Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and an important cause of sudden cardiac death. The apical phenotype (ApHCM) is often considered more benign, but recent data suggest increasing adverse outcomes. A meta-analysis published in The American Journal of Cardiology evaluated long-term outcomes of ApHCM compared with non-apical HCM (non-ApHCM).

The review searched PubMed, ScienceDirect, and the Cochrane Library using predefined terms, with inclusion limited to cohort studies directly comparing ApHCM and non-ApHCM. Endpoints included clinical, arrhythmia-related, and heart failure-related outcomes. Data were expressed as odds ratios for dichotomous measures and mean differences for continuous measures. Study quality was assessed using the Newcastle-Ottawa Scale.

Across six cohort studies with 8,179 patients, ApHCM showed a lower risk of major adverse cardiovascular events (odds ratio [OR] = 0.48; 95% confidence interval [CI] 0.40–0.59; p<0.00001) and all-cause mortality (OR = 0.44; 95% CI 0.30–0.63; p<0.0001). No difference was seen in sudden cardiac death, sustained monomorphic ventricular tachycardia, or heart failure outcomes, while apical aneurysm occurred more frequently in ApHCM.