Risk Stratification and Outcome of Patients With Hypertrophic Cardiomyopathy ≥60 Years of Age

• DOI: 10.1161/circulationaha.112.136085
• Publication Date: 2012-12-31T01:12:38Z
• Authors: Barry J. Maron; Ethan J. Rowin; Susan A. Casey; Tammy S. Haas; Raymond H.M. Chan; James E. Udelson; Ross F. Garberich; John R. Lesser; Evan Appelbaum; Warren J. Manning; Martin S. Maron
• Keywords: Sudden Death; Stroke

Background— Hypertrophic cardiomyopathy (HCM) is prominently associated with risk for sudden death and disease progression, largely in young patients. Whether patients of more advanced age harbor similar risks unresolved, often creating clinical dilemmas, particularly decisions primary prevention implantable defibrillators. Methods Results— We studied 428 consecutive HCM presenting at ≥60 years followed 5.8±4.8 years; 53% were women. Of the patients, 279 (65%) survived to 73±7 (range, 61–96 years), most (n=245, 88%) no/mild symptoms, including 135 ≥1 conventional factors 50 (37%) late gadolinium enhancement. Over follow-up, 149 (35%) died 80±8 age, mostly from non–HCM-related causes (n=133, 31%), a substantial proportion noncardiac (n=54). Sixteen (3.7%) had HCM-related mortality events (0.64%/y), embolic stroke (n=6), progressive heart failure or transplantation (n=3), postoperative complications (n=2), arrhythmic (n=5, 1.2% [0.20%/y]). All-cause was increased compared an age-matched US general population, predominantly as result diseases ( P <0.001; standard ratio, 1.5). Conclusions— surviving into seventh decade life are low disease-related morbidity/mortality, death, even factors. These data do not support aggressive prophylactic defibrillator implantation ages HCM. Other cardiac comorbidities have greater impact on survival than older