Long-Term Left Ventricular Remodeling of Patients With Hypertrophic Cardiomyopathy

Maria Beatrice Musumeci, Domitilla Russo, Luca Rosario Limite, Marco Canepa, Giacomo Tini, Matteo Casenghi, Pietro Francia, Carmen Adduci, Erika Pagannone, Damiano Magrì, Massimo Volpe, Camillo Autore

Research output: Contribution to journalArticle

Abstract

In hypertrophic cardiomyopathy (HC), a process of left ventricular (LV) remodeling carrying an adverse prognosis has been described. Conversely, a gradual and benign LV wall thinning has been suggested but never investigated. Therefore, we studied a HC cohort over a long period of time to evaluate the occurrence of a LV remodeling with a benign clinical course. Data of HC patients aged 18 to 65 years and without any condition known to influence LV remodeling were analyzed over a mean follow-up of 7.6 ± 5.7 years. Of 231 HC patients (65% males, mean age 46 ± 12 years), 47 (20%) developed LV remodeling, of whom 23 (10%) had a thinning ≥15% of LV maximal wall thickness from baseline without systolic dysfunction (MWT thinning); 13 (6%) progressed to a LV ejection fraction <50% (end-stage HC) and 11 (5%) developed an apical aneurysm. Follow-up length (odds ratio 1.07, 95% confidence interval 1.00 to 1.15, p = 0.06) and maximal LV wall thickness at baseline (odds ratio 1.14, 95% confidence interval 1.04 to 1.25, p = 0.004) were the main predictors of MWT thinning. Compared with patients with end-stage HC and apical aneurysm, those with MWT thinning showed lower HC-related morbidity (92% and 36% vs 22%, p = 0.003) and mortality (31% and 27% vs 4%, p = 0.02). Furthermore, they showed a combined HC-related morbidity and mortality similar to patients without LV remodeling (incidence 29/1000 vs 26/1000 patient-year, p = 0.77). In conclusion, a process of LV wall thinning with a benign outcome can occur over the long term in patients with HC. The prognostic importance of LV remodeling varies in relation to the different changes in LV morphology and function.

Original languageEnglish
Pages (from-to)1924-1931
Number of pages8
JournalThe American Journal of Cardiology
Volume122
Issue number11
DOIs
Publication statusPublished - Dec 1 2018

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    Musumeci, M. B., Russo, D., Limite, L. R., Canepa, M., Tini, G., Casenghi, M., Francia, P., Adduci, C., Pagannone, E., Magrì, D., Volpe, M., & Autore, C. (2018). Long-Term Left Ventricular Remodeling of Patients With Hypertrophic Cardiomyopathy. The American Journal of Cardiology, 122(11), 1924-1931. https://doi.org/10.1016/j.amjcard.2018.08.041