Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK

Nabeel Sheikh, Michael Papadakis, Vasileios F. Panoulas, Keerthi Prakash, Lynne Millar, Paolo Adami, Abbas Zaidi, Sabiha Gati, Mathew Wilson, Gerald Carr-White, Maria Teresa Esteban Tomé, Elijah R. Behr, Sanjay Sharma

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Abstract

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±16.6â .years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6-12 months and mean follow-up was 4.3±3.0years. 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.

Original languageEnglish
Pages (from-to)1797-1804
Number of pages8
JournalHeart
Volume102
Issue number22
DOIs
Publication statusPublished - 15 Nov 2016
Externally publishedYes

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Hypertrophic Cardiomyopathy
Hypertension
Hypertrophy
Ventricular Tachycardia
Heart Arrest
Cardiomyopathies
Ethnic Groups
Electrocardiography
Equipment and Supplies

Cite this

Sheikh, N., Papadakis, M., Panoulas, V. F., Prakash, K., Millar, L., Adami, P., ... Sharma, S. (2016). Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK. Heart, 102(22), 1797-1804. https://doi.org/10.1136/heartjnl-2016-309843
Sheikh, Nabeel ; Papadakis, Michael ; Panoulas, Vasileios F. ; Prakash, Keerthi ; Millar, Lynne ; Adami, Paolo ; Zaidi, Abbas ; Gati, Sabiha ; Wilson, Mathew ; Carr-White, Gerald ; Tomé, Maria Teresa Esteban ; Behr, Elijah R. ; Sharma, Sanjay. / Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK. In: Heart. 2016 ; Vol. 102, No. 22. pp. 1797-1804.
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abstract = "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{\^a} .years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6-12 months and mean follow-up was 4.3±3.0years. 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.",
author = "Nabeel Sheikh and Michael Papadakis and Panoulas, {Vasileios F.} and Keerthi Prakash and Lynne Millar and Paolo Adami and Abbas Zaidi and Sabiha Gati and Mathew Wilson and Gerald Carr-White and Tom{\'e}, {Maria Teresa Esteban} and Behr, {Elijah R.} and Sanjay Sharma",
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Sheikh, N, Papadakis, M, Panoulas, VF, Prakash, K, Millar, L, Adami, P, Zaidi, A, Gati, S, Wilson, M, Carr-White, G, Tomé, MTE, Behr, ER & Sharma, S 2016, 'Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK', Heart, vol. 102, no. 22, pp. 1797-1804. https://doi.org/10.1136/heartjnl-2016-309843

Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK. / Sheikh, Nabeel; Papadakis, Michael; Panoulas, Vasileios F.; Prakash, Keerthi; Millar, Lynne; Adami, Paolo; Zaidi, Abbas; Gati, Sabiha; Wilson, Mathew; Carr-White, Gerald; Tomé, Maria Teresa Esteban; Behr, Elijah R.; Sharma, Sanjay.

In: Heart, Vol. 102, No. 22, 15.11.2016, p. 1797-1804.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK

AU - Sheikh, Nabeel

AU - Papadakis, Michael

AU - Panoulas, Vasileios F.

AU - Prakash, Keerthi

AU - Millar, Lynne

AU - Adami, Paolo

AU - Zaidi, Abbas

AU - Gati, Sabiha

AU - Wilson, Mathew

AU - Carr-White, Gerald

AU - Tomé, Maria Teresa Esteban

AU - Behr, Elijah R.

AU - Sharma, Sanjay

PY - 2016/11/15

Y1 - 2016/11/15

N2 - 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±16.6â .years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6-12 months and mean follow-up was 4.3±3.0years. 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.

AB - 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±16.6â .years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6-12 months and mean follow-up was 4.3±3.0years. 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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U2 - 10.1136/heartjnl-2016-309843

DO - 10.1136/heartjnl-2016-309843

M3 - Article

VL - 102

SP - 1797

EP - 1804

JO - British Heart Journal

JF - British Heart Journal

SN - 1355-6037

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Sheikh N, Papadakis M, Panoulas VF, Prakash K, Millar L, Adami P et al. Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK. Heart. 2016 Nov 15;102(22):1797-1804. https://doi.org/10.1136/heartjnl-2016-309843