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January 3, 2024Heart Lung and Circulation7 citationsOpen Access

Clinical to Population Prevalence of Hypertrophic Cardiomyopathy Phenotype: Insights From the National Echo Database Australia

DPDavid PlayfordGSGeoff StrangeJAJ. Atherton

Key Result

Routine echocardiography identified a hypertrophic cardiomyopathy phenotype prevalence of 2.96% in men and 1.70% in women, estimating 17.5 male and 8.2 female cases per 10,000 Australian adults.

Study Design

Type

Observational (n=650,700)

Multicenter

Yes

Structured PICO

P
Population
650,700 adult men and women undergoing routine echocardiography in Australia, assessed for the presence of hypertrophic cardiomyopathy phenotype.
O
Outcome
Prevalence of hypertrophic cardiomyopathy (HCM) phenotype, defined as end-diastolic wall thickness ≥15 mm anywhere in the left ventricle in the absence of another known cause of hypertrophy.

This large national echocardiographic registry study demonstrates that the hypertrophic cardiomyopathy phenotype is relatively common, affecting an estimated 17.5 per 10,000 men and 8.2 per 10,000 women in Australia.

Limitations

  • Lack of clinical granularity to exclude other causes of ventricular hypertrophy such as hypertension, aortic stenosis, or cardiac amyloidosis.
  • Does not capture socio-economic profiles or genetic testing results.
  • Potential referral bias as individuals undergoing echocardiography are typically referred for known or suspected cardiac disease.
  • Apical wall thickness is not routinely measured, potentially missing some hypertrophic cardiomyopathy cases.
  • Limitations of pulsed-wave Doppler in accurately measuring high velocities across the left ventricular outflow tract.
  • Lack of granular clinical information on conditions that led to investigation (e.g., hypertension, coronary artery disease, cardiac amyloidosis)
  • Lack of information on functional status and symptomatic profile
  • Potential missed cases since increased wall thickness outside septal/posterior walls (e.g., apical) is not routinely captured in measurement fields
  • Lack of socio-economic and cultural profile data
  • Potential systematic biases in those being investigated as contributing centres are predominantly metropolitan

Abstract

BackgroundThere is a paucity of data describing the underlying prevalence of hypertrophic cardiomyopathy (HCM), a primary genetic disorder characterised by progressive left ventricular (LV) hypertrophy and sudden death, from both a clinical and a population perspective.MethodsWe screened the echocardiographic reports of 155,668 men and 147,880 women within the multicentre National Echo Database Australia (NEDA) (2001–2019). End-diastolic wall thickness ≥15 mm anywhere in the left ventricle was identified as a characteristic of an HCM phenotype according to current guideline recommendations. Applying a septal-to-posterior wall thickness ratio >1.3 and LV outflow tract obstruction ≥30 mmHg (when documented), we further identified asymmetric septal hypertrophy and obstructive HCM (oHCM), respectively. The observed pattern of phenotypical HCM within the overall NEDA cohort (>650,000 cases) was then extrapolated to the ∼539,000 (5.7% of adult population) and ∼474,000 (4.8%) Australian men and women, respectively, who were investigated with echocardiography in 2021 on an age-specific basis.ResultsOverall, 15,380 cases (mean age 71.1±14.6 years, 10,138 men 65.9%) with the characteristic HCM phenotype within the NEDA cohort were identified. Of these 15,380 cases, 5,552 (36.1%) had asymmetric septal hypertrophy, and 2,276 of the 10,290 cases with LV outflow tract obstruction profiling data (22.1%) had obstructive HCM. A further 3,389 of 13,715 cases (24.7%) had evidence of LV systolic dysfunction (LV ejection fraction 1.3 and LV outflow tract obstruction ≥30 mmHg (when documented), we further identified asymmetric septal hypertrophy and obstructive HCM (oHCM), respectively. The observed pattern of phenotypical HCM within the overall NEDA cohort (>650,000 cases) was then extrapolated to the ∼539,000 (5.7% of adult population) and ∼474,000 (4.8%) Australian men and women, respectively, who were investigated with echocardiography in 2021 on an age-specific basis. Overall, 15,380 cases (mean age 71.1±14.6 years, 10,138 men 65.9%) with the characteristic HCM phenotype within the NEDA cohort were identified. Of these 15,380 cases, 5,552 (36.1%) had asymmetric septal hypertrophy, and 2,276 of the 10,290 cases with LV outflow tract obstruction profiling data (22.1%) had obstructive HCM. A further 3,389 of 13,715 cases (24.7%) had evidence of LV systolic dysfunction (LV ejection fraction <55%). Within the entire NEDA cohort (including those without LV profiling), HCM was found in 10,138 of 342,161 men (2.96%; 95% confidence interval CI 2.91%–3.02%) and 5,242 of 308,539 women (1.70%; 95% CI 1.65%–1.75%). When extrapolated to the Australian population, we estimate that a minimum of 15,971 men and 8,057 women presented with echocardiographic features of phenotypical HCM in 2021. This translates into a minimum caseload/prevalence of ∼17 adult men (∼2.5 in those aged ≤50 years) and eight adult women (∼1 in those aged ≤50 years) per 10,000 population meeting phenotypical HCM criteria. Using contemporary Australian echocardiographic and population data, we estimate that a minimum of 15,971 (17.5 cases/10,000) men and 8,057 women (8.2 cases/10,000) had echocardiographic evidence of phenotypical HCM in 2021. These disease burden data are particularly relevant as new treatment options are emerging.

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Cite This Study

Playford et al. (2024) conducted an observational in Hypertrophic cardiomyopathy phenotype (n=650,700). Routine echocardiography was evaluated on Prevalence of hypertrophic cardiomyopathy phenotype. Routine echocardiography identified a hypertrophic cardiomyopathy phenotype prevalence of 2.96% in men and 1.70% in women, estimating 17.5 male and 8.2 female cases per 10,000 Australian adults.

synapsesocial.com/papers/6a35dc5921d3e324cb73181bhttps://doi.org/10.1016/j.hlc.2023.10.021
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): health status analysis of a randomised, double-blind, placebo-controlled, phase 3 trial2021 · 224 citations
  2. 2Incident aortic stenosis in 49 449 men and 42 229 women investigated with routine echocardiography2021 · 31 citations
  3. 3New Perspectives on the Prevalence of Hypertrophic Cardiomyopathy2015 · 1,422 citations
  4. 4Ejection fraction and mortality: a nationwide register‐based cohort study of 499 153 women and men2020 · 114 citations
  5. 5Prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults1995 · 2,294 citations