Prognosis for patients with apical hypertrophic cardiomyopathy: A multicenter cohort study based on propensity score
Huihui Ma1,2, Yongmei Zhou1,2, Ye He3
1Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
Insights
Apical hypertrophic cardiomyopathy (AHCM) patients demonstrated a favorable prognosis, experiencing lower rates of all-cause mortality, cardiovascular mortality, and sudden cardiac death compared to non-AHCM patients. This suggests AHCM is an independent predictor of better outcomes in hypertrophic cardiomyopathy.
Area of Science:
- Cardiology
- Internal Medicine
- Genetics
Background:
- Apical hypertrophic cardiomyopathy (AHCM) is a recognized subtype of hypertrophic cardiomyopathy (HCM).
- Limited research exists regarding the long-term prognosis and clinical outcomes specifically for AHCM patients.
- Understanding AHCM's prognostic implications is crucial for patient management and risk stratification.
Purpose of the Study:
- To investigate and compare the clinical prognosis of AHCM versus non-AHCM patients.
- To analyze mortality rates, including all-cause, cardiovascular, and sudden cardiac death (SCD), in a large cohort of Chinese HCM patients.
- To determine if AHCM is an independent predictor of mortality using propensity score matching and regression analysis.
Main Methods:
- A retrospective cohort study involving 2268 HCM patients from 13 tertiary hospitals (1996-2021).
- Propensity score matching (PSM) with a 1:2 ratio was used to balance baseline characteristics between 226 AHCM and 2042 non-AHCM patients.
- Cox proportional hazard regression models were employed to assess the impact of AHCM on mortality outcomes.
Main Results:
- Over a median follow-up of 5.1 years, 353 patients died. AHCM patients exhibited significantly lower rates of all-cause mortality (P = 0.003), cardiovascular mortality/cardiac transplantation (P = 0.03), and SCD (P = 0.02) post-matching.
- Cox regression identified AHCM as an independent predictor of all-cause HCM mortality (P = 0.004).
- While univariable analysis suggested AHCM predicted cardiovascular mortality/transplantation and SCD, these associations were not significant in multivariable models.
Conclusions:
- Apical hypertrophic cardiomyopathy is associated with a favorable prognosis, characterized by reduced all-cause mortality, cardiovascular mortality/cardiac transplantation, and SCD compared to non-AHCM.
- The findings indicate that AHCM may confer a better survival outlook within the broader HCM population.
- Further research may elucidate the specific mechanisms underlying the improved prognosis in AHCM.
Background:
Apical hypertrophic cardiomyopathy (AHCM) is a subtype of HCM, and few studies on the prognosis in AHCM are available.
Aims:
This study aimed to explore the clinical prognosis for AHCM and non-AHCM patients through clinical data based on propensity score matching (PSM) in a large cohort of Chinese HCM patients.
Methods:
The cohort study included 2268 HCM patients, 226 AHCM and 2042 non-AHCM patients from 13 tertiary hospitals, who were treated between 1996 and 2021. Fifteen demographic and clinical variables of 226 AHCM patients and 2042 non-AHCM patients were matched using 1:2 PSM. A Cox proportional hazard regression model was constructed to assess the effect of AHCM on mortality.
Results:
During a median follow-up of 5.1 (2.4-8.4) years, 353 (15.6%) of the 2268 HCM patients died, of whom 205 died due to cardiovascular mortality/cardiac transplantation and 94 experienced sudden cardiac death (SCD). In the matched cohort, the ACHM patients had lower rates of all-cause mortality (P = 0.003), cardiovascular mortality/cardiac transplantation (P = 0.03), and SCD (P = 0.02) than the non-AHCM patients. Furthermore, the Cox proportional hazard regression model showed that AHCM was an independent prognostic predictor of all-cause HCM mortality (P = 0.004) and a univariable prognostic predictor of cardiovascular mortality/cardiac transplantation (P = 0.03) and for SCD (P = 0.03). However, AHCM was not significant in multivariable Cox regression models in relation to cardiovascular mortality/cardiac transplantation and SCD.
Conclusion:
AHCM had a favorable prognosis both before and after matching, with lower all-cause mortality, cardiovascular mortality/cardiac transplantation, and SCD than non-AHCM.
