1
|
Rella V, Maurizi N, Bernardini A, Brasca FM, Salerno S, Meda M, Mariani D, Torchio M, Ravaro S, Cerea P, Castelletti S, Fumagalli C, Conte G, Auricchio A, Girolami F, Pieragnoli P, Carrassa GM, Parati G, Olivotto I, Perego GB, Cecchi F, Crotti L. Candidacy and long-term outcomes of subcutaneous implantable cardioverter-defibrillators in current practice in patients with hypertrophic cardiomyopathy. Int J Cardiol 2024; 409:132202. [PMID: 38795975 DOI: 10.1016/j.ijcard.2024.132202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND In patients with Hypertrophic Cardiomyopathy (HCM) S-ICD is usually the preferred option as pacing is generally not indicated. However, limited data are available on its current practice adoption and long-term follow-up. METHODS Consecutive HCM patients with S-ICD implanted between 2013 and 2021 in 3 international centers were enrolled in this observational study. Baseline, procedural and follow-up data were regularly collected. Efficacy and safety were compared with a cohort of HCM patients implanted with a tv-ICD. RESULTS Seventy patients (64% males) were implanted with S-ICD at 41 ± 15 years, whereas 168 patients with tv-ICD at 49 ± 16 years. For S-ICD patients, mean ESC SCD risk score was 4,5 ± 1.9%: 25 (40%) at low-risk, 17 (27%) at intermediate and 20 (33%) at high-risk. Patients were followed-up for 5.1 ± 2.3 years. Two patients (0.6 per 100-person-years, vs 0.4 per 100 person-years with tv-ICD, p = 0.45) received an appropriate shock on VF, 17 (24%) were diagnosed with de-novo AF. Inappropriate shocks occurred in 4 patients (1.2 per 100-person-years, vs 0.9 per 100 person-years with tv-ICD, p = 0.74), all before Smart-Pass algorithm implementation. Four patients experienced device-related adverse events (1.2 per 100-person-years, vs 1 per 100 person-years with tv-ICD, p = 0.35%). CONCLUSIONS S-ICDs were often implanted in patients with an overall low-intermediate ESC SCD risk, reflecting both the inclusion of additional risk markers and a lower decision threshold. S-ICDs in HCM patients followed for over 5 years showed to be effective in conversion of VF and safe. Greater scrutiny may be required to avoid overtreatment in patients with milder risk profiles.
Collapse
Affiliation(s)
- V Rella
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - N Maurizi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - A Bernardini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Santa Maria Nuova Hospital, Cardiology and Electrophysiology unit, Florence, Italy
| | - F M Brasca
- Istituto Auxologico Italiano IRCCS, Electrophysiology Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - S Salerno
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - M Meda
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - D Mariani
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - M Torchio
- Istituto Auxologico Italiano IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - S Ravaro
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy; Department of medicine and surgery, University Milano Bicocca, Milan, Italy
| | - P Cerea
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - S Castelletti
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - C Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Conte
- Istituto Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - A Auricchio
- Istituto Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - F Girolami
- Pediatric Cardiology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - P Pieragnoli
- Electrophysiology unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - G M Carrassa
- Electrophysiology unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - G Parati
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy; Department of medicine and surgery, University Milano Bicocca, Milan, Italy
| | - I Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Pediatric Cardiology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - G B Perego
- Istituto Auxologico Italiano IRCCS, Electrophysiology Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - F Cecchi
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - L Crotti
- Department of medicine and surgery, University Milano Bicocca, Milan, Italy; Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy.
| |
Collapse
|
2
|
Carrick RT, Ahamed H, Sung E, Maron MS, Madias C, Avula V, Studley R, Bao C, Bokhari N, Quintana E, Rajesh-Kannan R, Maron BJ, Wu KC, Rowin EJ. Identification of high-risk imaging features in hypertrophic cardiomyopathy using electrocardiography: A deep-learning approach. Heart Rhythm 2024; 21:1390-1397. [PMID: 38280624 PMCID: PMC11272903 DOI: 10.1016/j.hrthm.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) are at risk of sudden death, and individuals with ≥1 major risk markers are considered for primary prevention implantable cardioverter-defibrillators. Guidelines recommend cardiac magnetic resonance (CMR) imaging to identify high-risk imaging features. However, CMR imaging is resource intensive and is not widely accessible worldwide. OBJECTIVE The purpose of this study was to develop electrocardiogram (ECG) deep-learning (DL) models for the identification of patients with HCM and high-risk imaging features. METHODS Patients with HCM evaluated at Tufts Medical Center (N = 1930; Boston, MA) were used to develop ECG-DL models for the prediction of high-risk imaging features: systolic dysfunction, massive hypertrophy (≥30 mm), apical aneurysm, and extensive late gadolinium enhancement. ECG-DL models were externally validated in a cohort of patients with HCM from the Amrita Hospital HCM Center (N = 233; Kochi, India). RESULTS ECG-DL models reliably identified high-risk features (systolic dysfunction, massive hypertrophy, apical aneurysm, and extensive late gadolinium enhancement) during holdout testing (c-statistic 0.72, 0.83, 0.93, and 0.76) and external validation (c-statistic 0.71, 0.76, 0.91, and 0.68). A hypothetical screening strategy using echocardiography combined with ECG-DL-guided selective CMR use demonstrated a sensitivity of 97% for identifying patients with high-risk features while reducing the number of recommended CMRs by 61%. The negative predictive value with this screening strategy for the absence of high-risk features in patients without ECG-DL recommendation for CMR was 99.5%. CONCLUSION In HCM, novel ECG-DL models reliably identified patients with high-risk imaging features while offering the potential to reduce CMR testing requirements in underresourced areas.
