Heart failure & cardiomyopathies
Clinical Course and Treatment of Patients With Apical Aneurysms Due to Hypertrophic Cardiomyopathy
Authors' conclusion
Risk factors and aneurysm size were associated with subsequent VT, VF, or SCD. Patients with aneurysms in the lowest tercile of size have a low cumulative 5-year risk. Clinical AF occurred frequently. Stroke prevalence in absence of known stroke etiologies is uncommon and comparable to risk of severe bleeding.
Study context
- Population
- Patients with apical aneurysms due to hypertrophic cardiomyopathy (age 57.4 ± 13.5 years, 37% female)
- Participants
- 108 patients3 hypertrophic cardiomyopathy (HCM) centres
- Exposure
- Patients with vs without AHA/ACC risk factors; aneurysm size terciles
- Outcome
- Lethal and potentially lethal arrhythmias (VT, VF or SCD)
- Follow-up
- Median 5.9 (IQR: 3.7-10.0) years
Methodological detailsmulticentre (3 HCM centres)
- Multicentre (3 HCM centres)
Main finding
As reported in the abstract
VT, VF or SCD
| Outcome | Risk factor | No risk factor | Upper tercile | Lower tercile | P value |
|---|---|---|---|---|---|
| VT, VF or SCD | 55% | 10% | |||
| 5-year cumulative risk | — not stated in the abstract | — not stated in the abstract | 35% | 6% | P = 0.0046 |
— not stated in the abstract
- Risk factor vs No risk factor: P < 0.001
- Aneurysms <2 cm² and no risk factors: Ventricular tachycardia (VT), ventricular fibrillation (VF) or sudden cardiac death (SCD)
- 2.5%
Observational data: associations, not effects.
Further findings
ICD discharges or SCD
- ICD discharges or SCD (whole cohort)
- 21 (19.4%)
Clinical atrial fibrillation (AF)
- Clinical AF (whole cohort)
- 49 (45%)
Stroke without conventional cause
- Incidence
- 0.5%/year
- Stroke commonly associated with AF
Treatment
- Surgery (19%) effective in reducing symptoms
- VT ablation and surgery moderately effective in preventing recurrent VT
Original publication
Clinical Course and Treatment of Patients With Apical Aneurysms Due to Hypertrophic Cardiomyopathy. JACC Adv. Published 27 August 2024. doi:10.
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