Risk stratification and outcome of patients with hypertrophic cardiomyopathy ≥60 years of age

摘要

Objectives: The purpose of this study was to describe the clinical course and risk stratifyolder patients with hypertrophic cardiomyopathy (HCM)who were more than 60 years of age. Background: Two major problems associated with HCM are risk for sudden death and disease progression. These are relatively well defined in young patients. Whether patients of more advanced age harbour similar risks is unresolved and often creates clinical dilemmas, particularly in decisions for primary prevention of sudden death with implantable defibrillators. Methods: Patients for this study were selected from databases of 2 large HCM centers in USA. Consecutively presenting patients with HCM who were >=60 years of age at first presentation to these centers were selected for this study. These patients were followed up by hospital visit or telephone contact. Results: 428 consecutive older HCM patients were followed for 5.8+/-4.8 years. Of these, 279 (65%) survived to 73+/-7 years of age, most with no/mild symptoms including 135 with >=1 conventional sudden death risk factors and 50 (37%) with late gadolinium enhancement.On followup, 149 (35%) died at 80+/-8 years of age, mostly from nonHCMrelated causes(n=133, 31%), including a substantial proportion from non-cardiac disease (n=54). Sixteen patients (3.7%) had HCMrelatedmortality events (0.64%/year), including embolic stroke (n=6), progressive heart failure or transplantation (n=3),postoperative complications (n=2), and arrhythmic sudden death events (n=5, 1.2% [0.20%/year]). All-cause mortality wasincreased in HCM patients >=60 years of age compared with an age-matched US general population, predominantly as aresult of non-HCM-related diseases (P<0.001; standard mortality ratio, 1.5). Conclusions: HCM patients surviving into the seventh decade of life are at low risk for disease-related morbidity, mortality and sudden death, even in presence of conventional risk factors. Other cardiac or non-cardiac comorbidities have a greater impact on survival than HCM in older patients.