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Longitudinal Outcomes of Left Ventricular Outflow Tract Obstruction in Aortic Stenosis Versus Hypertrophic

Joy Yi-Shan Ong1, Tony Yi-Wei Li1, Aloysius Sheng-Ting Leow1

  • 1Department of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.

Medicina (Kaunas, Lithuania)
|June 27, 2025
PubMed

Insights

Severe aortic stenosis (AS) leads to worse heart failure outcomes and mortality than hypertrophic obstructive cardiomyopathy (HOCM). This study compared fixed AS obstruction versus dynamic HOCM obstruction in patients.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Echocardiography

Background:

  • Aortic stenosis (AS) and hypertrophic obstructive cardiomyopathy (HOCM) both cause left ventricular outflow tract (LVOT) obstruction.
  • Understanding the long-term effects of fixed obstruction in AS versus dynamic obstruction in HOCM is crucial for patient management.

Purpose of the Study:

  • To compare the longitudinal clinical outcomes of patients with severe valvular aortic stenosis (AS) and hypertrophic obstructive cardiomyopathy (HOCM).
  • To evaluate differences in heart failure, mortality, stroke, and cardiovascular hospitalization between fixed AS and dynamic HOCM obstruction.

Main Methods:

  • Retrospective analysis of consecutive patients diagnosed with severe AS or HOCM between 2010 and 2017.
  • Comparison of demographics, comorbidities, and clinical outcomes using Kaplan-Meier curves and multivariable Cox regression.
  • Echocardiographic parameters including mean pressure gradient (MPG), aortic valve area (AVA), LVOT gradient, and wall thickness were analyzed.

Main Results:

  • A total of 134 patients were included in the study.
  • Patients with AS showed significantly lower cumulative survival and higher all-cause mortality compared to HOCM patients (p=0.001).
  • Severe AS was independently associated with a higher incidence of heart failure outcomes (p=0.023), with no significant differences in stroke or CV hospitalization.

Conclusions:

  • Fixed LVOT obstruction in severe aortic stenosis is associated with poorer heart failure and mortality outcomes compared to dynamic obstruction in HOCM.
  • Severe AS is an independent predictor of adverse heart failure events, highlighting the distinct prognostic implications of these two LVOT obstruction types.

Keywords:
ASHOCMLVOT obstructionheart failuremortality outcomes

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