Apical hypertrophic cardiomyopathy was associated with a lower risk of major adverse cardiac events compared to non-apical HCM (11.4% vs 27.2%; HR 0.360; 95% CI 0.187-0.696; P=0.002).
Cohort (n=479)
No
Does the apical hypertrophic cardiomyopathy (ApHCM) phenotype predict a lower risk of adverse outcomes compared to non-ApHCM in patients with hypertrophic cardiomyopathy?
Patients with the apical variant of hypertrophic cardiomyopathy have a significantly better long-term prognosis, including lower rates of major adverse cardiac events and fatal ventricular arrhythmias, compared to those with non-apical HCM.
Effect estimate: HR 0.360 (95% CI 0.187-0.696)
Absolute Event Rate: 11.4% vs 27.2%
p-value: p=0.002
Abstract Aims As a special type of hypertrophic cardiomyopathy (HCM), apical HCM (ApHCM) has different clinical characteristics while its nature history and prognosis are not well recognized. We aimed to describe the characteristics and outcomes of ApHCM and identify predictors of adverse outcomes. Methods In this single-centre retrospective study, we included 479 patients with HCM and divided them into ApHCM and non-ApHCM groups. Clinical, electrocardiographic, echocardiographic and survival data were compared between the groups. The primary outcome was major adverse cardiac events in hospital and during follow-up. A two-sided P-value 0.05 was considered statistically significant. Results A total of 109 ApHCM patients and 370 non-ApHCM patients were analysed and 379 patients completed the follow-up among them. The age of enrolled patients was 61.0 (50.0–69.0) years, and 289 (60.3%) were male. Compared with non-ApHCM patients, ApHCM patients were older at diagnosis 55.0 (45.0–64.0) vs. 50.0 (40.0–61.0) years, P = 0.006 and had less positive family history for HCM 3 (2.8%) vs. 34 (9.2%), P = 0.027, more electrocardiographic abnormalities 101 (92.7%) vs. 287 (77.6%), P 0.001, lower brain natriuretic peptide level 135.5 (60.8–272.8) vs. 422.5 (182.8–888.2) pg/mL, P 0.001 and better left ventricular ejection fraction (LVEF) 69.00 (64.00–73.87) vs. 67.00 (60.24–73.45) %, P = 0.048 at baseline. During a median follow-up of 5.59 (2.33–10.30) years, the primary outcome occurred less frequently in ApHCM patients 11.4% vs 27.2%; hazard ratio (HR)adj 0.360 (95% confidence interval, CI: 0.187–0.696), P = 0.002; log rank P = 0.001. Specifically, ApHCM was characterized by fewer all-cause death (HRadj 0.545, 95% CI: 0.305–0.975; P = 0.041) and fatal ventricular arrhythmia or appropriate implantable cardioverter defibrillator intervention (HRadj 0.099, 95% CI: 0.013–0.724; P = 0.023). LVEF (HRadj 0.861, 95% CI: 0.763–0.971; P = 0.015) and age (HRadj 1.247, 95% CI: 1.095–1.419; P = 0.001) were identified as independent predictors of the composite outcome in ApHCM. Conclusions Patients with ApHCM may have better prognosis. LVEF and age were independent predictors of long-term outcomes in ApHCM.
Guo et al. (Sun,) conducted a cohort in Hypertrophic cardiomyopathy (n=479). Apical hypertrophic cardiomyopathy (ApHCM) vs. Non-apical hypertrophic cardiomyopathy (non-ApHCM) was evaluated on Major adverse cardiac events in hospital and during follow-up (HR 0.360, 95% CI 0.187-0.696, p=0.002). Apical hypertrophic cardiomyopathy was associated with a lower risk of major adverse cardiac events compared to non-apical HCM (11.4% vs 27.2%; HR 0.360; 95% CI 0.187-0.696; P=0.002).