Conference Coverage

Heart Failure Affects One-Third of Patients with Hypertrophic Cardiomyopathy, Women at Highest Risk

Anthony Calabro, MA

Key Highlights

  • 31% of patients with hypertrophic cardiomyopathy (HCM) met the criteria for heart failure.
  • Prevalence varied by subtype: 41% in obstructive, 26% in non-obstructive with preserved left ventricular ejection fraction (LVEF) and 65% in non-obstructive with reduced LVEF.
  • Female sex tripled the odds of heart failure across all subgroups.

Investigators at the American Heart Association Scientific Sessions 2025 in New Orleans, LA, presented data from the HiRO-HCM registry assessing heart failure prevalence and risk factors in hypertrophic cardiomyopathy (HCM). The study provides a comprehensive evaluation of heart failure burden and identifies key demographic and physiologic risk markers.

This cross-sectional analysis, which was developed by investigators from the Montreal Heart Institute and a Canadian multicenter consortium, included 1632 patients aged 16 years or older with confirmed HCM and comprehensive clinical data. Heart failure was defined as hospitalization for decompensated heart failure requiring diuretics, transplant, or mechanical circulatory support, or New York Heart Association (NYHA) class II or higher with elevated filling pressures (E/e′ ≥14 and/or NT-proBNP ≥400 ng/L; ≥800 ng/L for atrial fibrillation). Echocardiography and biomarker data were centrally analyzed. Logistic regression identified independent risk markers in the overall cohort and three subgroups: obstructive HCM (oHCM), non-obstructive with preserved ejection fraction (nHCM ≥50%), and non-obstructive with reduced ejection fraction (nHCM <50%).

Study Findings

Among the 1632 patients (mean age 58±14 years; 33% female), 510 (31%) met criteria for heart failure, including 93 hospitalizations and 26 transplants. Heart failure prevalence was highest in nHCM with reduced left ventricular ejection fraction (LVEF; 65%), followed by oHCM (41%) and nHCM with preserved LVEF (26%; P < .001). Multivariable analysis identified female sex as a robust risk factor for HF across all subgroups, conferring approximately a threefold increased risk (P < .001).

Clinical Implications

The high prevalence of heart failure in patients with HCM highlights the need for early identification and targeted management, particularly in women who face disproportionate risk. The study findings support integrating sex-specific evaluation and biomarker-based surveillance into HCM care pathways. Identifying patients with preserved ejection fraction but elevated filling pressures could optimize selection for emerging heart failure-targeted therapies.

Expert Commentary

In their study, the investigators noted that “female sex is a robust and consistent predictor of [heart failure] across all phenotypes. The findings underscore the importance of sex-specific evaluation and earlier recognition of [heart failure] symptoms in HCM management.” The authors also emphasized that these data should inform patient selection for novel therapeutic trials.

Conclusion

Heart failure affects one-third of patients with HCM, with female sex serving as a key independent risk marker across all subtypes. These findings reinforce the importance of individualized, sex-aware risk stratification and early symptom recognition in HCM management.

Reference
Bigras E, Boulet J, Garceau P, et al. Prevalence and risk markers for heart failure in hypertrophic cardiomyopathy: a multicenter cross-sectional study with central assessment of biomarkers and echocardiograms. Presented at: American Heart Association Scientific Sessions 2025; New Orleans, LA. https://professional.heart.org/en/meetings/scientific-sessions