Clinical characteristics, prognosis, and comparison of simple and mixed apical hypertrophic cardiomyopathy in 208 patients with apical hypertrophic cardiomyopathy Fan Chaomei, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing, China Author(s): Yan Lirong, Wang Zhiming, Oh Zhimin, Li Yishi, Tao Yongkang, Fan Chaomei, Chinese Academy of Medical Sciences, Peking Union Medical College, National Cardiology Center, Beijing, China Research background: apical hypertrophic cardiomyopathy is a relatively rare type of hypertrophic cardiomyopathy (HCM). Hypertrophic apical cardiomyopathy is a relatively rare type of hypertrophic cardiomyopathy (HCM), in which the hypertrophied area mainly involves the apical part of the left ventricle. The disease has been poorly studied in China, and the characteristics of Chinese patients with apical hypertrophic cardiomyopathy are unclear. Therefore, the aim of this study was to describe the clinical characteristics and prognosis of Chinese patients with apical hypertrophic cardiomyopathy (AHCM). METHODS: A retrospective analysis and follow-up of 206 patients with AHCM attending Fu Wai Hospital was performed, and their clinical manifestations, mortality of cardiovascular origin, and cardiovascular event rates were analyzed.AHCM can be classified into two subtypes: simple AHCM in which the site of hypertrophy is confined to the apical region only; and mixed AHCM in which there is a combination of other sites of ventricular wall hypertrophy, such as a combination of ventricular septal hypertrophy, but with the most hypertrophic site being the apical region. The most hypertrophic area was the apical area. Results: 208 patients with AHCM accounted for 16.0% of the patients with HCM in Fu Wai Hospital during the same period of time, including 153 (73.6%) males and 55 (26.4%) females, with a mean age of (52.2±12.4) years; among them, 134 (64.4%) patients with simple AHCM and 74 (35.6%) patients with mixed AHCM. The left atrial internal diameter and apical ventricular wall of patients with mixed AHCM were significantly larger than those of patients with simple AHCM. 171 patients (91.8%) were followed up for an average of (8.0 ± 3.5) years, and 2 deaths of cardiovascular origin occurred, with an overall cardiovascular mortality rate of 1.0%, and the 2 deaths were both in patients with mixed AHCM. The 10-year survival rate of patients with AHCM was 97.0 ± 2%, and the 10-year survival rate of patients with AHCM was 97.0 ± 2%. The 10-year survival rate of AHCM patients was 97.0 ± 2%. A total of 28 (17.8%) patients experienced cardiovascular events during follow-up, and the 10-year survival rate free of cardiovascular events was 77 ± 4%. Independent risk factors for cardiovascular events in patients with AHCM were found to be: age at diagnosis ≥ 60 years, left atrial internal diameter ≥ 36 mm and baseline cardiac function NYHA class ≥ III. The study concludes that the prevalence of AHCM in China is relatively high and the prognosis is good. However, cardiovascular events still occurred in 17.8% of patients. Mixed AHCM has fewer patients but poorer prognosis, so it is necessary to distinguish the two different types of AHCM.