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Risk Stratification and Outcome of Patients With Hypertrophic Cardiomyopathy ≥60 Years of Age
Study Questions:
Can we predict the clinical course and risk stratify patients ≥60 years of age with hypertrophic cardiomyopathy (HCM)?
Methods:
Two major centers analyzed databases of 428 HCM patients who were referred at age ≥60 years for evaluation, risk stratification, and clinical management. The diagnosis of HCM was based on echocardiography or cardiovascular magnetic resonance, which demonstrated left ventricular hypertrophy with a maximum wall thickness ≥15 mm, for which no other cause was identified.
Results:
Of the 428 patients, the mean age was 70 ± 7 years, with patients between ages 60 and 91 years; 53% were women. A total of 279 patients (65%) survived to 73 ± 7 years of age, and 149 (35%) died at 80 ± 8 years. Eighty-eight percent of patients had no symptoms, 48% of survivors had ≥1 sudden death risk factor, and 50 (37%) had late gadolinium enhancement. Only 16 patients (3.7%) had HCM-related mortality events. All-cause mortality was increased when compared to a matched US general population, mostly from non–HCM-related causes (p < 0.001; standard mortality ratio, 1.5). Coronary artery disease and cancer were the most common associated causes of death.
Conclusions:
Clinical markers that predict sudden death in younger HCM patients may not be as applicable for patients of advanced age. Patients of this age group are more likely to have other cardiac and noncardiac causes of mortality, thus questioning the utility of aggressive primary prevention implantable cardioverter-defibrillator (ICD) use in this patient population.
Perspective:
Often the focus of HCM involves risk stratification of the young and identifying factors that increase risk of sudden death in HCM. This data analysis demonstrates that patients with HCM who survive ≥60 years are at low risk of sudden death related to HCM. They are more likely to be affected by noncardiac comorbidities, where aggressive use of primary prevention ICD therapy may be uncertain.
Keywords: Uncertainty, Coronary Artery Disease, Neoplasms, Defibrillators, Gadolinium, Comorbidity, Risk Factors, Primary Prevention, Cause of Death, Biomarkers, Cardiomyopathies, Heart Failure, Hypertrophy, Magnetic Resonance Spectroscopy, Echocardiography
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