Left ventricular apical aneurysm in hypertrophic cardiomyopathy as a risk factor for sudden death at any age

Area of Science:

• Cardiology
• Sudden Cardiac Death Research
• Cardiovascular Imaging

Background:

• Aging is generally considered protective against sudden death (SD) in hypertrophic cardiomyopathy (HCM).
• Prophylactic implantable cardioverter-defibrillator (ICD) recommendations are less common in patients aged 60 years and older.
• Left ventricular apical aneurysms (LVAA) have not been widely recognized as a significant risk factor for SD in HCM.

Purpose of the Study:

• To investigate the association between left ventricular apical aneurysms (LVAA) and sudden death (SD) risk in patients with hypertrophic cardiomyopathy (HCM), particularly in older adults.
• To determine if LVAA represents a novel marker for SD in HCM patients aged 60 years and above.
• To evaluate the need for primary prevention of SD with ICDs in senior HCM patients with LVAA.

Main Methods:

• Case presentation of a 71-year-old HCM patient with an aborted SD event due to LVAA.
• Reappraisal of the Tufts HCM database, focusing on 118 patients with LVAA.
• Comparative analysis of SD event rates in HCM patients with and without LVAA, stratified by age (≥60 years vs. <60 years).

Main Results:

• A 71-year-old patient with HCM and LVAA experienced an aborted SD event, highlighting LVAA as a potential SD marker.
• In the HCM cohort with LVAA, 36% of SD events occurred in patients aged 60 years and older.
• HCM patients aged ≥60 years with LVAA had an 8-fold higher risk of SD compared to those without LVAA (16% vs. 2%; P < 0.001).

Conclusions:

• Left ventricular apical aneurysm (LVAA) is a significant and persistent risk factor for sudden death (SD) in hypertrophic cardiomyopathy (HCM) throughout life.
• The risk of SD associated with LVAA is notably high in older HCM patients (≥60 years).
• Senior HCM patients with LVAA should be considered for primary prevention of SD with implantable cardioverter-defibrillators (ICDs).