Vascular changes in hypertrophic cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Hypertrophic cardiomyopathy. Intervention: Hypertrophic cardiomyopathy vs. Healthy controls. Primary outcome: Vascular changes (myocardial blood flow, myocardial perfusion reserve, and microvascular alterations).

Q: What does this research mean for the field?

Vascular abnormalities, particularly reduced myocardial perfusion reserve, are prevalent in hypertrophic cardiomyopathy and correlate with structural remodeling, disease progression, and adverse outcomes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Julia E Visch; Ali Nassar; George Burchell; Tjeerd Germans; Jolanda van der Velden

doi:10.1093/cvr/cvag153

July 14, 2026Cardiovascular ResearchOpen Access

Vascular changes in hypertrophic cardiomyopathy

View Full Paper

Ask AI

Bookmark

Share

Key result

Hypertrophic cardiomyopathy is consistently associated with reduced myocardial perfusion reserve and microvascular structural alterations that correlate with disease progression and adverse outcomes.

Figures

Graphical abstract published by Cardiovascular Research — Graphical abstract · Published by Cardiovascular Research · CC BY

Why the study?

This review summarizes modalities for assessing (micro)vascular function in HCM and explores how vascular changes relate to disease progression, structural remodeling, fibrosis, and clinical outcomes.

Key Points

To synthesize evidence on cardiac and peripheral vascular dysfunction across imaging modalities and examine their relationship to disease progression in hypertrophic cardiomyopathy.
A systematic database search was conducted without time restrictions for human studies evaluating vascular changes across varying severities of hypertrophic cardiomyopathy, excluding secondary hypertrophy.
In positron emission tomography studies, resting myocardial blood flow was similar between patients and controls in 7 of 10 studies, but hyperaemic blood flow (9 of 9 studies) and coronary flow reserve (7 of 7 studies) were significantly lower in patients.
Cardiac magnetic resonance studies demonstrated significantly lower stress myocardial blood flow across 4 of 4 studies and lower myocardial perfusion reserve across 6 of 6 studies in patients compared to controls.
Invasive coronary angiography showed lower coronary flow reserve in all 5 studies evaluating it, alongside earlier maximal flow during rapid atrial pacing and systolic flow reversal.

Study Design

Type

Systematic Review

Structured PICO

P

Population

A systematic review of 130 studies evaluating cardiac and peripheral vascular changes in adult patients with hypertrophic cardiomyopathy.

E

Exposure

Assessment of (micro)vascular function using PET, CMR, angiography, scintigraphy, SPECT, peripheral measures, and histology.

C

Comparator

Healthy controls or patients with secondary hypertrophy (e.g., hypertension), depending on the included study.

O

Outcome

Vascular changes, including myocardial blood flow (MBF), myocardial perfusion reserve (MPR), and coronary flow reserve (CFR).surrogate

Limitations

No meta-analysis was conducted, lacking quantitative synthesis.
Substantial methodological heterogeneity, small cohort sizes, and use of older datasets.
Limited number of longitudinal and interventional studies.
Exclusion of hypertensive patients may have excluded relevant studies.
Low proportion of studies conducting genetic testing.
Limited data regarding the role of vascular dysfunction in genotype-positive/phenotype-negative individuals
Limited data in individuals with early or mild disease

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Microvascular dysfunction, evidenced by reduced myocardial perfusion reserve, is a consistent feature of HCM that correlates with disease severity, structural remodeling, and adverse clinical outcomes.

Abstract

AIMS: Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy along with (micro)vascular abnormalities. These include cardiac and peripheral vascular dysfunction, as well as structural vascular changes. This review summarizes the modalities for assessing (micro)vascular function and explores how vascular changes relate to disease progression, including structural remodeling, fibrosis, and clinical outcomes. METHODS AND RESULTS: A systematic search of multiple databases was conducted to identify studies investigating vascular changes in patients with HCM, varying in disease severity. Human studies were included without time restrictions and studies involving hypertrophy secondary to other conditions (e.g., hypertension, aortic stenosis) were excluded.A total of 130 studies were included. Vascular changes were assessed with Positron Emission Tomography (n = 24), Cardiac Magnetic Resonance Imaging (n = 21), angiography (n = 18), scintigraphy and Single Photon Emission Computed Tomography (n = 30), peripheral measures (n = 12), and histology (n = 29). Perfusion abnormalities were common in HCM. While resting myocardial blood flow appears to be similar between HCM patients and controls, myocardial perfusion reserve is consistently reduced, correlating with early disease features, structural remodeling, and adverse outcomes. Peripheral vascular dysfunction is also frequently observed, though findings vary and mechanisms remain unclear. CONCLUSION: Vascular abnormalities play a key role in the pathophysiology of HCM, and are closely linked to disease progression and prognosis. Data are limited regarding the role of vascular dysfunction in genotype-positive/phenotype-negative individuals and individuals with early or mild disease. Future research should focus on evaluating cardiac and peripheral vascular function across the disease spectrum to better understand underlying mechanisms and potential targets for intervention.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Visch et al. (2026) conducted a systematic review in Hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy vs. Healthy controls was evaluated on Vascular changes (myocardial blood flow, myocardial perfusion reserve, and microvascular alterations). Hypertrophic cardiomyopathy is consistently associated with reduced myocardial perfusion reserve and microvascular structural alterations that correlate with disease progression and adverse outcomes.

synapsesocial.com/papers/6a59c60da58755010b4714a6 https://doi.org/10.1093/cvr/cvag153

View Full Paper

Ask AI

Bookmark

Share

Vascular changes in hypertrophic cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Vascular changes in hypertrophic cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading