHCM group (6.3 vs. 0.7%, p < 0.01). Cardiovascular morbidity in the ASHCM and ApHCM groups were 39.9 and 18.5% (p < 0.01). In the multivariate Cox regression analysis late gadolinium enhancement (LGE; HR 4.81, 95% CI 1.28-78.0, p = 0.03) and unexplained syncope (HR 9.68, 95% CI 1.9-17.2, p < 0.01) were independent predictors for cardiovascular mortality. Unexplained syncope was independently associated with a higher risk for sudden cardiac death (HR 4.3, 95% CI 1.2-15.3, p = 0.02). Conclusions: After eliminating the interference of diagnostic age, gender and outflow tract obstruction, ASHCM represented a worse prognosis with a higher incidence of cardiovascular mortality and morbidity than ApHCM. LGE was a strong predictor for cardiovascular death.

High-sensitive cardiac Troponin T and NT-proBNP are associated with the left ventricular apical thickness in apical hypertrophic cardiomyopathy

“…NT-proBNP level was also found elevated in AHCM and related to adverse outcomes in a previous study [22]. Shuoyan An and colleagues described that NT-proBNP expression levels in AHCM patients were above normal, although lower than that in HCM patients [23]. Our study showed that NT-proBNP levels were elevated in AHCM patients, especially in those patients with abnormal hs-cTNT level.…”

Clinical Outcomes of Myocardial Bridging versus No Myocardial Bridging in Patients with Apical Hypertrophic Cardiomyopathy

“…In particular, Flett et al [28] reported 29% all-cause mortality in 193 AHCM patients, and confirmed an older age at baseline, female sex, and atrial fibrillation as independent predictors of cardiac mortality. Recently, An et al [29] presented a more favorable prognosis for AHCM than for ASHCM under specific circumstances, i.e., when previous confounding factors such as diagnostic age, sex, and the presence of outflow tract obstruction were controlled. In our study, there were no differences in previous confounding factors between the 2 groups, and the whole AHCM population still showed a low mortality (1.9%) during the median follow-up of 68.64 months.…”

Ventricular diastolic dimension over maximal myocardial thickness is robust landmark of systolic impairment in patients with hypertrophic cardiomyopathy

“…Further improvements on recognizing diffuse fibrosis and its clinical impact might be solved using novel CMR technologies for tissue mapping, which were also only partially identified in our study by late contrast sequences, however, burdened with technical inability to quantify those [ 21 ]. These as well might be points of potential for supplementary value of the GFI, since it was shown to act independently of conventional left ventricle volumetrics, where the latter has effects on causing falsely hyperdynamic function and consequential loss of prognostic value [ 35 ].…”