Concomitant hypertension in hypertrophic cardiomyopathy: clinical phenotype and prognostic associations of cardiovascular magnetic resonance biomarkers

AIMS: To characterize the cardiovascular magnetic resonance (CMR) phenotype of hypertensive hypertrophic cardiomyopathy (HCM) patients, assess the association between hypertension and all-cause mortality, and compare the long-term prognostic performance of CMR-derived biomarkers between hypertensive versus non-hypertensive HCM patients. METHODS: Between 2008 and 2024, all consecutive HCM patients referred for CMR from the HCM-LGE registry were included. The primary outcome was all-cause mortality. Clinical variables, cardiac volumes, myocardial mass, functions and tissue characterization with late gadolinium enhancement (LGE) were assessed in all patients. The prognostic value of hypertension and CMR-derived biomarkers were assessed using survival analysis. RESULTS: Among 2,873 patients with HCM (52±8 years, 56% males), 796 (28%) had hypertension. Hypertensive HCM patients had greater LGE extent (1.1±1.8 vs 0.9±1.5, p<0.001), more LGE multiple locations (17% vs 11%, p<0.001), more midwall LGE (35% vs 28%, p=0.001). After propensity score matching 1:1, survival curves showed an increased risk of all-cause mortality for hypertensive HCM patients at median 9 year-follow up (HR: 1.32 [95% CI: 1.04-1.69]; log-rank p=0.024). High LGE extent >3 segments and septal location of LGE were independently associated with mortality in hypertensive HCM patients (HR: 3.99 [95%CI: 2.21-7.18]; p=<0.001 and HR: 1.76 [95%CI: 1.03-3.01]; p=0.039, respectively) and non-hypertensive HCM patients (HR: 4.63 [95%CI: 2.15-9.97]; p<0.001 and HR: 1.48 [95%CI: 1.02-2.15]; p=0.040, respectively). CONCLUSION: In a large multicenter cohort of HCM patients, concomitant hypertension was associated with increased long-term mortality and prognostic associations of CMR-LGE biomarkers were found. These findings highlight the importance of comprehensive cardiovascular risk assessment in HCM patients.