Heart failure in hypertrophic cardiomyopathy

Clinical investigation, electro-and echocardiography were used in evaluation of 128 patients with hypertrophic cardiomyopathy. Thirty four of these patients (17 men and 17 women with mean age 52,4+/-2,3 years) had signs of stage II A-II B (NYHA class III) heart failure. The cause of heart failure in these patients was disturbed left ventricular diastolic function evidenced by decreased rapid filling volume and its fraction in stroke volume. Factors contributing to development and progression of heart failure were atrial fibrillation (in 18 patients), and infective endocarditis (in 3 patients). Most patients with heart failure had diffuse myocardial hypertrophy without left ventricular dilatation (mean value 41,8+/-3,8 mm) and dilated left atrium (mean value 44,6+/-1,5 mm). These findings combined with data of analysis of cardiac cycle phases allowed to consider disturbancers of left ventricular diastolic function (restrictive component) decisive for genesis of heart failure. Twenty three patients were followed-up for 8,7+/-0,6 years. During this period 9 patients died. Causes of death were heart failure in 3 and stroke in 1 while 5 patients died suddenly. Results of follow-up showed that therapy with calcium antagonists and beta-blockers did not alleviate myocardial hypertrophy.