Key result
Right ventricular hypertrophy in apical hypertrophic cardiomyopathy was associated with worse biventricular mechanics and higher 3-year heart failure hospitalization (35% vs 7%, p=0.003).
Why the study?
Right ventricular hypertrophy occurs in one third of patients with hypertrophic cardiomyopathy, but outcomes in apical hypertrophic cardiomyopathy have not been described.
Does the presence of right ventricular hypertrophy worsen ventricular mechanics and increase adverse events in patients with apical hypertrophic cardiomyopathy?
Cohort (n=91)
Does the presence of right ventricular hypertrophy worsen ventricular mechanics and increase adverse events in patients with apical hypertrophic cardiomyopathy?
Absolute Event Rate: 35% vs 7%
p-value: p=0.003
Right ventricular hypertrophy in apical hypertrophic cardiomyopathy is a marker for worse biventricular mechanics and a significantly higher risk of mid-term heart failure hospitalization.
May warrant closer HF surveillance in apical HCM with RVH; hypothesis-generating for prospective validation.
BACKGROUND: Right ventricular hypertrophy (RVH+) in hypertrophic cardiomyopathy occurs in one third of patients, however, outcomes in apical hypertrophic cardiomyopathy (ApHCM) have not been described. We hypothesized that RVH+ in ApHCM is associated with more ventricular remodeling and dysfunction, and increased adverse events when compared with those without RVH (RVH-). METHODS: Ninety-one ApHCM patients were retrospectively analyzed using 2D and speckle-tracking echocardiography (64 ± 16 years old, 43% female). RVH+ was defined as wall thickness >5 mm and was present in 23 (25%). Ventricular mechanics were characterized by global longitudinal strain (GLS), RV free wall strain, and myocardial work. RESULTS: New York Heart Association functional class > II, atrial fibrillation, and prior stroke were more prevalent in RVH+. Left ventricular (LV) size and ejection fraction were similar between groups, with greater septal (17 vs. 14 mm, p = .001) and apical (20 vs. 18 mm, p = .04) wall thickness in RVH+. When compared with RVH- patients, RVH+ had worse LV GLS (-8.6 vs. -12.8%), global work index (820 vs. 1172 mmHg%) (both p < .001), and work efficiency (76 vs. 83%, p = .001), as well as RV GLS (-14 vs. -17.5%) and free wall strain (-17.3 vs. -21.3%) (both p = .02). At 3-year follow-up RVH+ had greater incidence of heart failure hospitalization compared with RVH- (35 vs. 7%, p = .003). RVH+ was associated with RV GLS (β = .2, p = .03), independent of clinical and echocardiographic variables. CONCLUSIONS: RVH+ patients with ApHCM have worse biventricular mechanics and myocardial work, and more heart failure hospitalization, as RVH- at mid-term follow-up.
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Mihos et al. (2023) conducted a cohort in Apical hypertrophic cardiomyopathy (n=91). Right ventricular hypertrophy (RVH+) vs. No right ventricular hypertrophy (RVH-) was evaluated on Heart failure hospitalization (p=0.003). Right ventricular hypertrophy in apical hypertrophic cardiomyopathy was associated with worse biventricular mechanics and higher 3-year heart failure hospitalization (35% vs 7%, p=0.003).
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