Comparison of the prevalence, clinical features, and long-term outcomes of midventricular hypertrophy vs apical phenotype in patients with hypertrophic cardiomyopathy.
BACKGROUND
Previous studies on the association between the distribution of left ventricle hypertrophy and the clinical features of hypertrophic cardiomyopathy (HCM) have yielded unclear results. The aim of this study was to investigate the differences in the prevalence, clinical features, management strategies, and long-term outcomes between patients with midventricular hypertrophic obstructive cardiomyopathy (MVHOCM) and patients with apical HCM (ApHCM).


METHODS
A retrospective study of 60 patients with MVHOCM and 263 patients with ApHCM identified in a consecutive single-centre cohort consisting of 2068 patients with HCM was performed. The prevalence, clinical features, and natural history of the patients in these 2 groups were compared.


RESULTS
Compared with ApHCM patients, patients with MVHOCM tended to be much younger and more symptomatic during their initial evaluation. Over a mean follow-up of 7 years, the probability of cardiovascular mortality and that of morbidity was significantly greater in MVHOCM patients compared with ApHCM patients (log-rank, P < 0.001).


CONCLUSIONS
Our results suggest that, compared with ApHCM, MVHOCM represents an uncommon presentation of the clinical spectrum of HCM that is characterized by progressive clinical deterioration leading to increased cardiovascular mortality and morbidity. Our results also underscore the importance of the timely recognition of MVHOCM for the prediction of prognosis and the early consideration of appropriate management strategies.
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Chi
C
Cai
Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Fu-jian
FJ
Duan
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Yin-jian
YJ
Yang
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Xi-ying
XY
Guo
Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Yan-ling
YL
Liu
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Yu-qing
YQ
Liu
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Li-rong
LR
Yan
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Zhi-min
ZM
Xu
Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Shi-hua
SH
Zhao
The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Wei
W
Hua
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Yi-shi
YS
Li
Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: fred_fan2004@aliyun.com.
Chao-mei
CM
Fan
D055011:Ablation Techniques; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002312:Cardiomyopathy, Hypertrophic / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010641:Phenotype; D012189:Retrospective Studies; D013575:Syncope / Q000453:epidemiology; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D014859:Warfarin