Medical Care Center First Affiliated Hospital of Wenzhou Medical University Wenzhou China.
Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province Wenzhou Medical University Wenzhou China.
J Am Heart Assoc. 2024 Oct;13(19):e036663. doi: 10.1161/JAHA.124.036663. Epub 2024 Sep 18.
Apical hypertrophic cardiomyopathy (ApHCM) is a variant of hypertrophic cardiomyopathy, with distinct clinical characteristics and outcomes. We aimed to clarify the natural history of patients with ApHCM and identify the risk of end-stage heart failure incidence.
This retrospective study was conducted on patients with hypertrophic cardiomyopathy in China between January 2009 and February 2024. Patients were stratified into ApHCM and non-ApHCM groups. The primary outcome was a composite of major adverse cardiovascular events, including all-cause deaths, heart failure hospitalization, sudden cardiac death, and ventricular tachycardia. The secondary outcome was the incidence of end-stage heart failure, defined as left ventricular ejection fraction <50%. Kaplan-Meier and univariable and multivariable Cox proportional analyses were applied. Adjustment variables were included for important baseline characteristics, comorbidities, and medication use. Of 5653 patients enrolled with hypertrophic cardiomyopathy, 584 (10.3%) had ApHCM and 5069 (89.7%) had non-ApHCM. During the median follow-up period of 4.6 years (1.6-8.0 years), major adverse cardiovascular events occurred in 32.2% (n=1808), with a lower incidence in patients with ApHCM than non-ApHCM (20.4% versus 33.3%, <0.001). Non-ApHCM was an independent predictor of major adverse cardiovascular events (hazard ratio [HR], 1.65 [95% CI, 1.36-1.99]; <0.001). In the serial cohort, patients with ApHCM exhibited a lower incidence of end-stage heart failure than those with non-ApHCM (12.4% versus 2.7%, <0.001). Non-ApHCM was associated with a higher risk of end-stage heart failure development (HR, 2.31 [95% CI, 1.28-4.15]; <0.001). In subgroup and sensitivity analysis, the results were consistent for our main and secondary outcomes.
ApHCM is relatively common in hypertrophic cardiomyopathy and shows lower rates of all-cause mortality and heart failure hospitalizations than non-ApHCM.
心尖肥厚型心肌病（Apical hypertrophic cardiomyopathy，ApHCM）是肥厚型心肌病的一种变异型，具有独特的临床特征和结局。我们旨在阐明 ApHCM 患者的自然病史，并确定发生终末期心力衰竭的风险。
本回顾性研究纳入了 2009 年 1 月至 2024 年 2 月期间在中国就诊的肥厚型心肌病患者。患者被分为 ApHCM 和非 ApHCM 组。主要结局是主要不良心血管事件的复合结局，包括全因死亡、心力衰竭住院、心源性猝死和室性心动过速。次要结局是终末期心力衰竭的发生率，定义为左心室射血分数<50%。Kaplan-Meier 法和单变量及多变量 Cox 比例风险分析。调整变量包括重要的基线特征、合并症和药物使用。在纳入的 5653 例肥厚型心肌病患者中，584 例（10.3%）患有 ApHCM，5069 例（89.7%）患有非 ApHCM。在中位随访时间为 4.6 年（1.6-8.0 年）期间，主要不良心血管事件的发生率为 32.2%（n=1808），ApHCM 组的发生率低于非 ApHCM 组（20.4%与 33.3%，<0.001）。非 ApHCM 是主要不良心血管事件的独立预测因素（风险比[HR]，1.65[95%CI，1.36-1.99]；<0.001）。在连续队列中，ApHCM 组的终末期心力衰竭发生率低于非 ApHCM 组（12.4%与 2.7%，<0.001）。非 ApHCM 与终末期心力衰竭发展风险增加相关（HR，2.31[95%CI，1.28-4.15]；<0.001）。在亚组和敏感性分析中，我们的主要和次要结局的结果一致。
ApHCM 在肥厚型心肌病中较为常见，其全因死亡率和心力衰竭住院率低于非 ApHCM。
