Phenotyping the cardiomyopathy spectrum: large-scale analysis of clinical and comorbidity status in the prospective TORCH cohort
C Reich, F Sedaghat-Hamedani, J Trebing, E Kayvanpour, A Amr, J Koelemen, K Weitmann, W Hoffmann, N Frey, B MederAbstract
Background
Systematic characterization of cardiomyopathy (CMP) populations is critical for refining risk stratification and therapy.. The Translational Registry for Cardiomyopathies (TORCH) is a large-scale, prospective registry designed to map the clinical heterogeneity of cardiomyopathies. This study presents the baseline clinical and comorbidity profiles of the TORCH cohort stratified by phenotype.
Methods
We analyzed baseline data from 4639 patients enrolled in the TORCH and TORCH-Plus studies. Patients were stratified into CMP phenotypes, including Dilated Cardiomyopathy (DCM), Hypertrophic Cardiomyopathy (HCM), Cardiac Amyloidosis (CA), Left Ventricular Non-Compaction (LVNC), and Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). Statistical analysis focused on comparative profiling of baseline demographics, functional status (NYHA), and prevalence of cardiovascular comorbidities.
Results
The TORCH cohort (mean age 55.2 ± 14.6 years, 68.9% male) consists primarily of DCM (58.9%, n=2734) and HCM (28.9%, n=1341) patients, followed by CA (6.1%, n=284), LVNC (3.4%, n=158), and ARVC (2.6%, n=122). Significant differences in comorbidity profiles were observed between phenotypes. Patients with HCM exhibited a markedly higher prevalence of conventional cardiovascular risk factors at baseline, including hypertension (55.9% in HCM vs. 41.8% in DCM), dyslipidemia (39.7% in HCM vs. 29.1% in DCM) and sleep apnea (6.1% in HCM vs. 2.1%). Yet, the prevalence of Diabetes mellitus was higher in the DCM group (15.4% in DCM vs. 9.8% in HCM). Coronary artery disease (CAD) prevalence was highest in cardiac amyloidosis as expected by the older mean age at enrollment (34.5%), but was also significantly higher in HCM (18.4%) compared to DCM (12.0%), LVNC (10.1%), and ARVC (9.0%). Conversely, HCM patients demonstrated a significantly milder heart failure presentation at baseline compared to the DCM group. The prevalence of NYHA Class III/IV symptoms was 15.3% in HCM (vs. 26.2% in DCM). A history of heart failure decompensation was reported in only 4.9% of HCM patients (vs. 27.9% in DCM patients). The CA group was notable for the oldest mean age (70.8 ± 8.9 years) and a high prevalence of atrial fibrillation (53.2%).
Conclusion
The TORCH registry reveals distinct baseline comorbidity and functional profiles across cardiomyopathy phenotypes. Notably, the HCM population carried a higher burden of conventional cardiovascular risk factors (HTN, Dyslipidemia, CAD) while presenting with significantly milder heart failure symptoms compared to the DCM cohort. These findings underscore the differential role of risk factor management and the need for personalized approaches in patients with varying cardiomyopathy etiology.For image description, please refer to the figure legend and surrounding text.