Prognostic Implication of Left Ventricular Global Longitudinal Strain in Patients With Hypertrophic Cardiomyopathy and Coexisting Hypertension

Background and Objectives: The prognostic implication of coexisting hypertension in patients with hypertrophic cardiomyopathy (HCM) is poorly defined. This study aimed to evaluate the association between left ventricular global longitudinal strain (LV-GLS) and adverse cardiovascular (CV) events in patients with HCM and coexisting hypertension. Methods: We analyzed consecutive patients with HCM from 2 tertiary HCM referral centers. The primary outcome was CV events, defined as a composite of CV death, heart failure, and stroke. All LV-GLS measurements were conducted in a core laboratory. Results: Of 1,139 patients with HCM, 522 (45.8%) had hypertension. Patients with hypertension were older, had more CV comorbidities, and showed a lower LV-GLS (13.7% vs. 14.4%, p=0.001). During a median 6.6-year follow-up, 155 CV events occurred, with a significantly higher crude incidence in patients with hypertension than in those without (p=0.005). Lower LV-GLS was independently associated with a higher risk of CV events in patients with hypertension (per 1% decrease in LV-GLS, adjusted hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.13; p=0.013). When stratified by four groups based on hypertension and LV-GLS, CV events most frequently occurred in patients with both hypertension and a lower LV-GLS (<13.1%), with a significantly higher risk compared to those without hypertension and a higher LV-GLS (≥13.1%) (adjusted HR, 1.60; 95% CI, 1.01–2.54; p=0.044). Conclusions: Patients with HCM and coexisting hypertension were older, had more prevalent CV comorbidities, and exhibited a lower LV-GLS compared to those without hypertension. LV-GLS provides important prognostic information in patients with both HCM and hypertension.