Abstract 11952: Nonobstructive Hypertrophic Cardiomyopathy: Survival Analysis in Long-Term Follow-Up
Background: Nonobstructive hypertrophic cardiomyopathy (HCM) describes approximately 30% of all HCM cases and is known to portend better survival than obstructive HCM. However, survival of a large cohort with long-term follow-up compared to the general population has not been described.
Methods: Patients were identified retrospectively from our HCM database from April 1963 to September 2006. Their echocardiographic and clinical data were reviewed to confirm a diagnosis of nonobstructive HCM both at rest and with provocation. Survival status was ascertained by clinic visit, survey, or social security death index.
Results: 885 patients (60% male, median age at diagnosis 52 years) were identified with nonobstructive HCM based on echocardiographic and clinical data. Over a median follow-up of 10.7 years, there were 258 deaths (29%). Overall, the 20-year survival was no different than expected compared to age- and sex-matched white US population mortality rates (p=0.81). However, survival in women with nonobstructive HCM was worse than expected (p=0.008), and the odds of death for women was 1.9 times higher than for men (p≤0.0001). Women were significantly older at diagnosis (mean 52 versus 46 years, p ≤ 0.0001). NYHA class III/IV symptoms were present in 25% (220), and were more common in women (p = 0.003). Hypertension was present in 260 patients (30%), and was more prevalent in women (P≤0.001). However, the association between sex and death persisted, even after adjustment for age at diagnosis, NYHA class III/IV symptoms, and hypertension (adjusted odds ratio 1.7, p = 0.001).
Conclusions: Our 20-year follow-up of a large cohort of patients with nonobstructive HCM shows no difference in survival for males compared to age-and sex-matched white US population mortality rates. However, females with nonobstructive HCM demonstrate worse than expected survival. Furthermore, their survival is worse than men with nonobstructive HCM, even after adjusting for age at diagnosis, presence of NYHA class III/IV symptoms, and hypertension.
- © 2013 by American Heart Association, Inc.