Influence of heart failure phenotypes on prognosis of patients with hypertrophic cardiomyopathy

Background

Hypertrophic cardiomyopathy (HCM) is a highly heterogeneous disease with variable timings of complication onset and progression, whether different heart failure (HF) phenotypes are associated with adverse outcomes in HCM was incompletely unknown.

Objective

To explore the association of different HF phenotypes with all-cause mortality, cardiovascular events, and sudden death in HCM patients.

Methods

This retrospective, observational cohort study included 2292 HCM patients from 13 tertiary hospitals over the period from 1996 to 2021. The patients were categorized into four groups: without HF (HCM-non-HF), HF with highly preserved ejection fraction (HCM-HFhpEF) (LVEF ≥60 %), HF with low-normal ejection fraction (HCM-HFlnEF) (LVEF 50 %–59 %) and HF with reduced ejection fraction (HCM-HFrEF) (LVEF <50 %). Kaplan-Meier and Cox proportional hazards models were employed to evaluate the prognostic differences among HCM patients with different HF phenotypes.

Results

Overall, of 2292 patients included, the mean age was 56.95 ± 15.24 years, 38.5 % were female, with a median follow-up period of 4.5 years. All-cause death, cardiovascular events, and sudden death occurred in 19.3 %, 11.0 %, and 4.8 %, respectively. Compared with patients with HFhpEF, those with HFlnEF and HFrEF exhibited a higher risk of all-cause death [HCM-HFlnEF: adjusted hazard ratio (aHR): 1.50, 95 % confidence interval (CI): 1.16–1.95; HCM-HFrEF: aHR 2.35, 95 % CI:1.71–3.24] and cardiovascular events (HCM-HFlnEF: aHR: 1.71, 95 % CI:1.23–2.39; HCM-HFrEF: aHR 2.09, 95 % CI: 1.35–3.23), whereas there was no significant association with sudden death; those without HF did not demonstrate increased mortality risk.

Conclusions

Our study suggested that HCM patients with HFlnEF and HFrEF were associated with an significantly increased risk of all-cause and cardiovascular events.