Hispanic-Latino Race is Associated with Worse Heart Failure Symptoms in Patients with Hypertrophic Cardiomyopathy

Abstract

Background: Data regarding racial differences in patients with hypertrophic cardiomyopathy (HCM) is sparse. We hypothesized that Hispanic-Latino (HL), Non-Hispanic (NH), and African-American (AA) race impacts the clinical presentation of HCM. Methods: A total of 641 HCM patients (HL = 294, NH = 274, AA = 73) were identified retrospectively from our institutional registry between 2005–2021. Clinical characteristics, echocardiographic indices, and outcomes were assessed using analysis of variance, Kruskal-Wallis, and multivariate linear regression statistical analyses, with Dunn-Bonferroni and Tukey test applied in post-hoc pairwise assessments. Results: The HL and NH patients were older compared with AA (69.2 ± 14.7 vs 67.9 ± 15.3 vs 59.4 ± 15.8 years; p < 0.001). The HL group had higher prevalence of females compared with NH (62 vs 47%; p = 0.002), and more moderate-severe mitral regurgitation (35 vs 23 vs 12% p < 0.001) and a higher E/e’ ratio (16.4 ± 8.1 vs 14.9 ± 6.6 vs 13.3 ± 4.5; p = 0.002) when compared with NH and AA. Multivariate linear regression analysis revealed HL ethnicity (β = 0.1) was associated with worse New York Heart Association (NYHA) class independent from moderate-severe mitral regurgitation (β = 0.2), chronic obstructive pulmonary disease (β = 0.17), female gender (β = 0.13), coronary artery disease (β = 0.12), atrial fibrillation (β = 0.11), peak trans-mitral E-wave velocity (β = 0.11), left ventricular mass index (β = 0.1), and reverse septal curve morphology (β = 0.1) (model, r = 0.5, p < 0.001). At 2.5-year median follow-up, all-cause mortality (8%) and composite complications (33%) were similar across the cohort. Conclusions: HCM patients of HL race have worse heart failure symptoms when compared with NH and AA, with severity independent of cardiovascular co-morbidities.