Hypercontractile phenotype in hypertrophic cardiomyopathy indicates unfavorable hemodynamics, coronary flow and prognosis.
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Authors
WierzbowskaDrabik K.
Palinkas E.D.
D'Alfonso M.G.
Mori F.
Del Franco A.
Vazquez J.P.
Re F.
Tesic M.
DjordjevicDikic A.
Palinkas A.
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Issue Date
2025
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Article
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Aims Our aim was to assess the clinical and prognostic significance of the left ventricular (LV) hypercontractile phenotype (HP) in hypertrophic cardiomyopathy (HCM), which until now remains unclear. Methods and results We enrolled 1533 HCM patients (age 51 +/- 15 years, 965 males, 63%) with ejection fraction (EF) >= 50%, referred for rest transthoracic echocardiography (TTE) in 27 laboratories from 13 countries. Two-dimensional volumetric TTE assessment included LV outflow tract gradient (LVOTG), LV EF, and LV force (systolic blood pressure + LVOTG/ESV, mmHg/mL). HP was defined as the highest quartile of the force (> 7.32 mmHg/mL). Survival analysis was performed in a subset of 1200 patients with follow-up information. Compared with non-HP patients, HP showed higher heart rate (72 +/- 14 vs. 67 +/- 14 beats per minute, P 2, P = 0.011) and higher coronary flow velocity in the mid-distal left anterior descending artery (n = 325, 41 +/- 12 vs. 37 +/- 14 cm/s, P = 0.021). Force was moderately related to LV EF (r = 0.48, P , P = 0.011) and higher coronary flow velocity in the mid-distal left anterior descending artery (n = 325, 41 +/- 12 vs. 37 +/- 14 cm/s, P = 0.021). Force was moderately related to LV EF (r = 0.48, P 7.32 mmHg (the fourth quartile for analyzed patients) was associated with a hazard ratio of 1.44 (95% Confidence intervals 1.00-2.07) for all-cause death, independently of LVOTG and LV EF. Conclusion HP in HCM is associated with a disadvantageous systemic, cardiac and coronary hemodynamic profile as well as lower survival in the long-term. Copyright © 2025 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site - for further information please contact journals.permissions@oup.com.
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European Heart Journal Cardiovascular Imaging
Volume
26
Issue
19