Hypertrophic Cardiomyopathy in Greece

Clinical Course and Outcome

¹ From the Department of Cardiology, Hippokration Hospital, Athens, Greece
² From the Department of Cardiac Surgery, Hippokration Hospital, Athens, Greece
³ From the State Cardiac Department, Hippokration Hospital, Athens, Greece

Michael Kyriakidis, MD, Department of Cardiology, Laiko Hospital of Athens, 17 Agiou Thoma St, Goudi 115 27, Athens, Greece

Objective: Evaluation of clinical course and outcome of hypertrophic cardiomyopathy in a representative Greek population.

Background: Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy and varied clinical expression. Recent studies suggest ethnic differences.

Materials and methods: One hundred seventy-four consecutive Greek patients (117 male, 57 female, age 47 ± 16 years) from 143 different families were assessed at the Department of Cardiology of the University of Athens, Greece, and the State Cardiac Department, Hippokration Hospital, both located in Athens, Greece. To reduce selection bias, referral was based on disease diagnosis irrespective of clinical status or treatment needs. All patients were examined clinically, echocardiographically, and by ECG ambulatory monitoring at 6-month intervals for a period of 74 ± 22 months (range, 8 to 108 months).

Results: Most patients (n = 156, 89.7%) were in New York Heart Association (NYHA) functional class I or II. The disease was familial (at least one affected first-degree relative) in 81 of the 143 families (56.6%), and in 19 of these (13.3%) there was familial history of sudden cardiac death. At initial examination, intraventricular septal thickness was 17.3 ± 4.1 mm and posterior wall thickness was 13.7 ± 3.8 mm and a left ventricular outflow gradient > 30 mm Hg was present in 58 patients (33.3%). Similar were the findings during the last examination (17.5 ± 4.3 mm, 13.5 ± 4.4 mm, and 56 (32.2%, respectively, p = not significant). Episodes of nonsustained ventricular tachycardia were noted in 15 patients (8.6%). There were eight deaths during follow-up: four sudden deaths and four from intractable heart failure. Syncope was reported by all patients who died. The annual mortality in this study was 1%. Syncope and NYHA class were the only predictors of outcome.

Conclusions: In this representative Greek patient cohort with hypertrophic cardiomyopathy, the arrhythmogenic substrate was modest and the clinical course benign. Sudden cardiac death was infrequent and syncope, functional class, and ventricular arrhythmias were the only predictors of a poor outcome.

Key Words: Greece • hypertrophic cardiomyopathy

Submitted on November 3, 1997
Accepted on March 16, 1998

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