Collapse
Affiliation(s)
- Richard T Carrick
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland.
| | - Hisham Ahamed
- Amrita Institute of Medical Sciences and Research Centre, Amrita Hypertrophic Cardiomyopathy Center, Kochi, Kerala, India
| | - Eric Sung
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland
| | - Martin S Maron
- Lahey Hospital and Medical Center, Hypertrophic Cardiomyopathy Center, Burlington, Massachusetts
| | | | - Vennela Avula
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland
| | - Rachael Studley
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Chen Bao
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Nadia Bokhari
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Erick Quintana
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Ramiah Rajesh-Kannan
- Amrita Institute of Medical Sciences and Research Centre, Amrita Hypertrophic Cardiomyopathy Center, Kochi, Kerala, India
| | - Barry J Maron
- Lahey Hospital and Medical Center, Hypertrophic Cardiomyopathy Center, Burlington, Massachusetts
| | - Katherine C Wu
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Hypertrophic Cardiomyopathy Center, Burlington, Massachusetts
| |
Collapse
|
3
|
Nakamori S, Rowin EJ, Rodriguez J, Ngo LH, Manning WJ, Maron M, Nezafat R. Accelerated Myocardial Fibrosis in Young to Middle-aged Patients with Hypertrophic Cardiomyopathy. J Cardiovasc Magn Reson 2024:101072. [PMID: 39096972 DOI: 10.1016/j.jocmr.2024.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024] Open
Affiliation(s)
- Shiro Nakamori
- Departments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, MA; Tufts University School of Medicine, Boston, MA
| | - Jennifer Rodriguez
- Departments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Long H Ngo
- Departments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Departments of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, MA; Tufts University School of Medicine, Boston, MA
| | - Reza Nezafat
- Departments of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
4
|
Mistrulli R, Ferrera A, Salerno L, Vannini F, Guida L, Corradetti S, Addeo L, Valcher S, Di Gioia G, Spera FR, Tocci G, Barbato E. Cardiomyopathy and Sudden Cardiac Death: Bridging Clinical Practice with Cutting-Edge Research. Biomedicines 2024; 12:1602. [PMID: 39062175 PMCID: PMC11275154 DOI: 10.3390/biomedicines12071602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Sudden cardiac death (SCD) prevention in cardiomyopathies such as hypertrophic (HCM), dilated (DCM), non-dilated left ventricular (NDLCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC) remains a crucial but complex clinical challenge, especially among younger populations. Accurate risk stratification is hampered by the variability in phenotypic expression and genetic heterogeneity inherent in these conditions. This article explores the multifaceted strategies for preventing SCD across a spectrum of cardiomyopathies and emphasizes the integration of clinical evaluations, genetic insights, and advanced imaging techniques such as cardiac magnetic resonance (CMR) in assessing SCD risks. Advanced imaging, particularly CMR, not only enhances our understanding of myocardial architecture but also serves as a cornerstone for identifying at-risk patients. The integration of new research findings with current practices is essential for advancing patient care and improving survival rates among those at the highest risk of SCD. This review calls for ongoing research to refine risk stratification models and enhance the predictive accuracy of both clinical and imaging techniques in the management of cardiomyopathies.
Collapse
Affiliation(s)
- Raffaella Mistrulli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
| | - Armando Ferrera
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Luigi Salerno
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Federico Vannini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Leonardo Guida
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Sara Corradetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
| | - Lucio Addeo
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Corso Umberto I, 40, 80138 Naples, Italy
| | - Stefano Valcher
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
- Cardiovascular Department, Humanitas University, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy;
| | - Francesco Raffaele Spera
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| |
Collapse
|
5
|
Pan JA, Patel AR. The Role of Multimodality Imaging in Cardiomyopathy. Curr Cardiol Rep 2024; 26:689-703. [PMID: 38753290 PMCID: PMC11236518 DOI: 10.1007/s11886-024-02068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW There has been increasing use of multimodality imaging in the evaluation of cardiomyopathies. RECENT FINDINGS Echocardiography, cardiac magnetic resonance (CMR), cardiac nuclear imaging, and cardiac computed tomography (CCT) play an important role in the diagnosis, risk stratification, and management of patients with cardiomyopathies. Echocardiography is essential in the initial assessment of suspected cardiomyopathy, but a multimodality approach can improve diagnostics and management. CMR allows for accurate measurement of volumes and function, and can easily detect unique pathologic structures. In addition, contrast imaging and parametric mapping enable the characterization of tissue features such as scar, edema, infiltration, and deposition. In non-ischemic cardiomyopathies, metabolic and molecular nuclear imaging is used to diagnose rare but life-threatening conditions such amyloidosis and sarcoidosis. There is an expanding use of CCT for planning electrophysiology procedures such as cardioversion, ablations, and device placement. Furthermore, CCT can evaluate for complications associated with advanced heart failure therapies such as cardiac transplant and mechanical support devices. Innovations in multimodality cardiac imaging should lead to increased volumes and better outcomes.
Collapse
Affiliation(s)
- Jonathan A Pan
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA
| | - Amit R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA.
