Massimiliano Lorenzini1,2, Zacharias Anastasiou3, Constantinos O'Mahony1, Oliver P Guttman1, Juan Ramon Gimeno4, Lorenzo Monserrat5, Aristides Anastasakis6, Claudio Rapezzi2, Elena Biagini2, Pablo Garcia-Pavia7,8,9, Giuseppe Limongelli10, Menelaos Pavlou3, Perry M Elliott1. 1. Barts Heart Centre, Institute for Cardiovascular Science, St Bartholomew's Hospital, University College London, London, United Kingdom. 2. Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy. 3. Department of Statistical Science, University College London, London, United Kingdom. 4. Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain. 5. Cardiology Department and Research Unit, A Coruña University Hospital, Galician Health Service, A Coruña, Spain. 6. Unit of Inherited Cardiovascular Diseases, First Department of Cardiology, University of Athens, Athens, Greece. 7. Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta del Hierro-Majadahonda, Madrid, Spain. 8. Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares, Madrid, Spain. 9. Facultad de Ciencias de la Salud, University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain. 10. Department of Cardiothoracic Sciences, Monaldi Hospital, AORN Colli, Università della Campania "Luigi Vanvitelli," Naples, Italy.
Abstract
Importance: It is unclear whether hypertrophic cardiomyopathy (HCM) conveys excess mortality when compared with the general population. Objective: To compare the survival of patients with HCM with that of the general European population. Design, Setting, and Participants: Retrospective cohort study of 4893 consecutive adult patients with HCM presenting at 7 European referral centers between 1980 and 2013. The data were analyzed between April 2018 and August 2019. Main Outcomes and Measures: Survival was compared using standardized mortality ratios (SMRs) calculated with data from Eurostat, stratified by study period, country, sex, and age, and using a composite end point in the HCM cohort of all-cause mortality, aborted sudden cardiac death, and heart transplant. Results: Of 4893 patients with HCM, 3126 (63.9%) were male, and the mean (SD) age at presentation was 49.2 (16.4) years. During a median follow-up of 6.2 years (interquartile range, 3.1-9.8 years), 721 patients (14.7%) reached the composite end point. Compared with the general population, patients with HCM had excess mortality throughout the age spectrum (SMR, 2.0, 95% CI, 1.48-2.63). Excess mortality was highest among patients presenting prior to the year 2000 but persisted in the cohort presenting between 2006 and 2013 (SMR, 1.84; 95% CI, 1.55-2.18). Women had higher excess mortality than men (SMR, 2.66; 95% CI, 2.38-2.97; vs SMR, 1.68; 95% CI, 1.52-1.85; P < .001). Conclusions and Relevance: Among patients referred to European specialty centers, HCM was associated with significant excess mortality through the life course. Although there have been improvements in survival with time, potentially reflecting improved treatments for HCM, these findings highlight the need for more research into the causes of excess mortality among patients with HCM and for better risk stratification.
Importance: It is unclear whether hypertrophic cardiomyopathy (HCM) conveys excess mortality when compared with the general population. Objective: To compare the survival of patients with HCM with that of the general European population. Design, Setting, and Participants: Retrospective cohort study of 4893 consecutive adult patients with HCM presenting at 7 European referral centers between 1980 and 2013. The data were analyzed between April 2018 and August 2019. Main Outcomes and Measures: Survival was compared using standardized mortality ratios (SMRs) calculated with data from Eurostat, stratified by study period, country, sex, and age, and using a composite end point in the HCM cohort of all-cause mortality, aborted sudden cardiac death, and heart transplant. Results: Of 4893 patients with HCM, 3126 (63.9%) were male, and the mean (SD) age at presentation was 49.2 (16.4) years. During a median follow-up of 6.2 years (interquartile range, 3.1-9.8 years), 721 patients (14.7%) reached the composite end point. Compared with the general population, patients with HCM had excess mortality throughout the age spectrum (SMR, 2.0, 95% CI, 1.48-2.63). Excess mortality was highest among patients presenting prior to the year 2000 but persisted in the cohort presenting between 2006 and 2013 (SMR, 1.84; 95% CI, 1.55-2.18). Women had higher excess mortality than men (SMR, 2.66; 95% CI, 2.38-2.97; vs SMR, 1.68; 95% CI, 1.52-1.85; P < .001). Conclusions and Relevance: Among patients referred to European specialty centers, HCM was associated with significant excess mortality through the life course. Although there have been improvements in survival with time, potentially reflecting improved treatments for HCM, these findings highlight the need for more research into the causes of excess mortality among patients with HCM and for better risk stratification.
Authors: Ella Field; Gabrielle Norrish; Vanessa Acquaah; Kathleen Dady; Marcos Nicolas Cicerchia; Juan Pablo Ochoa; Petros Syrris; Karen McLeod; Ruth McGowan; Hannah Fell; Luis R Lopes; Elena Cervi; Juan Pablo Pablo Kaski Journal: J Med Genet Date: 2021-08-16 Impact factor: 5.941