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Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

Dai-Yin Lu1,2,3, Iraklis Pozios1, Bereketeab Haileselassie1,4

  • 1Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD.

Journal of the American Heart Association
|February 27, 2018
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) patients with obstructive or nonobstructive forms face higher risks of adverse cardiovascular events. Nonobstructive HCM shows increased arrhythmia risk, while labile HCM has a benign course, guiding risk stratification and management.

Area of Science:

  • Cardiology
  • Genetics
  • Internal Medicine

Background:

  • Hypertrophic cardiomyopathy (HCM) is a prevalent inherited cardiac condition.
  • HCM is characterized by variable left ventricular outflow tract obstruction.
  • Understanding hemodynamic variations is crucial for patient outcomes.

Purpose of the Study:

  • To compare cardiovascular outcomes across three hemodynamic groups in a large hypertrophic cardiomyopathy cohort.
  • To identify specific risks associated with obstructive, nonobstructive, and labile HCM.
  • To inform risk stratification and management strategies for different HCM phenotypes.

Main Methods:

  • Prospective enrollment of 705 HCM patients from January 2005 to June 2015.
  • Phenotypic characterization using echocardiography to assess left ventricular outflow tract pressure gradients.
  • Composite cardiovascular end point including atrial fibrillation, ventricular arrhythmias, heart failure, and death, with a mean follow-up of 3.4 years.

Main Results:

  • Obstructive HCM patients were older with higher BMI and NYHA class.
  • Nonobstructive HCM patients had higher rates of sustained ventricular tachycardia/ventricular fibrillation and ICD implantation.
  • Obstructive and nonobstructive HCM were significantly associated with more adverse events compared to labile HCM.

Conclusions:

  • Nonobstructive HCM is linked to significant morbidity and higher arrhythmic risk.
  • Labile HCM demonstrates a relatively benign clinical course.
  • Tailored risk stratification for nonobstructive HCM and less aggressive management for labile HCM are suggested.
Abstract

Keywords:
classificationhypertrophic cardiomyopathyoutcome

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