| |
Collapse
|
6
|
Sun D, Schaff HV, Nishimura RA, Geske JB, Dearani JA, Ommen SR. Outcomes of concomitant myectomy and left ventricular apical aneurysm repair in patients with hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2024; 168:96-103.e1. [PMID: 37029070 DOI: 10.1016/j.jtcvs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy with left ventricular apical aneurysm is a phenotype associated with a 4-fold increase in the risk for sudden cardiac death. In this study, we describe the surgical outcome of concomitant apical aneurysm repair in patients undergoing transapical myectomy for hypertrophic cardiomyopathy. METHODS We identified 67 patients with left ventricular apical aneurysms who underwent transapical myectomy and apical aneurysm repair between July 2000 and August 2020. Long-term survival was compared with that of 2746 consecutive patients undergoing transaortic septal myectomy for obstructive hypertrophic cardiomyopathy with subaortic obstruction. RESULTS Transapical myectomy was indicated for midventricular obstruction (n = 44) or left ventricular remodeling for diastolic heart failure (n = 29). Preoperatively, 74.6% (n = 50) of patients were in New York Heart Association class III/IV heart failure, and 34.3% (n = 23) of patients had experienced syncope or presyncope. Atrial fibrillation was documented in 22 patients (32.8%), and episodes of ventricular arrhythmias were recorded in 30 patients (44.8%). Thrombus was present in the apical aneurysm in 6 patients. During a median (interquartile range) follow-up of 4.9 (1.8-7.6) years, the estimated 1- and 5-year survivals were 98.5% and 94.5%, respectively, which were not significantly different from that of patients undergoing transaortic septal myectomy for obstructive hypertrophic cardiomyopathy (P = .52) or an age- and sex-matched US general population (P = .40). CONCLUSIONS Apical aneurysm repair in conjunction with septal myectomy is a safe procedure, and the good long-term survival of patients suggests that the procedure may reduce cardiac-related death in this high-risk hypertrophic cardiomyopathy population.
Collapse
Affiliation(s)
- Daokun Sun
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| |
Collapse
|
7
|
Fox N, Fox N, Jacobsen AP, Blumenthal RS, Barouch LA. Vigorous Exercise in Patients with Hypertrophic Cardiomyopathy. Curr Sports Med Rep 2024; 23:270-274. [PMID: 38941549 DOI: 10.1249/jsr.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
ABSTRACT Hypertrophic cardiomyopathy is a genetic heart condition occurring in up to 1 in 200 patients in the United States, many of whom are young and otherwise healthy. This condition puts those affected at increased risk for adverse cardiac outcomes, including sudden cardiac arrest and death, with particular concern for this to occur during exercise and other forms of exertion. Recent studies aimed at evaluating the risk of exercise in hypertrophic cardiomyopathy patients have suggested that moderate and even vigorous exercise may be safe for certain patients. Clinical guidelines are changing to reflect this recent information and to encourage a shared decision-making approach, which can allow more hypertrophic cardiomyopathy patients to participate in health-promoting exercise activities.
Collapse
Affiliation(s)
- Nolan Fox
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Nicholas Fox
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lili A Barouch
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| |
Collapse
|
8
|
Hashimoto K, Yamamoto H, Harada A, Yamada H, Ikeda Y, Hashimoto T. Hypertrophic cardiomyopathy-related left ventricular pseudoaneurysm: A case report. Heliyon 2024; 10:e32197. [PMID: 38868059 PMCID: PMC11168430 DOI: 10.1016/j.heliyon.2024.e32197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
Background Myocardial infarction-related left ventricular pseudoaneurysm (LVP), covered by the adjacent pericardial or scar tissue, is a fatal sequela of left ventricular rupture. Whereas hypertrophic cardiomyopathy (HCM) may cause left ventricular true aneurysm. Differentiating LVP from left ventricular true aneurysm is crucial because their natural histories and treatment strategies are distinct. However, the incidence and management of HCM-related LVP remain unknown. Case presentation An 88-year-old man was admitted to our hospital with sudden-onset chest pain. Upon initial examination, vital signs were stable, and a grade 4/6 systolic murmur was noted. An electrocardiogram revealed atrial fibrillation and poor R-wave progression without ST-T changes or negative T-waves. An echocardiography showed mild left ventricular hypertrophy, mid-ventricular obstruction with a significant intraventricular pressure gradient, left ventricular outflow tract obstruction, and a small left ventricular apical outpouching. Cardiac computed tomography angiography (CCTA) assisted in the diagnosis of LVP, and an accompanying pericardial effusion suggested impending cardiac rupture. Because the patient initially refused our proposed urgent surgery, medication was initiated with continuous hemodynamic monitoring in the intensive care unit; however, the patient's condition did not improve. During a semi-urgent surgical repair of the aneurysmal wall, LVP was observed and confirmed by pathology. Myocardial tissue adjacent to the pseudoaneurysm was consistent with that of HCM. Subsequently, a final diagnosis of HCM-related LVP was made. The postoperative course was notable for transient profound hypotension. Thereafter, the patient died of non-occlusive mesenteric ischemia on day 6. Conclusions To our knowledge, this is the first reported case of HCM-related LVP mimicking impending cardiac rupture. Our case highlights the importance of considering HCM-related LVP in patients with left ventricular outpouching and CCTA in the LVP diagnosis. In further research, data on the appropriate management of HCM-related LVP should be accumulated.
Collapse
Affiliation(s)
- Katsuya Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Atsushi Harada
- Department of Cardiovascular Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamada
- Department of Cardiovascular Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| |
Collapse
|
9
|
Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2324-2405. [PMID: 38727647 DOI: 10.1016/j.jacc.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
Collapse
|
10
|
Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Zhang Y, Adamo M, Zou C, Porcari A, Tomasoni D, Rossi M, Merlo M, Liu H, Wang J, Zhou P, Metra M, Sinagra G, Zhang J. Management of hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2024; 25:399-419. [PMID: 38625835 PMCID: PMC11142653 DOI: 10.2459/jcm.0000000000001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
Hypertrophic cardiomyopathy is an important cause of heart failure and arrhythmias, including sudden death, with a major impact on the healthcare system. Genetic causes and different phenotypes are now increasingly being identified for this condition. In addition, specific medications, such as myosin inhibitors, have been recently shown as potentially able to modify its symptoms, hemodynamic abnormalities and clinical course. Our article aims to provide a comprehensive outline of the epidemiology, diagnosis and treatment of hypertrophic cardiomyopathy in the current era.
