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Changing Demographics in Hypertrophic Cardiomyopathy and Implications for Management: Clinical Research

      ABSTRACT

      Purpose;

      To determine whether clinicians are encountering a phenotype of hypertrophic cardiomyopathy evolving from the disease recognized several years ago.

      Methods

      3, 161 consecutive patients encountered with established hypertrophic cardiomyopathy (2003-2020), studied clinically and with imaging.

      Results

      Patients were identified as progressively older now (average 56 ± 15 years) compared to 44 ± 17 years previously (p<0.001), also with an increasing frequency of outflow obstruction (from 46% to 61% of patients; p<0.001), albeit without more advanced heart failure symptoms. Notably, maximum left ventricular wall thickness (usually ventricular septum) decreased progressively over the same period (20.4 ± 5.7 to 17.5 ± 3.4 mm).

      Conclusions

      These novel observations are counter-initiative to practitioners expecting hypertrophic cardiomyopathy to be associated with particularly substantial hypertrophy, and potentially impact disease recognition, while also highlighting emergence of symptomatic obstructive patients with septal thickness <15 mm, requiring modification of traditional myectomy operation. While a primary change in phenotypic expression of hypertrophic cardiomyopathy cannot be excluded by our data, these observations most likely reflect evolving referral practice patterns including such greater diagnostic suspicion for the disease in the community particularly at advanced ages and/or with less substantial left ventricular hypertrophy.

      Key Words

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