Background This study investigated the influence of African/Afro-Caribbean (black) ethnicity on the clinical profile and outcomes in hypertrophic cardiomyopathy (HCM).
Methods 425 consecutive patients with HCM (163 black and 262 Caucasians (white); mean age 52.5±16.6 years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6–12 months and mean follow-up was 4.3±3.0 years. The primary outcome was a composite of cardiovascular death, cardiac arrest or appropriate device therapy.
Results A fortuitous diagnosis of HCM was more commonly made in black compared with white patients (31.3% vs 19.1%, p=0.004). An abnormal ECG at presentation was more frequent in black patients (98.2% vs 90.5%, p=0.002), with T-wave inversion being a common feature (91.4% vs 73.0%, p<0.001). Asymmetric septal hypertrophy was the predominant pattern in both ethnic groups; however, apical (22.2% vs 10.7%, p<0.001) and concentric (9.3% vs 1.5%, p<0.001) patterns were more prevalent in black patients. Hypertension was more frequent in black patients (58.3% vs 31.7%, p<0.001). There were no ethnic differences in risk factor profile or primary outcome. Independent predictors of the primary outcome were non-sustained ventricular tachycardia (HR 6.03, 95% CI 3.06 to 11.91, p≤0.001) and hypertension at presentation (HR 2.02, 95% CI 1.05 to 3.88, p=0.036), with an additive effect.
Conclusion Black ethnicity is an important determinant of the phenotypic expression of HCM but does not adversely affect outcomes. Apical and concentric hypertrophy are common in black patients and may hinder the identification of HCM in this cohort. Hypertension has an adverse effect on outcome, irrespective of ethnicity.
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Contributors NS, MP and SS: study design, data collection and interpretation, quality control, statistical analysis, manuscript preparation and manuscript revision; VFP: data interpretation, quality control, statistical analysis, manuscript preparation and manuscript revision; KP, LM, PA, AZ, SG, MW, GC-W and ERB: data collection and interpretation, quality control and manuscript preparation; MTET: study design, data interpretation, quality control, statistical analysis, manuscript preparation and manuscript revision.
Funding NS, MP, KP, LM, AZ and SG were funded by research grants from the charitable organisation Cardiac Risk in the Young. NS, ERB and SS have also received research grants from the British Heart Foundation.
Competing interests None declared.
Ethics approval Ethical approval was granted by the local research ethics committee in accordance with the Declaration of Helsinki and patients provided oral consent for their anonymised data to be used for this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All additional unpublished information is kept on a secure server in the institution and only available to the first, second and senior authors of the manuscript.