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

Shuoyan An1, Chaomei Fan, Lirong Yan

  • 1Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Cardiology
|September 6, 2016
PubMed

Insights

Asymmetric septal hypertrophic cardiomyopathy (ASHCM) carries a worse prognosis than apical hypertrophic cardiomyopathy (ApHCM), with higher cardiovascular mortality and morbidity. Late gadolinium enhancement (LGE) is a key predictor of cardiovascular death in these patients.

Area of Science:

  • Cardiology
  • Cardiovascular Disease Research
  • Hypertrophic Cardiomyopathy

Background:

  • Prognosis in hypertrophic cardiomyopathy (HCM) is influenced by age, gender, and outflow tract obstruction.
  • Apical hypertrophic cardiomyopathy (ApHCM) and asymmetric septal hypertrophic cardiomyopathy (ASHCM) are distinct HCM phenotypes.
  • Comparative long-term outcome data between ApHCM and ASHCM, adjusted for key prognostic factors, are limited.

Purpose of the Study:

  • To compare the long-term prognosis of ApHCM versus ASHCM.
  • To evaluate outcomes after controlling for diagnostic age, gender, and outflow tract obstruction.
  • To identify independent predictors of cardiovascular mortality in HCM patients.

Main Methods:

  • Retrospective analysis of 540 patients (270 ApHCM, 270 ASHCM) from a single-center cohort.
  • Matching of ApHCM and ASHCM groups by age, gender, and outflow tract obstruction.
  • Comparison of clinical characteristics and long-term cardiovascular outcomes.

Main Results:

  • ASHCM patients experienced significantly higher cardiovascular mortality (6.3% vs. 0.7%) and morbidity (39.9% vs. 18.5%) compared to ApHCM patients.
  • Mean follow-up was 6.6 years for ASHCM and 7.6 years for ApHCM.
  • Late gadolinium enhancement (LGE) and unexplained syncope were independent predictors of cardiovascular mortality.

Conclusions:

  • ASHCM is associated with a worse long-term prognosis than ApHCM, independent of age, gender, and outflow tract obstruction.
  • LGE is a significant predictor of cardiovascular death in HCM.
  • Unexplained syncope independently predicts increased risk for sudden cardiac death.
Abstract

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