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[Clinical aspects, course and prognosis of various forms of hypertrophic cardiomyopathy]
Insights
This study differentiates hypertrophic cardiomyopathy types, finding surgery significantly improves outcomes for obstructive hypertrophic cardiomyopathy (HOCM) patients unresponsive to conservative treatment.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- Hypertrophic cardiomyopathy (HCM) presents in various forms, including typical obstructive (HOCM), atypical obstructive, and nonobstructive (HNCM).
- Distinguishing these subtypes is crucial for accurate diagnosis and treatment planning.
Purpose:
- To characterize and compare the clinical presentation, disease course, and prognosis of typical HOCM, atypical HOCM, and HNCM in 353 patients.
- To evaluate the efficacy of conservative versus surgical treatment for HOCM.
Summary:
- Distinct differences were observed in clinical features, ECG findings, and echocardiographic results among the HCM subtypes.
- Echocardiography showed limitations in differentiating atypical HOCM from HNCM.
- Surgical intervention demonstrated significantly higher improvement rates and survival rates for HOCM patients compared to conservative management, with reduced syncope post-surgery.
Impact:
- Surgical treatment is confirmed as the preferred therapy for HOCM cases refractory to conservative measures.
- The findings suggest that surgical intervention improves the overall prognosis for patients with HOCM.
Abstract:
To characterize the different types of hypertrophic cardiomyopathy [typical (subaortic) hypertrophic obstructive cardiomyopathy (HOCM) (n = 235), atypical (midventricular or apical) HOCM (n = 33), and hypertrophic nonobstructive cardiomyopathy (HNCM) (n = 85)], studies of the clinical picture, course, and prognosis were performed in 353 patients. Clinical picture. There were found to be distinct differences between the diseases in terms of incidence, symptoms, findings at auscultation, carotid pulse tracings, ECG (incidence of abnormal negative T-waves), and echocardiography. Echochardiography proved to be diagnostically less specific than invasive methods, however, and in particular often failed to distinguish between atypical HOCM and HNCM. Clinical course. There was no evidence of a change from one form of hypertrophic cardiomyopathy to the other. The Sokolow-Lyon index in the ECG did not increase in any group. The rate of complications (endocarditis, systemic emboli) varied between 0.61 and 1.28 events per 100 patient years. Only 7.4%-23.5% of patients with HOCM improved as a result of conservative treatment, compared to 83%-87.5% of surgical patients. In addition, the rate of postoperative syncope was reduced by 90%. Prognosis. 90 patients were operated on. Operative mortality in typical HOCM was 4.5% over the last 5 years. If this is disregarded, the cumulative survival rates are significantly higher in surgical patients with typical HOCM than in those treated conservatively. The data confirm surgical treatment to be the therapy of choice in patients with HOCM refractory to conservative treatment. The prognosis seems to be improved by operation.