Collapse
Affiliation(s)
- Yuhui Zhang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Changhong Zou
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aldostefano Porcari
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Maddalena Rossi
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Marco Merlo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Huihui Liu
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jinxi Wang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ping Zhou
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Jian Zhang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
12
|
Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB. Obstruction in Hypertrophic Cardiomyopathy: Many Faces. J Am Soc Echocardiogr 2024; 37:613-625. [PMID: 38428652 DOI: 10.1016/j.echo.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, exhibits left ventricular hypertrophy not secondary to other causes, with varied phenotypic expression. Enhanced actin-myosin interaction underlies excessive myocardial contraction, frequently resulting in dynamic obstruction within the left ventricle. Left ventricular outflow tract obstruction, occurring at rest or with provocation in 75% of HCM patients, portends adverse prognosis, contributes to symptoms, and is frequently a therapeutic target. Transthoracic echocardiography plays a crucial role in the screening, initial diagnosis, management, and risk stratification of HCM. Herein, we explore echocardiographic evaluation of HCM, emphasizing Doppler assessment for obstruction. Echocardiography informs management strategies through noninvasive hemodynamic assessment, which is frequently obtained with various provocative maneuvers. Recognition of obstructive HCM phenotypes and associated anatomical abnormalities guides therapeutic decision-making. Doppler echocardiography allows monitoring of therapeutic responses, whether it be medical therapies (including cardiac myosin inhibitor therapy) or septal reduction therapies, including surgical myectomy and alcohol septal ablation. This article discusses the hemodynamics of obstruction and practical application of Doppler assessment in HCM. In addition, it provides a visual atlas of obstruction in HCM, including high-quality figures and complementary videos that illustrate the many facets of dynamic obstruction.
Collapse
Affiliation(s)
- Muhannad Abbasi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kevin C Ong
- Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Brian Newman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
13
|
Liebregts M. Trans-Atlantic Differences in Approach to Sudden Death Prevention in Patients With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:869-875. [PMID: 38522619 DOI: 10.1016/j.cjca.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024] Open
Abstract
The American approach to predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy diverges from the European method in that it relies on major risk factors independently justifying the implantation of an implantable cardioverter-defibrillator for primary prevention, whereas the European approach uses a mathematical equation to estimate a 5-year risk percentage. The aim of this review is to outline the differences between the American and European guidelines and to show how they have arisen. Furthermore, it will provide insight into the future of SCD risk prediction in patients with hypertrophic cardiomyopathy. The American SCD risk prediction method has high sensitivity but limited specificity, whereas the European method has the opposite. These differences in sensitivity and specificity likely contribute to the fact that primary prevention implantable cardioverter-defibrillator utilization is twofold higher in the United States. It is highly likely that new insights and new imaging modalities will enhance prediction models in the near future. Genotyping could potentially assume a significant role. Left ventricular global longitudinal strain was recently shown to be an independent predictor of SCD. Furthermore, after late gadolinium enhancement, additional cardiac magnetic resonance techniques such as T1 mapping and diffusion tensor imaging are showing encouraging outcomes in predicting SCD. Ultimately, it is conceivable that integrating diverse morphological and genetic characteristics through deep learning will yield novel insights and enhance SCD prediction methods.
Collapse
MESH Headings
- Humans
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Europe/epidemiology
- Primary Prevention/methods
- United States/epidemiology
- Risk Assessment/methods
- Defibrillators, Implantable
- Risk Factors
Collapse
Affiliation(s)
- Max Liebregts
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
| |
Collapse
|
14
|
Pan JA. Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy: Is There More to it Than Size? JACC Cardiovasc Imaging 2024; 17:498-500. [PMID: 38180415 PMCID: PMC11227108 DOI: 10.1016/j.jcmg.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Jonathan A Pan
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
| |
Collapse
|
15
|
Li J, Fang J, Liu Y, Wei X. Apical hypertrophic cardiomyopathy: pathophysiology, diagnosis and management. Clin Res Cardiol 2024; 113:680-693. [PMID: 37982860 PMCID: PMC11026226 DOI: 10.1007/s00392-023-02328-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
Since the first description of apical hypertrophic cardiomyopathy (ApHCM) in 1976, contrasting information from all over the world has emerged regarding the natural history of the disease. However, the recommended guidelines on hypertrophic cardiomyopathy (HCM) pay a cursory reference to ApHCM, without ApHCM-specific recommendations to guide the diagnosis and management. In addition, cardiologists may not be aware of certain aspects that are specific to this disease subtype, and a robust understanding of specific disease features can facilitate recognition and timely diagnosis. Therefore, the review covers the incidence, pathogenesis, and characteristics of ApHCM and imaging methods. Echocardiography and cardiovascular magnetic resonance imaging (CMR) are the most commonly used imaging methods. Moreover, this review presents the management strategies of this heterogeneous clinical entity. In this review, we introduce a novel transapical beating-heart septal myectomy procedure for ApHCM patients with a promising short-time result.
Collapse
Affiliation(s)
- Jiangtao Li
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Jing Fang
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
| | - Xiang Wei
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China.
| |
Collapse
|
16
|
Crean AM. Scanning the Imaging Horizon for Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:899-906. [PMID: 38467329 DOI: 10.1016/j.cjca.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
In this article some of the recent advances in the use of noninvasive imaging applied to patients with hypertrophic cardiomyopathy (HCM) are discussed. Echocardiography and cardiac computed tomography are briefly discussed with respect to their power to detect apical aneurysmal disease. Echocardiographic phenotype-genotype correlations and the use of echocardiography to characterize myocardial work are reviewed. Positron emission tomography is reviewed in the context of ischemia imaging and also in the context of the use of a new tracer that might allow for recognition of early activation of the fibrosis pathway. Next, the technical capabilities of cardiovascular magnetic resonance to measure myocardial perfusion, oxygenation, and disarray are discussed as they apply to HCM. The application of radiomics to improve prediction of sudden cardiac death is touched upon. Finally, a deep learning approach to the recognition of HCM vs phenocopies is presented as a potential future diagnostic aid in the not-too-distant future.
