Introduction:
Hypertrophic cardiomyopathy (HCM) can lead to heart failure with preserved ejection fraction (HFpEF) due to left ventricular outflow tract obstruction (LVOTO). Septal myectomy can relieve LVOTO leading to resolution of HFpEF. However, some patients have persistent HFpEF even after myectomy without LVOTO. We aimed to characterize HCM patients with HFpEF post myectomy compared to those without HFpEF post myectomy and those with HFpEF and non-obstructive HCM.
Hypothesis:
There are distinct features of HCM patients with HFpEF after myectomy, no HFpEF after myectomy, and non-obstructive HCM with HFpEF.
Methods:
In this retrospective study, patients over age 18 were screened for HCM diagnosis between years 2003 and 2020, HCM was confirmed with echocardiogram and chart review. HFpEF was defined as use of loop diuretic for decongestion, with a left ventricular ejection fraction 50% or greater. Patients with septal myectomy were identified. Analysis of variance and chi-squared tests were performed.
Results:
Of 2571 patients with HCM diagnosis, there were 194 patients with HCM and HFpEF, 27 patients had HFpEF after myectomy (30%) compared to 61 patients without HFpEF after myectomy. 106 patients had nonobstructive HCM with HFpEF. A significant number of patients identifying as black or African American were in the nonobstructive HFpEF group. Hypertension was more prevalent in those with HFpEF after myectomy and non-obstructive HCM with HFpEF. Stroke was increased in the non-obstructive HCM with HFpEF (Table).
Conclusions:
30% of HCM patients develop HFpEF post myectomy, with a higher incidence of hypertension compared to those without HFpEF. Non-obstructive HCM patients, more frequently black and African American, had higher rates of hypertension and diabetes, and higher risk of ischemic stroke and mortality. These phenotypes of HCM represent an important area of investigation to assess risk for stroke and development of HFpEF after myectomy.
078 Apical Myomectomy for Management of Heart Failure With Preserved Ejection Fraction in the Context of Apical Hypertrophic Cardiomyopathy
