Regular paper
Relation of left ventricular thickness to age and gender in hypertrophic cardiomyopathy

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Abstract

Left ventricular (LV) wall thickening is the most consistent clinical marker of hypertrophic cardiomyopathy (HC), and characteristically increases substantially during adolescence. In this study, we used 2-dimensional echocardiography to develop a cross-sectional profile of LV wall thicknesses in adult patients with HC. We studied a regional community-based cohort of 239 consecutively enrolled patients (aged 18 to 91 years). On average, maximum LV wall thickness decreased relative to increasing age (p = 0.007) within 4 age groups: 22.8 ± 5.1 mm (18 to 39 years) to 22.1 ± 5.1 mm (40 to 59 years) to 21.1 ± 3.7 mm (60 to 74 years) to 20.8 ± 3.6 mm (≥75 years). The LV thickness index (summation of wall thicknesses in all 4 segments) also decreased with age (p = 0.017): 63.0 ± 12.2 mm to 59.8 ± 11.9 mm to 58.3 ± 10.4 mm to 57.9 ± 9.8 mm. Decreasing magnitude of LV hypertrophy was independently associated with increasing age, but not with other relevant disease variables, such as symptoms and outflow obstruction. However, when separated by gender, this inverse relation between age and LV wall thickness was statistically significant only for women (p = 0.007). In conclusion, in an unselected HC cohort, cross-sectional analysis showed a modest but statistically significant inverse relation between age and LV hypertrophy that was largely gender-specific for women. This association constitutes another facet of the natural history of this complex and heterogenous disease and may reflect disproportionate occurrence of premature death in young patients with HC with marked hypertrophy or possibly gradual LV remodeling.

Section snippets

Selection of patients

The present study population was comprised of 239 consecutively enrolled adult patients with HC who were evaluated at the Minneapolis Heart Institute from 1981 to 2000, and who met the following criteria: (1) a technically satisfactory 2-dimensional echocardiogram at or near study entry, to permit reliable identification of the distribution and extent of LV hypertrophy9, 11, 25, 26; and (2) ≥18 years of age at initial echocardiographic study.

Diagnosis of HC was made by echocardiography based on

Relation between age and extent of left ventricular hypertrophy

In the overall study group of 239 patients, an inverse relation was identified between age and both maximal LV wall thickness (r = −0.17; p = 0.007) and the calculated LV wall thickness index (r = −0.16; p = 0.017) (i.e., both measures of LV hypertrophy decreased progressively with greater patient age) (TABLE 1, TABLE 2).

Maximal LV wall thickness and the wall thickness index were significantly higher in the youngest age subgroup (18 to 39 years) compared with the oldest patient subgroup (≥75

Discussion

The present cross-sectional study in a large regional and unselected adult HC population establishes a modest but statistically significant inverse relation between age and LV wall thickness, and underscores the important principle in HC that LV hypertrophy is a dynamic (i.e., not static) feature of the disease. Younger adults showed substantially more severe (and diffuse) LV hypertrophy than older patients, as evidenced by maximal wall thickness as well as the wall thickness index (a measure

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