Clinical and Morphologic Features of Hypertrophic Cardiomyopathy in Elderly Patients 85 Years or Older.

Abstract

We studied the distinctive morphology of the left ventricle (LV) and attempted to relate advanced age and hypertension to this characteristic feature in elderly patients with hypertrophic cardiomyopathy (HC). Fourteen elderly patients > or = 85 years old (mean age 90 +/- 5 years) with HC were compared with 45 young patients < or = 40 years (mean age 34 +/- 4 years) with this disease. More mild hypertension in the elderly (10/14, 71%) than in the young (0%), and more syncope in the young (10/45, 22%) than in the elderly (0%) were observed. Echocardiography showed that the elderly patients had relatively mild LV wall thickening, generally confined to the septum (elderly vs young: 18 +/- 4 vs 25 +/- 8 mm, p < 0.001), with more basal septal bulging (elderly vs young: 12/14, 86% vs 0%, p < 0.001) and anterior septal hypertrophy of LV (elderly vs young: 11/14, 79% vs 0%, p < 0.001). Elderly patients with mild hypertension showed a predominantly basal septal bulging (10/10, 100%) and anterior septal hypertrophy of LV (9/10, 90%). HC in elderly patients > or = 85 years old has a striking LV morphology. Mild hypertension and advanced age may contribute to the distinctive geometry.

Left Ventricular Regional Variations in Myosin Isoform Shift in Dahl Salt-Sensitive Hypertensive Rats.

“…Whether this decrease was due to a pressure difference or to other non-mechanical factors remains unknown. Aging may be a non-mechanical factor, because basal septal hypertrophy is enhanced, especially in elderly hypertensive patients (13,14). Cardiac angiotensin II is linked to the formation of pressure-overload hypertrophy (21).…”

“…After 2 or 4 weeks, the hearts were dissected and the LVs were separated into four parts (the base and mid- after blood pressure is controlled (12). Studies have confirmed this prominence of the basal septal hypertrophy in hypertensives, and especially in elderly hypertensives (13,14). These observations suggest that myocardial hypertrophy as a response to pressure overload may develop differently at individual regions of the left ventricle (LV).…”

The pathology of hypertrophic cardiomyopathy

“…In one study, the concentric pattern of hypertrophy was found to be more common in elderly patients with HCM, compared with younger subjects in whom asymmetrical hypertrophy was more prevalent 39 . However, other echocardiographic studies do not support these observations 40 . With both the symmetrical and asymmetrical forms of HCM, right ventricular involvement has been reported in 17.6% of cases 27 …”

Miocardiopatía hipertrófica obstructiva en una paciente octogenaria

“…Key features that distinguish HCM from hypertensive heart disease are the asymmetric distribution of the hypertrophy and left ventricular outflow tract (LVOT) obstruction. 6,15 Management options in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) are β-blockers, non-dihydropyridine calcium channel blockers, and disopyramide, alone or in combination. Hypertension is frequent as a comorbid condition in these types of patients, and many antihypertensive drugs are relatively contraindicated in HOCM because of the risk of decreased cardiac output, such as diuretics and vasodilators.…”