Abstract
Purpose
This study aimed to determine whether clinicians are encountering a phenotype of hypertrophic
cardiomyopathy that is evolving from the disease recognized several years ago.
Methods
A total of 3161 consecutive patients with established hypertrophic cardiomyopathy
were encountered (2003-2020) and studied clinically with imaging.
Results
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).
Conclusions
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.
Keywords
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References
- Diagnosis and evaluation of hypertrophic cardiomyopathy: JACC State-of-the-Art Review.J Am Coll Cardiol. 2022; 79: 372-389
- The hypertrophic cardiomyopathy phenotype viewed through the prism of multimodality imaging: clinical and etiologic implications.JACC Cardiovasc Imaging. 2020; 13: 2002-2016
- 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
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Article Info
Publication History
Published online: May 29, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
