Abstract 14156: Risk Stratification and Outcome of Patients with Hypertrophic Cardiomyopathy Over 60 Years of Age: Does Age Count?
Background. Hypertrophic cardiomyopathy (HCM) is an unpredictable disease prominently associated with the risk for undesirable consequences, such as sudden death in young patients and competitive athletes. However, whether patients of advanced ages harbor a risk for sudden death similar to younger HCM patients is unresolved, often creating dilemmas in decision-making for primary prevention implantable defibrillators.
Methods. We studied 429 consecutive HCM patients presenting at age ≥ 60 years (range to 91), and followed for 5.2 ± 4.8 years; 53% were female and 55% had ≥1 conventional HCM sudden death risk factor.
Results. Of the 429 patients, 279 (65%) have survived to age 72 ± 7.4 year; 150 patients (35%) have died at 61 to 97 years of age (mean 80 ± 8), including 133 from non-cardiac or non-HCM causes, and 17 (4%) due to HCM (1.0%/year). Only 5 of these 17 patients (1.2% overall; 0.2%/year) had arrhythmia-related HCM sudden death events at ages 61-76 years, and in the absence of coronary artery disease. Of the 154 patients with contrast-CMR studies, 73 (47%) had late gadolinium enhancement (LGE) (i.e. presumed myocardial fibrosis), including 12% with diffuse/marked distribution ; 47 of the 73 patients with LGE (64%) had ≥ 1 risk factor for sudden death, and 2 of these patients died suddenly.
Conclusions. In HCM, advanced age is associated with a low risk for sudden death, even when conventional risk factors are present. Contrast-CMR detected myocardial fibrosis does not appear to be a risk marker in this age group. These data suggest that older age itself mediates risk in HCM, and therefore it may be unnecessary to aggressively promote prophylactic defibrillator implants for patients who have survived with clinical stability beyond 60 years of age.
- © 2011 by American Heart Association, Inc.