Collapse
Affiliation(s)
- Andrew M Crean
- Manchester Heart Center, University of Manchester, Manchester, United Kingdom; Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
17
|
Colle B, Demeure F, Higny J, Benoit M, Henry JP, Michaux I, Robaye B, Xhaët O, Gabriel L, Guedes A, Blommaert D, Dulieu N, Berners Y, Wery F, Droogmans S, Cosyns B, Luchian ML. Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches. Diagnostics (Basel) 2024; 14:948. [PMID: 38732361 PMCID: PMC11083388 DOI: 10.3390/diagnostics14090948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.
Collapse
Affiliation(s)
- Benjamin Colle
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Jean-Philippe Henry
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Isabelle Michaux
- Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Nathalie Dulieu
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Yannick Berners
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Fabian Wery
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Steven Droogmans
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| |
Collapse
|
18
|
Pu L, Li J, Qi W, Zhang J, Chen H, Tang Z, Han Y, Wang J, Chen Y. Current perspectives of sudden cardiac death management in hypertrophic cardiomyopathy. Heart Fail Rev 2024; 29:395-404. [PMID: 37865929 DOI: 10.1007/s10741-023-10355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder characterized by left ventricular hypertrophy. Sudden cardiac death (SCD) is a rare but the most catastrophic complication in patients with HCM. Implantable cardioverter-defibrillators (ICDs) are widely recognized as effective preventive measures for SCD. Individualized risk stratification and early intervention in HCM can significantly improve patient prognosis. In this study, we review the latest findings regarding pathogenesis, risk stratification, and prevention of SCD in HCM patients, highlighting the clinic practice of cardiovascular magnetic resonance imaging for SCD management.
Collapse
Affiliation(s)
- Lutong Pu
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan Province, Guoxue Xiang No. 37, Chengdu, 610041, China
| | - Jialin Li
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan Province, Guoxue Xiang No. 37, Chengdu, 610041, China
| | - Weitang Qi
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan Province, Guoxue Xiang No. 37, Chengdu, 610041, China
| | - Jinquan Zhang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Zihuan Tang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Yuchi Han
- Wexner Medical Center, College of Medicine, The Ohio State University, Columbus, USA
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan Province, Guoxue Xiang No. 37, Chengdu, 610041, China.
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan Province, Guoxue Xiang No. 37, Chengdu, 610041, China.
- Center of Rare Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610041, China.
| |
Collapse
|
19
|
Santoro F, Vitale E, Ragnatela I, Cetera R, Leopzzi A, Mallardi A, Matera A, Mele M, Correale M, Brunetti ND. Multidisciplinary approach in cardiomyopathies: From genetics to advanced imaging. Heart Fail Rev 2024; 29:445-462. [PMID: 38041702 DOI: 10.1007/s10741-023-10373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Cardiomyopathies are myocardial diseases characterized by mechanical and electrical dysfunction of the heart muscle which could lead to heart failure and life-threatening arrhythmias. Certainly, an accurate anamnesis, a meticulous physical examination, and an ECG are cornerstones in raising the diagnostic suspicion. However, cardiovascular imaging techniques are indispensable to diagnose a specific cardiomyopathy, to stratify the risk related to the disease and even to track the response to the therapy. Echocardiography is often the first exam that the patient undergoes, because of its non-invasiveness, wide availability, and cost-effectiveness. Cardiac magnetic resonance imaging allows to integrate and implement the information obtained with the echography. Furthermore, cardiomyopathies' genetic basis has been investigated over the years and the list of genetic mutations deemed potentially pathogenic is expected to grow further. The aim of this review is to show echocardiographic, cardiac magnetic resonance imaging, and genetic features of several cardiomyopathies: dilated cardiomyopathy (DMC), hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), left ventricular noncompaction cardiomyopathy (LVNC), myocarditis, and takotsubo cardiomyopathy.
Collapse
Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
| | - Enrica Vitale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Rosa Cetera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | | | | | - Annalisa Matera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Marco Mele
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| |
Collapse
|
20
|
Schaff HV, Juarez-Casso FM. Treatment Strategies for Hypertrophic Cardiomyopathy: Surgical. Am J Cardiol 2024; 212S:S53-S63. [PMID: 38368037 DOI: 10.1016/j.amjcard.2023.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 02/19/2024]
Abstract
Septal myectomy is a well-established procedure for septal reduction in patients with obstructive hypertrophic cardiomyopathy (HCM) who have not responded to medical treatment. The surgical approach is tailored to the unique pathophysiology and septal morphology of the patient. Extended transaortic myectomy is the standard procedure for patients with isolated subaortic obstruction, the most common type of HCM. However, transapical myectomy is a useful adjunct for patients with long or midventricular obstruction and is our preferred technique for ventricular enlargement in patients with severe symptomatic diastolic heart failure because of extensive apical hypertrophy. Septal myectomy provides excellent postoperative outcomes as regards symptom relief and functional improvement, and operative morbidity and mortality rates are low in experienced centers. This article summarizes our current surgical management of patients with HCM and details operative methods and outcomes.
Collapse
Affiliation(s)
- Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | | |
Collapse
|
21
|
Maron BJ, Rowin EJ, Maron MS. Advances in the Management of Hypertrophic Cardiomyopathy Leading to Low Disease-Related Mortality in 2023. Am J Cardiol 2024; 212S:S77-S82. [PMID: 38368039 DOI: 10.1016/j.amjcard.2023.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common often inherited heart disease encumbered throughout much of its almost 60-year history by the expectation of an unfavorable outcome with shortened longevity. However, it is notable that in 2023, most patients affected with HCM can now achieve normal or extended life expectancy without major disability because of a comprehensive constellation of management strategies that have evolved largely over the last 20 years. Distinct adverse disease pathways dictate high-benefit low-risk personalized treatments, without reliance on genomics and sarcomere mutations, including: primary prevention implantable defibrillators for sudden cardiac death prevention, surgical myectomy and percutaneous alcohol septal ablation to reverse heart failure symptoms, anticoagulation to prevent embolic stroke associated with concomitant atrial fibrillation, external defibrillation and hypothermia for out-of-hospital cardiac arrest, and heart transplant in a small patient subgroup with end-stage disease. Large cohort studies using these contemporary management strategies achieved remarkably low HCM-related mortality (0.5%/year) across all age groups, which is lower than in the other cardiac or noncardiac risks of living, and largely confined to nonobstructive patients with progressive heart failure, including those awaiting heart transplant.
