Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape.

Abstract

The striking clinical and pathologic features of hypertrophic cardiomyopathy have been defined almost exclusively in the young. Little is known about this condition in the elderly, although it is assumed to be part of a single disease. Accordingly, we studied 28 patients who were 65 years of age and older (mean age, 72±6.4 years) who were diagnosed as having hypertrophic cardiomyopathy by M-mode, two-dimensional, and Doppler echocardiography and compared them with a group of 28 consecutive patients with this disease who were younger than 40 years of age (mean age, 26±9.5 years). No clinically detectable differences existed between the two groups, except for an increased incidence of mild hypertension in the elderly. Echocardiography in both groups showed hypertrophy with a small left ventricular cavity, and Doppler outflow tract velocity or cardiac catheterization in most patients showed systolic anterior motion of the mitral valve or a systolic outflow tract gradient or both. Significant differences existed between both groups, however, concerning left ventricular size and shape. The elderly group had a predominantly ovoid cavity contour with normal septal curvature. In contrast, in the young group, a markedly abnormal cardiac shape predominated (p<0.0001) with a crescent-shaped left ventricular cavity and a reversed curvature of the interventricular septum. The right ventricular free wall was prominent by echocardiography in the young compared with the elderly group (p<0.001). Apart from a more frequent history of mild hypertension in the elderly, likely related to age, these findings show that hypertrophic cardiomyopathy, when present in the elderly, has similar clinical features to that in the young. However, the elderly had a strikingly different and generally undetected cardiac shape by echocardiography, supporting the notion that hypertrophic cardiomyopathy in the elderly may be a disease distinctively diferent from that which predominates in the young. (Circulation 1989;79:580-589

Gender Differences in the Presentation of Adult Obstructive Hypertrophic Cardiomyopathy With Resting Gradient

“…14,15 Our study results of significantly more SAM in male than female patients (78.3 vs 47.4%, p=0.0008) can be accounted for, at least in part, by the age differential between the present male and female patients. After adjustment for age, we found that the difference in the prevalence of SAM became marginally significant (p=0.0670).…”

“…13 Our results are also consistent with other published studies, which demonstrated statistically significant thicker IVS and LVPW in youthful patients with HCM than in the elderly. 14,15 In fact, after adjustment for age, we found that the difference in IVSt became statistically insignificant (p=0.1948).…”

“…As listed in Table 3, most published reports on HCM showed a male predominance (>50%) in the young population (mean age <55 years) 2-4,32-38 and a female predominance in the elderly population (mean age >55 years), 28,39,40 as demonstrated in Fig 1. And, as listed in Table 4, women appear to present with HCM 5-15 years later than their male counterparts. 1,12,14,41 In other studies, it was found that HCM in the elderly appeared to be a subset with distinctive left ventricular morphology and female predominance. They have a relatively small heart, an ovoid left ventricular cavity contour, a reduced left ventricular outflow tract, anterior displacement of the mitral valve and sizable deposits of calcium in the region of the mitral annulus.…”

Morphologic Characteristics of Hypertrophic Cardiomyopathy of the Elderly With Cardiac Myosin-Binding Protein C Gene Mutations

“…5,[12][13][14] They reportedly show more predominantly an ovoid LV cavity contour with normal septal curvature, a proximal septal bulge, and mitral 12 In addition, the prevalence of a proximal septal bulge and mitral annular calcification was higher in the elderly patients than that in the young patients. Lewis et al reported that obstruction in the small LVOT was frequent in the elderly, in addition to an ovoid-shaped LV cavity.…”

“…Wigle score was also calculated as previously reported. 19 Furthermore, we studied the morphologic features according to the report by Lever et al 12 In brief, (1) septal curvature was evaluated in the apical 4-chamber view (Fig 1). An abnormal convexity of the septum toward the LV cavity was defined as reversed septal curvature, which produced a crescent-shaped LV cavity.…”