Epidemiological characteristics of patients with cardiomyopathy presenting with heart failure

Background

Cardiomyopathies comprise a diverse spectrum of myocardial diseases and represent an important cause of heart failure (HF). Despite advances in classification and genetics, real-world data describing the clinical and epidemiological characteristics of HF patients across different cardiomyopathy phenotypes remain limited.

Purpose

To characterize the distribution and baseline clinical profiles of cardiomyopathy subtypes among patients presenting with HF in a multicenter registry.

Methods

This observational study analyzed 947 consecutive patients enrolled in a multicenter HF registry. Cardiomyopathy was identified in 144 patients (14.8%). Subtypes included dilated, hypertrophic, restrictive, arrhythmogenic right ventricular cardiomyopathy (ARVC), peripartum, Takotsubo, and left ventricular noncompaction cardiomyopathy. Demographic were compared across cardiomyopathy subtypes.

Results

Among patients with non-ischemic HF (n = 388), cardiomyopathy represented the most frequent cause overall (37.6%), followed by valvular heart disease (34.0%) and arrhythmia-related HF (12.4%) (Table 1). The distribution of non-ischemic HF etiology differed significantly across LVEF phenotypes (p < 0.0001). Cardiomyopathy-related HF predominated in HFrEF (54.2%).

Within the cardiomyopathy subgroup (n = 146), dilated cardiomyopathy was the predominant subtype (67.8%), followed by hypertrophic (11.6%), peripartum (7.5%), noncompaction (6.8%), restrictive (3.4%), ARVC (2.1%), and Takotsubo cardiomyopathy (0.7%) (Table 1). Dilated cardiomyopathy was strongly associated with HFrEF (81.7%), whereas hypertrophic cardiomyopathy showed a heterogeneous LVEF distribution, with the majority presenting as HFpEF (60.0%) or HFmEF (37.5%). Sex distribution differed significantly across subtypes (p < 0.001), with male predominance in dilated, hypertrophic, restrictive, and ARVC cardiomyopathies, while Takotsubo cardiomyopathy occurred exclusively in women. Rates of HF-related hospitalization, emergency department admission, and oral diuretic dose escalation did not differ significantly. Hypertension prevalence was more frequent in dilated and hypertrophic cardiomyopathy. A family history of HF and genetically confirmed cardiomyopathy were significantly more common in hypertrophic, restrictive, and ARVC subtypes. The use of implantable cardiac devices was common but comparable across cardiomyopathy phenotypes (Table 2).

Conclusion

In this real-world HF population, cardiomyopathy accounted for nearly 15% of cases, with dilated cardiomyopathy as the dominant subtype. While functional status and short-term healthcare utilization were broadly comparable, cardiomyopathy phenotypes demonstrated distinct patterns in sex distribution, hypertension burden, familial clustering, and genetic background. These findings emphasize the heterogeneity of cardiomyopathy-related HF and support phenotype-specific risk assessment in specialized HF care settings.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.