Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

Abstract

Aims: The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

Methods and results: 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

Conclusion: Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Keywords: Cardiovascular risk factors; Diabetes; Genotype; Hypertension; Hypertrophic cardiomyopathy; Obesity.

Figure 1

Associations of common cardiovascular risk factors with HCM phenotype. Up-arrows represent positive associations and down-arrows represent negative associations. HTN, hypertension; DM, diabetes mellitus; NYHA, New York Heart Association; AF, atrial fibrillation; LBBB, left bundle branch block; LVTOG, left ventricular outflow tract gradient; LVH, left ventricular hypertrophy; FHxSCD, family history of sudden cardiac death; VO2, maximal oxygen consumption on the CPET; LVEF, left ventricular ejection fraction; LGE, late gadolinium enhancement; VF, ventricular fibrillation; ICD, implantable cardioverter-defibrillator; ASA, alcohol septal ablation; LVEDD, left ventricular end-diastolic dimension; MLVWT, maximal left ventricular wall thickness; CMR, cardiac magnetic resonance; FS, fractional shortening.