Collapse
Affiliation(s)
- Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| |
Collapse
|
22
|
Goldie FC, Lee MMY, Coats CJ, Nordin S. Advances in Multi-Modality Imaging in Hypertrophic Cardiomyopathy. J Clin Med 2024; 13:842. [PMID: 38337535 PMCID: PMC10856479 DOI: 10.3390/jcm13030842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by abnormal growth of the myocardium with myofilament disarray and myocardial hyper-contractility, leading to left ventricular hypertrophy and fibrosis. Where culprit genes are identified, they typically relate to cardiomyocyte sarcomere structure and function. Multi-modality imaging plays a crucial role in the diagnosis, monitoring, and risk stratification of HCM, as well as in screening those at risk. Following the recent publication of the first European Society of Cardiology (ESC) cardiomyopathy guidelines, we build on previous reviews and explore the roles of electrocardiography, echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging. We examine each modality's strengths along with their limitations in turn, and discuss how they can be used in isolation, or in combination, to facilitate a personalized approach to patient care, as well as providing key information and robust safety and efficacy evidence within new areas of research.
Collapse
Affiliation(s)
- Fraser C. Goldie
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
| | - Matthew M. Y. Lee
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
| | - Caroline J. Coats
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Sabrina Nordin
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| |
Collapse
|
23
|
Maron MS, Rowin EJ, Maron BJ. The Paradigm of Sudden Death Prevention in Hypertrophic Cardiomyopathy. Am J Cardiol 2024; 212S:S64-S76. [PMID: 38368038 DOI: 10.1016/j.amjcard.2023.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common and, often, inherited cardiac disease, once regarded as largely untreatable with ominous prognosis and, perhaps, most visibly as a common cause of sudden cardiac death (SCD) in the young. However, HCM is now more accurately considered a treatable disease with management options that significantly alter its clinical course. This is particularly true for SCD because the penetration of implantable cardioverter-defibrillators into HCM practice enables primary prevention device therapy that reliably terminates potentially lethal ventricular tachyarrhythmias (3% to 4%/year). This therapeutic advance is largely responsible for >10-fold decrease in the overall disease-related mortality to 0.5%/year, independent of patient age. A guideline-based clinical risk stratification algorithm has evolved, which included variables identifiable with cardiac magnetic resonance: ≥1 risk markers judged major within the clinical profile of an individual patient, associated with a measure of physician judgment and shared decision-making, can be sufficient to consider the recommendation of a prophylactic defibrillator implant. Implantable cardioverter-defibrillator decisions using the American College of Cardiology and the American Heart Association traditional major risk marker strategy are associated with a 95% sensitivity for identifying those patients who subsequently experience appropriate therapy, albeit often 5 to 10+ years after implant but without heart failure deterioration or death after a device intervention. A mathematical SCD risk score proposed by European Society of Cardiology is associated with a relatively low sensitivity (33%) for predicting and preventing SCD events but with potential for less device overtreatment.
Collapse
Affiliation(s)
- Martin S Maron
- Lahey Hospital and Medical Center, HCM Center, Burlington, Massachusetts.
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, HCM Center, Burlington, Massachusetts
| | - Barry J Maron
- Lahey Hospital and Medical Center, HCM Center, Burlington, Massachusetts
| |
Collapse
|
24
|
Wang J, Yang S, Ma X, Zhao K, Yang K, Yu S, Yin G, Dong Z, Song Y, Cui C, Li J, Wang C, Hao J, Lu M, Chen X, Zhao S. Assessment of late gadolinium enhancement in hypertrophic cardiomyopathy improves risk stratification based on current guidelines. Eur Heart J 2023; 44:4781-4792. [PMID: 37795986 DOI: 10.1093/eurheartj/ehad581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND AIMS Identifying patients with hypertrophic cardiomyopathy (HCM) who are candidates for implantable cardioverter defibrillator (ICD) implantation in primary prevention for sudden cardiac death (SCD) is crucial. The aim of this study was to externally validate the 2022 European Society of Cardiology (ESC) model and other guideline-based ICD class of recommendation (ICD-COR) models and explore the utility of late gadolinium enhancement (LGE) in further risk stratification. METHODS Seven hundred and seventy-four consecutive patients who underwent cardiac magnetic resonance imaging were retrospectively enrolled. RESULTS Forty-six (5.9%) patients reached the SCD-related endpoint during 7.4 ± 2.5 years of follow-up. Patients suffering from SCD had higher ESC Risk-SCD score (4.3 ± 2.4% vs. 2.8 ± 2.1%, P < .001) and LGE extent (13.7 ± 9.4% vs. 4.9 ± 6.6%, P < .001). Compared with the 2014 ESC model, the 2022 ESC model showed increased area under the curve (.76 vs. .63), sensitivity (76.1% vs. 43.5%), positive predictive value (16.8% vs. 13.6%), and negative predictive value (98.1% vs. 95.9%). The C-statistics for SCD prediction of 2011 American College of Cardiology (ACC)/American Heart Association (AHA), 2014 ESC, 2020 AHA/ACC, and 2022 ESC models were .68, .64, .76 and .78, respectively. Furthermore, in patients without extensive LGE, LGE ≥5% was responsible for seven-fold SCD risk after multivariable adjustment. Whether in ICD-COR II or ICD-COR III, patients with LGE ≥5% and <15% showed significantly worse prognosis than those with LGE <5% (all P < .001). CONCLUSIONS The 2022 ESC model performed better than the 2014 ESC model with especially improved sensitivity. LGE enabled further risk stratification based on current guidelines.
