Clinical and imaging predictors of mortality and adverse outcomes in a latin american cohort with hypertrophic cardiomyopathy
M Bustamante, M P Villa Saldarriaga, L V Lopez Gutierrez, J D Orozco Burbano, C I Saldarriaga GiraldoAbstract
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease and is characterised by myocardial hypertrophy in the absence of abnormal loading conditions. Its clinical course is heterogeneous, ranging from asymptomatic patients to advanced heart failure or sudden cardiac death. Prognosis has improved with early diagnosis, risk stratification and disease-specific therapies; however, predicting mortality and other adverse outcomes remains challenging, particularly in Latin American populations where data are scarce. This study aimed to identify clinical, echocardiographic and cardiac magnetic resonance (CMR) imaging predictors associated with mortality and major adverse outcomes in patients with HCM
Methods
This was an observational, retrospective and analytical study including 117 patients with HCM followed at a cardiovascular referral centre in Colombia. Demographic, clinical, echocardiographic and CMR variables were collected. The primary outcome was the identification of predictors of all-cause mortality; secondary outcomes included predictors of cardiovascular hospitalisation, implantable cardioverter-defibrillator (ICD) implantation and heart transplantation. Quantitative variables were expressed as means and standard deviations, qualitative variables as absolute and relative frequencies, and a p value <0.05 was considered statistically significant
Results
The mean age was 57±19 years, and 52% of patients were women. The prevalence of arterial hypertension was 51% and dyslipidaemia 30%. In the mortality analysis, no significant differences were observed in age, comorbidities or interventricular septal thickness between deceased and surviving patients. However, patients who died exhibited a higher extent of myocardial fibrosis (20% vs 11%) and worse functional class (60% vs 19%). Regarding secondary outcomes, predictors of hospitalisation included a history of stroke (OR 11.8; p=0.006), atrial fibrillation (OR 5.9; p=0.001) and a higher percentage of myocardial fibrosis (OR 1.07; p=0.03). Younger age (OR 0.96; p=0.001), a history of syncope (OR 3.78; p=0.002), atrial fibrillation (OR 3.39; p=0.01), non-sustained ventricular tachycardia (OR 5.00; p=0.002) and greater interventricular septal thickness (OR 3.31; p=0.008) were identified as prognostic factors for ICD implantation. Predictors associated with the need for heart transplantation included a history of sudden cardiac death (p=0.014) and atrial fibrillation (p=0.006)
Conclusion
In this cohort, overall mortality was low (4%) during follow-up, reflecting adequate follow-up and comprehensive management of patients with HCM. Nevertheless, several variables with potential prognostic value for clinically relevant outcomes were identified. These findings may help refine risk stratification strategies in underrepresented populations, integrating clinical features, electrocardiographic findings and advanced imaging to guide therapeutic decision-making and prevent fatal events