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Comparison of Clinical Features in Blacks Versus Whites With Hypertrophic Cardiomyopathy

Lars L Sorensen1, Aurelio Pinheiro2, Veronica Lea Dimaano2

  • 1Division of Cardiology, Johns Hopkins HCM Center of Excellence, Baltimore, Maryland; Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.

The American Journal of Cardiology
|April 17, 2016
PubMed

Insights

Black patients with hypertrophic cardiomyopathy (HC) show distinct differences, including more abnormal EKGs and apical hypertrophy, but less outflow tract obstruction. They also experience reduced exercise capacity compared to white patients with HC.

Area of Science:

  • Cardiology
  • Genetics
  • Internal Medicine

Background:

  • Hypertrophic cardiomyopathy (HC) is a genetic heart disease with varied clinical presentations.
  • Systematic comparisons of the HC phenotype between racial groups, specifically Black and White individuals, are limited.
  • Understanding these differences is crucial for accurate diagnosis and tailored treatment strategies.

Purpose of the Study:

  • To systematically examine and compare the clinical presentation, echocardiographic findings, and exercise capacity of hypertrophic cardiomyopathy (HC) in Black versus White patients.
  • To identify potential racial disparities in the phenotype of HC.
  • To inform clinical practice and research regarding HC in diverse populations.

Main Methods:

  • Retrospective analysis of 441 consecutive HC patients (76 Black, 365 White) from a specialized HC clinic.
  • Comparison of clinical presentation, electrocardiogram (ECG) findings, exercise capacity, and echocardiographic parameters (left ventricular morphology, hemodynamics).
  • Statistical analysis to determine significant differences between Black and White patient groups.

Main Results:

  • Black patients with HC more frequently presented with abnormal ECGs (93% vs. 80%, p=0.009), particularly repolarization abnormalities (79% vs. 56%, p<0.001).
  • Apical hypertrophy was more prevalent in Black patients (26% vs. 9%, p<0.001).
  • Black patients exhibited less severe systolic anterior movement of the mitral valve and significantly lower resting (9 vs. 16 mmHg, p<0.001) and provoked (36 vs. 59 mmHg, p=0.002) left ventricular outflow tract gradients. Despite this, Black patients had lower exercise capacity (1.45 METs, p=0.005).

Conclusions:

  • Black individuals with HC present with a distinct phenotype characterized by a higher incidence of ECG abnormalities and apical hypertrophy.
  • This phenotype is associated with a lower prevalence of obstructive features like systolic anterior mitral valve motion and left ventricular outflow tract obstruction.
  • Despite a less obstructive profile, Black patients demonstrate significantly reduced exercise capacity, highlighting a critical area for clinical attention and management.

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