Hypertrophic cardiomyopathy: Prevalence, hypertrophy patterns, and their clinical and ECG findings in a hospital at Qatar

Abstract

Background:Hypertrophic cardiomyopathy (HCM) is a genetic disease associated with risk of morbidity and sudden cardiac death. The prevalence, hypertrophy patterns, mode of presentations, and different ECG findings vary in different regions of the world. To date, no data is present regarding these variables in Qatar.Patients and Methods:A retrospective, cross sectional, descriptive analysis of all patients referred for echocardiography study at Hamad General Hospital, Qatar. The study period was from January 2008 till December 2010.Aims:To study 1) the prevalence of HCM, 2) the different patterns of hypertrophy, and 3) the clinical and ECG presentations in this population.Results:Out of the 29,286 cases evaluated, 38 patients were found to have HCM (0.13%). Their clinical, ECG, and echocardiography findings were analyzed. Mean age was 47 y, 35 males (92%) and 3 females (8%). Four patterns of hypertrophy were described; 17 (44.7%) had septal hypertrophy alone, 6 (15.8%) had septal and other segments hypertrophy but sparing the apex, 10 (26.3%) had apical segments along with any other segment hypertrophy, and 5 (13.2%) had apical hypertrophy alone. No obstruction was found in 19 (50%), left ventricular outflow (LVO) tract obstruction was found in 13 (34%), and mid cavity obstruction (MCO) in 6 (16%). Twenty one (55.3%) patients were referred because of chest pain, 15 (39.5%) with palpitations, 15 (39.5%) with shortness of breath, and 5 (13.2%) with syncope. Nine patients (23.7%) were asymptomatic and were referred because of cardiac murmur during routine examination. ECG evidence of LV hypertrophy was found in 29 (76.3%).Conclusion:The prevalence of HCM in our population group is 0.13% with a male predominance (12:1). There was a diversity of clinical presentation, ECG abnormalities and patterns of LV hypertrophy among HCM patients.

Familial Hypertrophic Cardiomyopathy: Late Potentials and Other Prognostic Markers

“…Regarding the pattern of hypertrophy, asymmetric septal hypertrophy was the most common in our sample, corresponding to 73%, which is compatible with previous studies [15]. However, the presence of obstructive hypertrophy was 14%, which is slightly above 25% to 34% described in the literature [12,15].…”

“…Regarding the pattern of hypertrophy, asymmetric septal hypertrophy was the most common in our sample, corresponding to 73%, which is compatible with previous studies [15]. However, the presence of obstructive hypertrophy was 14%, which is slightly above 25% to 34% described in the literature [12,15]. Obstructive HCM is associated with independent risk for mortality and sudden death and is also correlated with symptomatic manifestations [12][13][14][15].…”

“…However, the presence of obstructive hypertrophy was 14%, which is slightly above 25% to 34% described in the literature [12,15]. Obstructive HCM is associated with independent risk for mortality and sudden death and is also correlated with symptomatic manifestations [12][13][14][15]. Sudden death might be the initial manifestation in 6% of children and adolescents with HCM, which justify studies to identify risk factors in this population.…”

Electrocardiographic predictors of myocardial fibrosis and apical hypertrophic cardiomyopathy

“…1. Apical LV thickness >15 mm that cannot be solely explained by abnormal loading condition or flow-limiting coronary artery disease (Helmy et al, 2011); or, 2. Ratio of maximal apical part to maximal posterior part that is >1.5 (Eriksson et al, 2002) that cannot be solely explained by abnormal loading condition or flow-limiting coronary artery disease.…”

Contemporary Diagnosis and Management of Hypertrophic Cardiomyopathy: The Role of Echocardiography and Multimodality Imaging

“…Syed et al proposed the following five-phenotype classification: type A, a predominant mid-septal convexity toward the LV cavity, with the cavity often having a crescent shape (reverse curvature septum HCM); type B, a generally ovoid LV cavity, with the septum being concave to the LV cavity and a prominent basal septal bulge (sigmoid septum HCM); type C, an overall straight septum that is neither predominantly convex nor concave toward the LV cavity (neutral septum HCM); type D, predominant apical distribution of hypertrophy (apical HCM); and type E, predominant hypertrophy at the mid-ventricular level (mid-ventricular HCM) [ 16 ]. Helmy proposed another classification based on clinical presentation: pattern 1, septal hypertrophy alone; pattern 2, septum and adjacent segments’ hypertrophy, but not apical hypertrophy; pattern 3, apical in combination with other LV segments’ hypertrophy; and pattern 4, apical hypertrophy alone [ 17 ]. These differences are likely determined by the underlying genetic substrate, but the data are currently insufficient to confirm this hypothesis.…”