Changing Demographics in Hypertrophic Cardiomyopathy and Implications for Management: Clinical Research



      This study aimed to determine whether clinicians are encountering a phenotype of hypertrophic cardiomyopathy that is evolving from the disease recognized several years ago.


      A total of 3161 consecutive patients with established hypertrophic cardiomyopathy were encountered (2003-2020) and studied clinically with imaging.


      Patients were identified as progressively older now (average 56 ± 15 years) compared with previously (44 ± 17 years; P < .001), and with an increasing frequency of outflow obstruction (from 46% to 61% of patients; P < .001), albeit without more advanced heart failure symptoms. Notably, maximum left ventricular wall thickness (usually ventricular septum) decreased progressively over the same period (20.4 ± 5.7 to 17.5 ± 3.4 mm).


      These novel observations are counter-intuitive to practitioners (expecting hypertrophic cardiomyopathy to be associated with particularly substantial hypertrophy), and potentially impact disease recognition, while also highlighting emergence of symptomatic obstructive patients with mild septal thickness < 15 mm, requiring modification of the traditional myectomy operation. While a primary change in the phenotypic expression of hypertrophic cardiomyopathy cannot be excluded by our data, these observations most likely reflect evolving referral practice patterns including greater diagnostic suspicion for the disease in the community particularly at advanced ages, and/or with less substantial left ventricular hypertrophy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Maron BJ
        • Desai MY
        • Nishimura RA
        • et al.
        Diagnosis and evaluation of hypertrophic cardiomyopathy: JACC State-of-the-Art Review.
        J Am Coll Cardiol. 2022; 79: 372-389
        • Rowin EJ
        • Maron BJ
        • Maron MS.
        The hypertrophic cardiomyopathy phenotype viewed through the prism of multimodality imaging: clinical and etiologic implications.
        JACC Cardiovasc Imaging. 2020; 13: 2002-2016
        • Ommen SR
        • Mital S
        • Burke MA
        • et al.
        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.
        Circulation. 2020; 142: e533-e557
        • Rowin EJ
        • Maron BJ
        • Chokshi A
        • et al.
        Clinical spectrum and management implications of left ventricular outflow obstruction with mild ventricular septal thickness in hypertrophic cardiomyopathy.
        Am J Cardiol. 2018; 122: 1409-1420
        • Rowin EJ
        • Maron BS
        • Haas TS
        • et al.
        Hypertrophic cardiomyopathy with left ventricular apical aneurysm: implications for risk stratification and management.
        JACC. 2017; 69: 761-773
        • Maron BJ
        • Desai MY
        • Nishimura RA
        • et al.
        Management of hypertrophic cardiomyopathy: JACC state-of-the-art review.
        J Am Coll Cardiol. 2022; 79: 390-414