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Ethnic and sex-related differences at presentation in apical hypertrophic cardiomyopathy: An observational

Shafik Khoury1, Raghav T Bhatia1, Sarandeep Marwaha1

  • 1Cardiovascular Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, United Kingdom.

International Journal of Cardiology
|August 13, 2023
PubMed

Insights

Ethnicity and sex influence apical hypertrophic cardiomyopathy (ApHCM) presentation. Black patients and hypertensive males show mixed hypertrophy, while females present later with fewer ECG changes.

Area of Science:

  • Cardiology
  • Genetics
  • Medical Imaging

Background:

  • Apical hypertrophic cardiomyopathy (ApHCM) is a distinct form of hypertrophic cardiomyopathy.
  • Understanding variations in clinical presentation and cardiovascular magnetic resonance (CMR) findings is crucial for patient management.
  • Investigating the impact of ethnicity and sex can reveal important demographic differences in ApHCM.

Purpose of the Study:

  • To determine if ethnicity and sex are associated with different clinical presentations of ApHCM.
  • To identify variations in cardiovascular magnetic resonance (CMR) findings based on ethnicity and sex in ApHCM patients.
  • To explore demographic and clinical differences in ApHCM patients.

Main Methods:

  • Retrospective observational cohort study of 150 consecutive ApHCM patients from a UK tertiary referral center (2010-2020).
  • Data collected included demographics, clinical information, 12-lead electrocardiogram (ECG), and CMR findings.
  • ApHCM phenotypes were classified as 'pure' (isolated apical hypertrophy) or 'mixed' (apical and septal hypertrophy with greater apical wall thickness).

Main Results:

  • Females were diagnosed later than males, exhibiting less prominent ECG changes, higher left atrial area index, and increased hypertension.
  • Black patients showed higher left ventricular mass index, more hypertension, and a higher prevalence of the 'mixed' ApHCM type.
  • Hypertensive males predominantly presented with the 'mixed' phenotype.

Conclusions:

  • Black ethnicity and male sex with hypertension are linked to mixed apical and basal hypertrophy.
  • White, Asian, and non-hypertensive males tend to have hypertrophy confined to the apex.
  • Females present at an older age and are less likely to exhibit deep T-wave inversion on ECG.
Abstract

Keywords:
Apical hypertrophyHypertensionHypertrophic cardiomyopathyMagnetic resonance imaging

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