Collapse
Affiliation(s)
- Jiaxin Wang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Shujuan Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xuan Ma
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Kai Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Shiqin Yu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Gang Yin
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Zhixiang Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Song
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chen Cui
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jinghui Li
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jun Hao
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Minjie Lu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xiuyu Chen
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Shihua Zhao
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
25
|
Polovina M, Tschöpe C, Rosano G, Metra M, Crea F, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Corrado D, Bayes-Genis A, Bozkurt B, Filippatos G, Keren A, Skouri H, Moura B, Volterrani M, Abdelhamid M, Ašanin M, Krljanac G, Tomić M, Savarese G, Adamo M, Lopatin Y, Chioncel O, Coats AJS, Seferović PM. Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies. Eur J Heart Fail 2023; 25:2144-2163. [PMID: 37905371 DOI: 10.1002/ejhf.3076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Despite improvement in survival with contemporary treatment, SCD remains an important cause of mortality in cardiomyopathies. It occurs at a rate ranging between 0.15% and 0.7% per year (depending on the cardiomyopathy), which significantly surpasses SCD incidence in the age- and sex-matched general population. The risk of SCD is affected by multiple factors including the aetiology, genetic basis, age, sex, physical exertion, the extent of myocardial disease severity, conduction system abnormalities, and electrical instability, as measured by various metrics. Over the past decades, the knowledge on the mechanisms and risk factors for SCD has substantially improved, allowing for a better-informed risk stratification. However, unresolved issues still challenge the guidance of SCD prevention in patients with cardiomyopathies. In this review, we aim to provide an in-depth discussion of the contemporary concepts pertinent to understanding the burden, risk assessment and prevention of SCD in cardiomyopathies (dilated, non-dilated left ventricular, hypertrophic, arrhythmogenic right ventricular, and restrictive). The review first focuses on SCD incidence in cardiomyopathies and then summarizes established and emerging risk factors for life-threatening arrhythmias/SCD. Finally, it discusses validated approaches to the risk assessment and evidence-based measures for SCD prevention in cardiomyopathies, pointing to the gaps in evidence and areas of uncertainties that merit future clarification.
Collapse
Affiliation(s)
- Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute. Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Biykem Bozkurt
- Section of Cardiology, Winters Center for Heart Failure, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Hadassah-Hebrew University Medical Center Jerusalem, Clalit Services District of Jerusalem, Jerusalem, Israel
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milenko Tomić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University for Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | | | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| |
Collapse
|
26
|
Hen Y, Otaki Y, Iguchi N, Takara A, Takada K, Kanisawa M, Machida H, Inoue K, Takamisawa I, Takayama M. High-risk imaging characteristics in left ventricular apex for the life-threatening arrhythmic events in Japanese hypertrophic cardiomyopathy patients. Heart Vessels 2023; 38:1442-1450. [PMID: 37587371 DOI: 10.1007/s00380-023-02295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
Left ventricular (LV) apical aneurysm is known to be associated with the life-threatening arrhythmic events in hypertrophic cardiomyopathy (HCM). However, the current 2014 ESC guideline has not included apical aneurysm as a major risk factor for sudden cardiac death and 2018 JCS guideline includes it only as a modulator, while it has been included as a new major risk marker in 2020 AHA/ACC guideline. Therefore, we sought to identify high-risk imaging characteristics in LV apex which is associated with a higher occurrence of ventricular tachycardia/fibrillation (VT/VF). In 99 consecutive Japanese HCM patients (median age, 65 years; 59 males) undergoing implantable cardioverter-defibrillator (ICD) implantation for primary prevention following cardiac magnetic resonance including late gadolinium enhancement (LGE), the occurrence of appropriate ICD interventions for VT/VF was evaluated for 6.2 (median) years after ICD implantation. Overall, appropriate ICD interventions occurred in 43% with annual rates of 7.0% for appropriate interventions. Kaplan-Meier analysis demonstrated that the presence of LV apical aneurysm was significantly associated with a higher occurrence of appropriate interventions (annual rates 18.9% vs. 6.4%, P = 0.013). Similarly, patients with high LV mid-to-apex pressure gradient (annual rates 14.9% vs. 6.2%, P = 0.022) and presence of apical LGE (annual rates 10.9% vs. 4.0%, P = 0.001) experienced appropriate interventions more frequently. An aneurysm, high-pressure gradient, and LGE in an apex are associated with VT/VF. These characteristics in apex should be kept in mind when implanting ICD in Japanese HCM patients as a primary prevention.
Collapse
MESH Headings
- Aged
- Humans
- Male
- Aneurysm
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Contrast Media
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- East Asian People
- Gadolinium
- Risk Factors
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/therapy
- Ventricular Fibrillation/etiology
- Ventricular Fibrillation/prevention & control
- Female
- Heart Aneurysm/diagnostic imaging
- Heart Aneurysm/etiology
- Heart Ventricles/diagnostic imaging
Collapse
Affiliation(s)
- Yasuki Hen
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan.
| | - Yuka Otaki
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Ayako Takara
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Kaori Takada
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Mitsuru Kanisawa
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Haruhiko Machida
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan
| |
Collapse
|
27
|
Habib M, Hoss S, Adler A, Katz O, Halloun Habib H, Fardfini K, Rakowski H, Chan RH. Apical Aneurysm Development in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2023; 16:e015555. [PMID: 37905406 DOI: 10.1161/circimaging.123.015555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Manhal Habib
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, ON, Canada. Now with Department of Cardiology, Rambam Health Care Campus, Haifa, Israel (M.H.)
