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Hypercontractile phenotype in hypertrophic cardiomyopathy indicates unfavorable hemodynamics, coronary flow and

Karina Wierzbowska-Drabik1, Eszter Dalma Pálinkás2, Maria Grazia D'Alfonso3

  • 1Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Lodz, Poland.

European Heart Journal. Cardiovascular Imaging
|August 29, 2025
PubMed

Insights

The left ventricular hypercontractile phenotype (HP) in hypertrophic cardiomyopathy (HCM) is linked to poorer cardiac function and reduced long-term survival in patients with preserved ejection fraction.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Echocardiography

Background:

  • Hypertrophic cardiomyopathy (HCM) is a complex genetic heart disease.
  • The clinical and prognostic significance of the left ventricular (LV) hypercontractile phenotype (HP) in HCM remains unclear.
  • Preserved ejection fraction (EF) is common in HCM patients, but outcomes can vary.

Purpose of the Study:

  • To assess the clinical and prognostic significance of the LV hypercontractile phenotype (HP) in hypertrophic cardiomyopathy (HCM).
  • To investigate the hemodynamic profile and long-term survival associated with HP in HCM patients with preserved EF.

Main Methods:

  • 1533 HCM patients with EF ≥ 50% underwent transthoracic echocardiography (TTE).
  • LV force was calculated (systolic blood pressure + LVOTG/ESV) and HP defined as the highest quartile (> 7.32 mmHg/mL).
  • Survival analysis was performed on 1200 patients with follow-up data.

Main Results:

  • HP patients exhibited higher heart rate, lower stroke volume, larger left atrial volume index, and increased coronary flow velocity.
  • LV force correlated moderately with LV EF and weakly with LV outflow tract gradient (LVOTG).
  • A force > 7.32 mmHg/mL was independently associated with a 1.44-fold increased hazard of all-cause death (HR 1.44, 95% CI 1.00-2.07).

Conclusions:

  • The LV hypercontractile phenotype (HP) in HCM is associated with unfavorable systemic, cardiac, and coronary hemodynamic profiles.
  • HP in HCM patients with preserved EF is linked to significantly lower long-term survival.
  • These findings highlight the prognostic importance of assessing LV force in HCM management.
Abstract

Keywords:
coronary flowechocardiographyhypercontractile phenotypehypertrophic cardiomyopathyprognosis

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