Evaluation of Aortic Dilation in Patients With Hypertrophic Cardiomyopathy in a Tertiary Center for Cardiovascular Disease

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Background Hypertrophic cardiomyopathy (HCM) is a common genetic cardiac disease primarily affecting the left ventricle. While the disease is traditionally associated with myocardial hypertrophy and left ventricular outflow tract (LVOT) obstruction, aortic dilation has emerged as a potentially serious but underrecognized complication. This study aimed to determine the prevalence of aortic dilation in HCM patients and to identify associated clinical and echocardiographic factors. Methods In this cross‐sectional, retrospective study, 216 adult patients diagnosed with HCM at Rajaie Cardiovascular Institute (Tehran, Iran) from 2016 to 2021 were evaluated. Patients with significant valvular disease, congenital aortic anomalies, prior aortic surgery, or other cardiomyopathies were excluded. Clinical data and echocardiographic measurements, including aortic dimensions indexed to body surface area (BSA), were collected. Cardiac magnetic resonance imaging (MRI) data of myocardial fibrosis were also assessed in a subset of patients. Logistic regression was used to identify factors independently associated with aortic dilation. Results Dilated ascending aorta was present in 56 patients (26.3%), while 12 patients (5.6%) had dilation of the sinus of Valsalva (SOV). Dilated ascending aorta was significantly associated with older age ( p = 0.001), hypertension ( p = 0.001), and increased BSA ( p = 0.002). LV end‐systolic diameter (LVESD) also showed a significant correlation ( p = 0.002). Multivariate analysis identified age (OR = 1.063), hypertension (OR = 5.49), LVESD (OR = 3.25), and right ventricular hypertrophy (OR = 4.99) as independent predictors of ascending aorta dilation. SOV dilation was similarly associated with age (OR = 1.117) and lower weight (OR = 0.915). Although myocardial fibrosis was more common in patients with ascending aorta dilation, this did not reach statistical significance ( p = 0.006). Conclusion Aortic dilation is a relatively common finding in patients with HCM and is significantly associated with age, hypertension, and structural cardiac remodeling. Routine evaluation of the ascending aorta and SOV in HCM patients may aid in the early detection and management of this potential complication.

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