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Updated: Sep 12, 2025

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Systematic Review and Meta-Analysis Comparing Long-Term Outcomes in Apical Versus Nonapical Hypertrophic

Jonathan V Lee1, Mirela Emmanuela1, Andrew Patricio2

  • 1Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.

The American Journal of Cardiology
|August 10, 2025
PubMed

Insights

Apical hypertrophic cardiomyopathy (ApHCM) patients generally have better outcomes than non-ApHCM patients, with lower risks of major adverse cardiovascular events and mortality. However, apical aneurysms are more common in ApHCM.

Area of Science:

  • Cardiology
  • Genetics
  • Internal Medicine

Background:

  • Hypertrophic Cardiomyopathy (HCM) is a leading inherited cause of Sudden Cardiac Death (SCD).
  • Apical HCM (ApHCM) is a distinct phenotype, traditionally considered more benign.
  • Emerging data suggest an increasing rate of adverse outcomes in ApHCM.

Purpose of the Study:

  • To compare the long-term clinical outcomes of ApHCM versus non-ApHCM patients.
  • To evaluate differences in adverse events, including mortality, arrhythmias, and heart failure.

Main Methods:

  • Systematic review and meta-analysis of cohort studies comparing ApHCM and non-ApHCM.
  • Data extracted from PubMed, ScienceDirect, and Cochrane Library.
  • Outcomes assessed included major adverse cardiovascular events (MACE), mortality, SCD, VT, and heart failure endpoints.

Main Results:

  • ApHCM patients had significantly lower risks of MACE (OR=0.48) and all-cause mortality (OR=0.44) compared to non-ApHCM.
  • No significant difference was observed in the risk of SCD or sustained monomorphic VT.
  • Apical aneurysms were more prevalent in the ApHCM group.

Conclusions:

  • Apical HCM demonstrates a more favorable long-term prognosis compared to other HCM phenotypes.
  • Phenotypic classification is crucial for accurate prognostication and personalized management of HCM patients.
  • Further research may clarify the specific mechanisms driving outcomes in ApHCM.

Keywords:
apicalhypertrophic cardiomyopathyprognosisseptal

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