Retrospective analysis of clinical phenotype and prognosis of hypertrophic cardiomyopathy complicated with hypertension

Qin Luo,Bilian Yu,Xiaoyu Tang,Jin Chen,Tianhua Zhang

doi:10.1038/s41598-019-57230-z

Abstract

We here studied the clinical features, cardiac structure, and functional changes and prognosis of hypertrophic cardiomyopathy (HCM) patients with hypertension (HTN). A total of 90 HCM patients with HTN and 172 patients without HTN were divided into a hypertensive group and non-hypertensive group. The clinical characteristics, cardiac structure and function, and prognosis of the two groups were compared. Our study found that HCM patients with HTN had fewer syncope events in their medical histories (8% vs. 22%, P < 0.01) and sudden deaths in the family (3% vs. 10%, P < 0.05). The prevalence of apical hypertrophy (18% vs. 7%, P < 0.01) and midventricular obstruction (26% vs. 15%, P < 0.05) was higher in the HTN group. Besides, simple HCM patients had more pathogenic gene mutations, while those with HTN were more likely to have mutations of uncertain clinical significance (64% vs. 24%, P < 0.05). Evaluation of 5-year survival rate showed a trend for a worse prognosis in HCM patients with HTN, but the results were not statistically insignificant (P = 0.065). In conclusion, we found that the clinical phenotypes of HCM patients with HTN differed from those of patients with HCM alone, suggesting that HTN may play a pathogenic role in the pathogenesis of hypertensive hypertrophic cardiomyopathy patients.

Highlights

We here studied the clinical features, cardiac structure, and functional changes and prognosis of hypertrophic cardiomyopathy (HCM) patients with hypertension (HTN)
In 1985, Topol et al.[5] found some hypertension patients characterized as concentric hypertrophy, abnormal diastolic function, and hyperdynamic left ventricular contraction and put forward the concept of “hypertensive hypertrophic cardiomyopathy” (HHCM)
Considering HTN was not the primary cause of the cardiomyopathy, the “2011 ACCF/ AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy” stated that the patients with a history of HTN and characterized as a diagnostic sarcomere mutation or marked ventricular wall thickness >25 mm, LVOT obstruction, or both induced by systolic anterior motion (SAM), can be classified as HCM with HTN6

Summary

Introduction

We here studied the clinical features, cardiac structure, and functional changes and prognosis of hypertrophic cardiomyopathy (HCM) patients with hypertension (HTN). Considering HTN was not the primary cause of the cardiomyopathy, the “2011 ACCF/ AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy” stated that the patients with a history of HTN and characterized as a diagnostic sarcomere mutation or marked ventricular wall thickness >25 mm, LVOT obstruction, or both induced by systolic anterior motion (SAM), can be classified as HCM with HTN6. It is not clear whether HTN plays a role in the development of disease in these patients. We tried to study the clinical features, cardiac structure, and functional changes and prognosis of HCM patients with HTN, so providing reference data for the clinical diagnosis and treatment of HCM

Methods

Results

Conclusion