Coronary artery disease characterization and plaque morphology in patients with hypertrophic cardiomyopathy

The prevalence of coronary artery disease and plaque characteristics in patients with hypertrophic cardiomyopathy have not been fully evaluated. We aimed to assess the incidence of coronary artery disease, plaque morphology, and plaque burden in patients with hypertrophic cardiomyopathy compared to non-hypertrophic cardiomyopathy subjects.

We conducted a retrospective cohort study involving consecutive patients with hypertrophic cardiomyopathy and controls referred for coronary CTA to evaluate stable chest pain. CTA was assessed using the Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0, with quantitative plaque analysis performed using dedicated software.

A total of 925 patients were included: 137 (15%) with hypertrophic cardiomyopathy and 788 (85%) controls. In multivariable analysis, hypertrophic cardiomyopathy was associated with a 78% lower likelihood of obstructive coronary artery disease (≥50% luminal stenosis) (adjusted OR 0.22, 95% CI 0.11-0.43, P<0.001). After propensity score-matching (n=270), obstructive coronary artery disease remained significantly less prevalent in hypertrophic cardiomyopathy patients compared to matched controls (9.6% vs. 30.4%; P<0.001). High-risk plaque rate was lower among hypertrophic cardiomyopathy patients (10.4% vs. 20%, P=0.003), as was overall plaque burden (CAD-RADS ≥P3) (19.3% vs. 34.1%, P=0.006). At 1-year follow-up, percutaneous coronary intervention rate was lower in hypertrophic cardiomyopathy patients (3% vs. 11.9%, P=0.005), with no differences in death and stroke.

Among hypertrophic cardiomyopathy patients undergoing CTA for stable chest pain, a lower incidence of obstructive coronary artery disease and more stable coronary plaque features were observed compared to controls.