The burden of hypertrophic cardiomyopathy-related major adverse cardiovascular events prior to comprehensive HCM care
L Rushkin, A Leslie, R Bhatia, N RezaAbstract
Background
There are limited data regarding the incidence and trajectories of patients with hypertrophic cardiomyopathy (HCM) who experience HCM-related major adverse cardiovascular events (MACE) prior to their evaluation at a comprehensive HCM center.
Methods
Single center retrospective analysis of consecutive probands with HCM seen for an initial clinical visit at a comprehensive HCM center between March 2017 and July 2025. Data regarding clinical characteristics and treatment course through the time of this visit were extracted. HCM-related MACE was defined as atrial or ventricular arrhythmia requiring treatment, syncope, sudden cardiac arrest, stroke, heart failure, or urgent evaluation for chest pain. Baseline characteristics were reported as median (interquartile range [IQR]) for non-normally distributed continuous variables and frequencies and percentages for categorical variables.
Results
Of 474 probands, 276 patients (58.2%) experienced a MACE prior to their initial visit at a comprehensive HCM center (MACE+). The most common MACE was atrial arrhythmia (27.5%), followed by urgent chest pain evaluation (22.1%), heart failure (20.3%), and syncope (14.1%). Those who were MACE+ more often had obstructive HCM (55.4% vs. 44.9%), hypertension (71.7% vs. 59.6%), and overweight/obesity (79.3% vs. 73.7%); (p<0.05 for all). There were no significant differences in presenting left ventricular (LV) ejection fraction, maximal LV wall thickness, or LV outflow tract gradients between the two groups. At the time of initial visit at a comprehensive HCM center, 11.6% of MACE+ were on no HCM-specific medications. Those who were MACE+ had more advanced New York Heart Association functional class (34.8% with class III/IV vs. 14.1%) and experienced a longer interval between HCM diagnosis and evaluation by an HCM specialist (1.5 years [IQR 0.2, 6.6] vs. 0.7 years [IQR 0.2, 3.8]; p=0.01).
Conclusions
In this cohort, patients who experienced HCM-related MACE prior to their first evaluation at a comprehensive HCM center carried a higher cardiometabolic comorbidity burden and were delayed in referral to an HCM specialist. Further research will analyze driving factors for these differences.