Genotype-negative hypertrophic cardiomyopathy: Exploring the role of cardiovascular risk factors in disease expression
Stephan A C Schoonvelde, Edgar E. Nollet, Peter-Paul Zwetsloot, Christian Knackstedt, Tjeerd Germans, Alexander Hirsch, Arend F. L. Schinkel, Marjon A. van Slegtenhorst, Judith M.A. Verhagen, Rudolf A. de Boer, Jolanda van der Velden, Michelle Michels
Abstract
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disease. An inheritable cause is identified in approximately half of patients. Earlier research has identified clinical differences between genotype-positive (G+) and genotype-negative (G-) HCM patients, which this study aimed to further explore. METHODS AND RESULTS: Differences in baseline characteristics, including cardiovascular risk factors (CVRF), and phenotypical factors between G+ and G- patients were explored. Subanalyses among distinct age groups and sexes were performed. A total of 422 HCM (46 % G-, 54 % G+) patients were included. G- patients were older (62 vs 54 years, p < 0.001), experienced more limiting cardiac symptoms (47 % vs 28 %, p = 0.008), and more frequent left ventricular outflow tract obstruction (57 % vs 38 %, p < 0.001). CVRF were more prevalent in G- than in G+ HCM patients (70 % vs 41 %, p < 0.001), with hypertension being the most prevalent factor (51 % vs 22 %, p < 0.001). Despite adjusting for patient age, CVRF presence significantly predicted G- classification (OR 2.3, 95 %CI 1.5-3.6, p < 0.001). Female G- patients were less prevalent in younger age groups, and only in the older age group (>60 years) were female G- patients diagnosed later than their G+ counterparts. CONCLUSION: CVRF, particularly hypertension, are more prevalent in G- patients independent of age, suggesting that cardiovascular health may contribute to HCM disease development. Male-female differences suggest female-specific factors affecting the development of HCM in women. Recognizing G- HCM as a distinct clinical entity may have important implications for patient management, and a more comprehensive understanding of its aetiology may aid in tailoring future therapies.