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



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


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


      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).


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Maron BJ
        • Desai MY
        • Nishimura RA
        • et al.
        Diagnosis and evaluation of hypertrophic cardiomyopathy: JACC State-of-the-Art Review.
        JACC. 2022; 79: 372-389
        • Rowin EJ
        • Maron BJ
        • Maron MS.
        The hypertrophic cardiomyopathy phenotype viewed through the prism of multimodality imaging: Clinical and etiologic implications.
        JACC Cardiovasc Imaging. 2020; 13: 2002-2016
        • Ommen SR
        • Mital S
        • Burke MA
        • et al.
        2020 AHA/ACC guidelines for the diagnosis and treatment of patients with hypertrophic cardiomyopathy.
        Circulation. 2020; 142: e533-e557
        • Rowin EJ
        • Maron BJ
        • Chokshi A
        • et al.
        Clinical spectrum and management implications of left ventricular outflow obstruction with mild ventricular septal thickness in hypertrophic cardiomyopathy.
        Am J Cardiol. 2018; 122: 1409-1420
        • Rowin EJ
        • Maron BS
        • Haas T
        • et al.
        Hypertrophic Cardiomyopathy with left ventricular aneurysm: Implications for risk stratification and management.
        JACC. 2017; 69: 761-773
        • Maron BJ
        • Desai MY
        • Nishimura RA
        • et al.
        Management of hypertrophic cardiomyopathy: JACC State-of-the-Art Review.
        J Am Coll Cardiol. 2022; 79: 390-414