To date, there has not been a large systematic examination of the hypertrophic cardiomyopathy
(HC) phenotype in blacks versus whites. In this study, we investigate differences
in presentation of HC between blacks and whites. We included 441 consecutive patients
with HC seen at the Johns Hopkins HC clinic in the period from February 2005 to June
2012. We compared 76 blacks for clinical presentation, electrocardiogram, exercise
capacity, left ventricular morphology, and hemodynamics by echocardiography to 365
whites. Black patients with HC more often presented with abnormal electrocardiogram
(93% vs 80%, p = 0.009), driven by a significant difference in repolarization abnormalities
(79% vs 56%, p <0.001). Apical hypertrophy was more common in blacks (26% vs 9%, p
<0.001); however, blacks had less severe systolic anterior movement of the mitral
valve and had significantly lower left ventricular outflow tract gradients at rest
(9 mm Hg; interquartile range [IQR] 7 to 19 vs 16 mm Hg; IQR 8 to 40, p <0.001) and
during provocation (36 mm Hg; IQR 16 to 77 vs 59 mm Hg; IQR 26 to 110, p = 0.002).
Despite the nonobstructive pathophysiology, blacks had lower exercise capacity (adjusted
difference 1.45 metabolic equivalents [0.45 to 2.45], p = 0.005). In conclusion, blacks
have an HC phenotype characterized by lower prevalence of the well-recognized echocardiographic
features of HC such as systolic anterior movement of the mitral valve and left ventricular
outflow tract obstruction and display worse exercise capacity.
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Article info
Publication history
Published online: March 19, 2016
Accepted:
March 10,
2016
Received in revised form:
March 10,
2016
Received:
January 7,
2016
Footnotes
See page 1819 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
