Ann Thorac Surg. 2025 Dec 31:S0003-4975(25)01274-3. doi: 10.1016/j.athoracsur.2025.12.009. Online ahead of print.
ABSTRACT
BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is a structurally heterogeneous disease with variable clinical outcomes. While septal myectomy provides symptomatic benefits, interindividual differences in postoperative risk and long-term prognosis remain unknown.
METHODS: A retrospective cohort of 699 patients with HOCM was analyzed. A Latent class analysis model was derived to identify distinct subgroups. Group-specific postoperative and long-term outcomes were compared. A decision tree model was developed to simplify clinical classification.
RESULTS: Three subgroups were identified: Group 1 (younger patients), Group 2 (older patients with smaller left atrial diameter [LAD]), and Group 3 (older patients with enlarged LAD). Compared with Group 1, Group 3 had a significantly higher risk of postoperative new-onset atrial fibrillation, prolonged ventilation, renal failure, and composite complications During a median follow-up of 7.7 years, Group 3 showed an increased risk of composite outcome of all-cause mortality and cardiac readmission (adjusted hazard ratio, 1.67; 95% CI, 1.13-2.45, P = 0.009) and major adverse cardiac and cerebrovascular events (adjusted hazard ratio, 2.18; 95% CI, 1.17-4.05; P = 0.014). Group 1 had the highest risk of ventricular arrhythmias compared with Group 2 (adjusted hazard ratio, 2.58; 95% CI, 1.20-5.57; P = 0.016). A simplified decision tree using age ≥ 50 years and LAD ≥ 42 mm achieved a classification accuracy of 95.7%.
CONCLUSIONS: Latent class analysis revealed distinct subgroups of HOCM. Older patients with enlarged LAD portended the highest cardiovascular risk, while younger patients had elevated arrhythmia risk. Subgroup-based stratification may inform personalized perioperative and long-term surveillance strategies in HOCM patients.
PMID:41482024 | DOI:10.1016/j.athoracsur.2025.12.009