Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK.
BACKGROUND
This study investigated the influence of African/Afro-Caribbean (black) ethnicity on the clinical profile and outcomes in hypertrophic cardiomyopathy (HCM).


METHODS
425 consecutive patients with HCM (163 black and 262 Caucasians (white); mean age 52.5±16.6 years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6-12 months and mean follow-up was 4.3±3.0 years. The primary outcome was a composite of cardiovascular death, cardiac arrest or appropriate device therapy.


RESULTS
A fortuitous diagnosis of HCM was more commonly made in black compared with white patients (31.3% vs 19.1%, p=0.004). An abnormal ECG at presentation was more frequent in black patients (98.2% vs 90.5%, p=0.002), with T-wave inversion being a common feature (91.4% vs 73.0%, p<0.001). Asymmetric septal hypertrophy was the predominant pattern in both ethnic groups; however, apical (22.2% vs 10.7%, p<0.001) and concentric (9.3% vs 1.5%, p<0.001) patterns were more prevalent in black patients. Hypertension was more frequent in black patients (58.3% vs 31.7%, p<0.001). There were no ethnic differences in risk factor profile or primary outcome. Independent predictors of the primary outcome were non-sustained ventricular tachycardia (HR 6.03, 95% CI 3.06 to 11.91, p≤0.001) and hypertension at presentation (HR 2.02, 95% CI 1.05 to 3.88, p=0.036), with an additive effect.


CONCLUSIONS
Black ethnicity is an important determinant of the phenotypic expression of HCM but does not adversely affect outcomes. Apical and concentric hypertrophy are common in black patients and may hinder the identification of HCM in this cohort. Hypertension has an adverse effect on outcome, irrespective of ethnicity.
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Nabeel
N
Sheikh
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Michael
M
Papadakis
National Heart and Lung Institute, Imperial College Healthcare NHS Trust, London, UK.
Vasileios F
VF
Panoulas
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Keerthi
K
Prakash
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Lynne
L
Millar
Sapienza University of Rome, Rome, Italy.
Paolo
P
Adami
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Abbas
A
Zaidi
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Sabiha
S
Gati
Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Mathew
M
Wilson
Guys and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, UK.
Gerald
G
Carr-White
St. George's University of London, London, UK.
Maria Teresa Esteban
MTE
Tomé
St. George's University of London, London, UK.
Elijah R
ER
Behr
St. George's University of London, London, UK.|Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK.
Sanjay
S
Sharma