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CLINICAL STUDY: HYPERTROPHIC CARDIOMYOPATHY

Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy

Barry J. Maron, MD, FACC^*,*, Iacopo Olivotto, MD, Pietro Bellone, MD, Maria Rosa Conte, MD, Franco Cecchi, MD, Björn P. Flygenring, MD, FACC^*, Susan A. Casey, RN^*, Thomas E. Gohman, BA^*, Sergio Bongioanni, MD and Paolo Spirito, MD, FACC^||

^* Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Ospedale di Careggi, Florence, Italy
Ospedale Santa Corona, Pietra Ligure, Italy
Ospedale di Rivoli, Turin, Italy
^|| Ente Ospedaliero Ospedali Galliera, Genoa, Italy

Manuscript received November 21, 2000; revised manuscript received September 25, 2001, accepted October 19, 2001.

^* Reprint requests and correspondence: Dr. Barry J. Maron, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 60, Minneapolis, Minnesota 55407, USA.
hcm.maron{at}mhif.org

OBJECTIVES: We sought to assess the occurrence and clinical significance of stroke and peripheral arterial embolizations at non-central nervous system sites in a large, community-based cohort with hypertrophic cardiomyopathy (HCM).

BACKGROUND: Such vascular events are insufficiently appreciated complications of HCM for which there is limited information on occurrence, clinical profile and determinants.

METHODS: We assessed the clinical features of patients with stroke and other peripheral vascular events in a consecutive group of patients with HCM from four regional cohorts not subject to significant tertiary referral bias.

RESULTS: Of the 900 patients, 51 (6%) patients experienced stroke or other vascular events over 7 ± 7 years, including 44 patients with stroke; 21 (41%) of these 51 patients died or were permanently disabled. The overall incidence was 0.8%/year and 1.9% for patients >60 years old. Age at first event ranged from 29 to 86 years (mean 61 ± 14 years). Most (n = 37; 72%) events occurred in those >50 years, although 14 (28%) younger patients (50 years) also had events. Multivariate analysis showed stroke and other peripheral vascular events to be independently associated with congestive symptoms and advanced age, as well as with atrial fibrillation (in 45 [88%] of 51 patients), at the initial evaluation. The cumulative incidence of these events among patients with atrial fibrillation was significantly higher in non-anticoagulated patients as compared with patients receiving warfarin (31% vs. 18%; p < 0.05).

CONCLUSIONS: Stroke and peripheral embolizations showed a 6% prevalence rate and an incidence of 0.8%/year in a large, unselected HCM group. These profound complications of HCM, which may lead to disability and death, were substantially more common in the elderly, occurred almost exclusively in patients with paroxysmal or chronic atrial fibrillation and appeared to be reduced in frequency by anticoagulation.

Abbreviations and Acronyms   AF   atrial fibrillation   CNS   central nervous system   HCM   hypertrophic cardiomyopathy   LV   left ventricular   NYHA   New York Heart Association   TIA   transient ischemic attack

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