Invasive Cardiac Hemodynamics in Apical Hypertrophic Cardiomyopathy
Awais A Malik1, Ushasi Saraswati2, William R Miranda2
1Mayo Clinic, Department of Cardiovascular Medicine Jacksonville FL USA.
Insights
Apical hypertrophic cardiomyopathy often causes elevated left ventricular filling pressures and pulmonary hypertension. Invasive hemodynamics reveal these issues in most patients, with many experiencing reduced cardiac output and right-sided heart failure.
Area of Science:
- Cardiology
- Cardiovascular Research
- Internal Medicine
Background:
- Apical hypertrophic cardiomyopathy (AHC) can cause symptomatic limitations due to diastolic dysfunction, elevated left ventricular filling pressures, and pulmonary hypertension (PH).
- Understanding the invasive cardiac hemodynamics in AHC patients is crucial for managing their condition.
Purpose of the Study:
- To describe the invasive cardiac hemodynamics in a cohort of patients diagnosed with apical hypertrophic cardiomyopathy.
Main Methods:
- Retrospective analysis of 47 patients with AHC who underwent invasive hemodynamic catheterization.
- Data collected included left ventricular filling pressures, pulmonary hypertension, cardiac index, and presence of right-sided heart failure.
Main Results:
- 86% of patients exhibited elevated left ventricular filling pressures at rest or during exercise.
- Pulmonary hypertension was diagnosed in 81% of patients, with 20% of these also having right-sided heart failure.
- Reduced cardiac index was observed in 76% of patients with elevated resting filling pressures.
Conclusions:
- Invasive hemodynamic assessment in AHC patients frequently reveals elevated left ventricular filling pressures and pulmonary hypertension.
- A significant proportion of AHC patients with PH also develop right-sided heart failure.
Background:
Symptomatic limitations in apical hypertrophic cardiomyopathy may occur because of diastolic dysfunction with resultant elevated left ventricular filling pressures, cardiac output limitation to exercise, pulmonary hypertension (PH), valvular abnormalities, and/or arrhythmias. In this study, the authors aimed to describe invasive cardiac hemodynamics in a cohort of patients with apical hypertrophic cardiomyopathy.
Methods And Results:
Patients presenting to a comprehensive hypertrophic cardiomyopathy center with apical hypertrophic cardiomyopathy were identified (n=542) and those who underwent invasive hemodynamic catheterization (n=47) were included in the study. Of these, 10 were excluded due to postmyectomy status or incomplete hemodynamic data. The mean age was 56±18 years, 16 (43%) were women, and ejection fraction was preserved (≥50%) in 32 (91%) patients. The most common indication for catheterization was dyspnea (48%) followed by suspected PH (13%), and preheart transplant evaluation (10%). Elevated left ventricular filling pressures at rest or exercise were present in 32 (86%) patients. PH was present in 30 (81%) patients, with 6 (20%) also having right-sided heart failure. Cardiac index was available in 25 (86%) patients with elevated resting filling pressures. Of these, 19 (76%) had reduced cardiac index and all 6 with right-sided heart failure had reduced cardiac index. Resting hemodynamics were normal in 8 of 37 (22%) patients, with 5 during exercise; 3 of 5 (60%) patients had exercise-induced elevation in left ventricular filling pressures.
Conclusions:
In patients with apical hypertrophic cardiomyopathy undergoing invasive hemodynamic cardiac catheterization, 86% had elevated left ventricular filling pressures at rest or with exercise, 81% had PH, and 20% of those with PH had concomitant right-sided heart failure.
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