The impact of diabetes mellitus on the clinical phenotype of hypertrophic cardiomyopathy

Abstract

Aims Diabetes mellitus (DM) aggravates the clinical features of ischaemic and hypertensive heart diseases and worsens the prognosis of heart failure patients. Hypertrophic cardiomyopathy (HCM) and diabetes coexist fairly frequently in elderly patients but the impact of DM on the clinical phenotype of HCM is yet unknown. We sought to describe if predominant features of heart failure in DM patients exist independently in HCM. Methods and results We reviewed clinical characteristics of 937 patients, age ≥40, diagnosed with HCM, from two tertiary medical centres in Spain and Israel. A propensity score matched cohort of 294 patients was also analysed. Our cohort comprised 102 HCM patients with diabetes (8.7%). Patients with DM were older at diagnosis {median 56 [interquartile range (IQR) 47–67] vs. 53 (IQR 43–63), P = 0.02} and had a higher prevalence of comorbidities. Hypertrophic cardiomyopathy patients with DM had a higher prevalence of diastolic dysfunction, pulmonary hypertension, significant mitral regurgitation, and pacemaker implantation. Hypertrophic cardiomyopathy patients with DM had a higher New York Heart Association (NYHA) class (P < 0.001) and lower exercise capacity [7.0 METS (IQR 5.0–10.0) vs. 9.0 METS (IQR 6.6–11.0), P = 0.002]. These findings were independent of age, gender, country of origin, hypertension, and coronary artery disease. Patients with diabetes had a significantly higher 15-year mortality (22% vs. 15%, P = 0.03), with no differences in sudden cardiac death, appropriate implanted cardioverter-defibrillator therapy, or heart transplantation. Conclusion Hypertrophic cardiomyopathy patients with diabetes are older and have a higher cardiovascular risk profile. They have a lower functional capacity and more heart failure symptoms due to diastolic dysfunction.

Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

“…In the present study, LGE positive patients had a trend towards a higher prevalence of diabetes mellitus than in LGE negative patients. The presence of diabetes may have an impact on the features of HCM because of diabetes is correlated with higher degrees of diastolic dysfunction 37 . In addition, LGE negative patients had the highest heart rate among the groups.…”

Impact of type 2 diabetes mellitus on mid-term mortality for hypertrophic cardiomyopathy patients who underwent septal myectomy

“…Recently, one study reported the impact of DM on the clinical phenotype of HCM [3]. They showed that HCM patients with diabetes have a higher cardiovascular risk profile, a lower functional capacity, and more heart failure symptoms.…”

“…Diabetes mellitus (DM) is highly common among patients with cardiovascular disease and is associated with increased burden of morbidity and hospitalization [3]. The functional changes occurring in DM can significantly alter the hemodynamic stress on the heart.…”

Adiponectin receptor 1 variants contribute to hypertrophic cardiomyopathy that can be reversed by rapamycin

“…HCM is predominantly caused by mutations in sarcomeric protein-encoding genes, most frequently in myosin binding protein C3 (MYBPC3) or -myosin heavy chain 7 (MYH7) (1)(2)(3)(4)(5). Notably, 30 to 40% of patients with HCM are negative for sarcomeric genes and exhibit HCM with unknown causes (1)(2)(3)(4). Recent emerging evidence suggests that ~10% of HCM cases coexist with diabetes mellitus in the absence of hypertension and obesity (3).…”

“…Notably, 30 to 40% of patients with HCM are negative for sarcomeric genes and exhibit HCM with unknown causes (1)(2)(3)(4). Recent emerging evidence suggests that ~10% of HCM cases coexist with diabetes mellitus in the absence of hypertension and obesity (3).…”