Heart failure profile in hypertrophic cardiomyopathy
N Przytula, E Dziewiecka, K Graczyk, M Winiarczyk, A Stepien-Wroniecka, S Wisniowska-Smialek, D Kapusta, J Gasiorek, V Kyslyi, P RubisAbstract
Background
Heart failure (HF) in hypertrophic cardiomyopathy (HCM) remains under-recognized and poorly characterized. Although HCM is often considered to have a benign course, a subset of patients develops HF with a significant clinical impact.
Objective
To determine the prevalence of HF in HCM using guideline-based and clinically accessible diagnostic criteria, and to compare clinical and echocardiographic features between patients with and without HF.
Methods
We evaluated 454 consecutive patients diagnosed with HCM between 2017-2023 with available baseline clinical, echocardiographic, and biomarkers data. We applied the following, guidelines-endorsed, definitions of HF: left ventricular ejection fraction (LVEF) <50%; or in the case of LVEF≥50% - the additional criteria were applied: NT-proBNP >300 ng/L in sinus rhythm or >500 ng/L in atrial fibrillation (AF) in combination with NYHA class ≥II and at least two echocardiographic criteria indicating elevated filling pressure (E/e' >9), atrial remodeling (volume index >34 mL/m² or area ≥25 cm²) or tricuspid regurgitant velocity >2.8 m/s.
Results
Based on the predefined criteria – HF was diagnosed in 159 (35%) patients, including 39 (8%) patients with LVEF<50% (end-stage HCM). Age did not differ between groups, whereas there were twice more women in HF cohort (Table 1). The overall burden of comorbidities was similar; however, AF was 2.5-times more prevalent in HF patients. The LV outflow track obstruction (LVOTO) gradient and the prevalence of late gadolinium enhancement did not differ between groups; however, HF group not only had worse LV but also RV systolic function.
Conclusions
More than one-third of unselected HCM patients fulfilled ESC guidelines endorsed definition of HF. While in 8% of patients HF was attributed to LV systolic dysfunction (or HF with reduced LVEF), great majority of patients had HF with preserved LVEF with various degree of LV diastolic dysfunction. Surprisingly, HF symptoms were not associated with higher LVOTO prevalence; however, AF presence and RV dysfunction were more prevalent in HCM patients with HF diagnosis.Table 1.For image description, please refer to the figure legend and surrounding text.