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Zhang R, Zhao F, Wang J, Qin Y, Wang T, Chu AA. Case Report: Integrated echocardiographic assessment guided Liwen procedure for treating obstructive hypertrophic cardiomyopathy with ventricular aneurysm. Front Cardiovasc Med 2023; 10:1278457. [PMID: 38028451 PMCID: PMC10646534 DOI: 10.3389/fcvm.2023.1278457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease, with an estimated incidence of 0.2%-6%, and is the main cause of sudden cardiac death (SCD) in young athletes. Left ventricular apical aneurysm (LVAA) is a rare subtype of HCM, accounting for about 5% of HCM patients, and has a higher incidence of cardiovascular adverse events. In cases of hypertrophic obstructive cardiomyopathy with LVAA (HOCM-LVAA) that do not respond adequately to optimized medical therapy, the echocardiography-guided percutaneous intra-myocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) emerges as a promising and effective novel therapeutic approach. In this case report, we present for the first time a comprehensive application of echocardiographic techniques, including TTE, 2-D STE, and contrast enhancement, in the diagnosis, treatment, surgical guidance, and assessment of therapeutic outcomes in a case of HOCM-LVAA.
Collapse
Affiliation(s)
| | | | | | | | | | - Ai-Ai Chu
- Department of Echocardiography, First Clinical Medicine School, Gansu Province Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| |
Collapse
|
29
|
Qi W, Pu L, Zhang J, Chen H, Tang Z, Wang J, Han Y, Chen Y. Validation of the Risk Stratification for Sudden Cardiac Death in Chinese Patients With Hypertrophic Cardiomyopathy. Curr Probl Cardiol 2023; 48:101875. [PMID: 37331610 DOI: 10.1016/j.cpcardiol.2023.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
Accurate identification of hypertrophic cardiomyopathy (HCM) patients at high risk of sudden cardiac death (SCD) event is challenging. The objective of this study was to validate the three SCD risk stratifications recommended by the 2014 European Society of Cardiology (ESC) guideline, the 2020 American Heart Association /American College of Cardiology (AHA/ACC) guideline, and the 2022 ESC guideline in Chinese patients with HCM. Our study population are made up of a cohort of 856 HCM patients without prior SCD events. The endpoint was defined as SCD or equivalent events (successful resuscitation after cardiac arrest or appropriate ICD shock for ventricular tachycardia or ventricular fibrillation). During a median follow-up of 43 months, SCD endpoints occurred in 44 (5.1%) patients. A total of 34 (77.3%) patients suffering from SCD events were classified correctly into high-risk groups by the 2020 AHA/ACC guideline, 27(61.4%) by the 2022 ESC guideline, and 13 (29.6%) by the 2014 ESC guideline. The C-statistic of the 2020 AHA/ACC guideline was 0.68 (95% CI, 0.60-0.76), which performed better than the 2022 ESC guideline (0.65: 95% CI, 0.56-0.73), and the 2014 ESC guideline (0.58: 95% CI, 0.48-0.67). The 2020 AHA/ACC guideline displayed better discrimination for SCD risk stratification in Chinese HCM patients than the other two guidelines, with a higher sensitivity but lower specificity.
Collapse
MESH Headings
- Humans
- United States
- Risk Assessment
- Risk Factors
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Arrhythmias, Cardiac
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- China/epidemiology
Collapse
Affiliation(s)
- Weitang Qi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lutong Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jinquan Zhang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Zihuan Tang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuchi Han
- Wexner Medical Center, College of Medicine, The Ohio State University, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|
30
|
Vidal-Perez R, Brandão M, Zaher W, Casado-Arroyo R, Bouzas-Mosquera A, Fontes-Carvalho R, Vazquez-Rodriguez JM. Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies. World J Cardiol 2023; 15:487-499. [PMID: 37900906 PMCID: PMC10600791 DOI: 10.4330/wjc.v15.i10.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Cardiomyopathies represent a diverse group of heart muscle diseases with varying etiologies, presenting a diagnostic challenge due to their heterogeneous manifestations. Regular evaluation using cardiac imaging techniques is imperative as symptoms can evolve over time. These imaging approaches are pivotal for accurate diagnosis, treatment planning, and optimizing prognostic outcomes. Among these, cardiovascular magnetic resonance (CMR) stands out for its ability to provide precise anatomical and functional assessments. This manuscript explores the significant contributions of CMR in the diagnosis and management of patients with cardiomyopathies, with special attention to risk stratification. CMR's high spatial resolution and tissue characterization capabilities enable early detection and differentiation of various cardiomyopathy subtypes. Additionally, it offers valuable insights into myocardial fibrosis, tissue viability, and left ventricular function, crucial parameters for risk stratification and predicting adverse cardiac events. By integrating CMR into clinical practice, clinicians can tailor patient-specific treatment plans, implement timely interventions, and optimize long-term prognosis. The non-invasive nature of CMR reduces the need for invasive procedures, minimizing patient discomfort. This review highlights the vital role of CMR in monitoring disease progression, guiding treatment decisions, and identifying potential complications in patients with cardiomyopathies. The utilization of CMR has significantly advanced our understanding and management of these complex cardiac conditions, leading to improved patient outcomes and a more personalized approach to care.
Collapse
Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), A Coruña 15006, Galicia, Spain.
| | - Mariana Brandão
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Wael Zaher
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Brussels, Belgium
| | - Ruben Casado-Arroyo
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Brussels, Belgium
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), A Coruña 15006, Galicia, Spain
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
| | | |
Collapse
|
31
|
Crean AM, Small GR, Saleem Z, Maharajh G, Ruel M, Chow BJW. Application of Cardiovascular Computed Tomography to the Assessment of Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 205:481-492. [PMID: 37683571 DOI: 10.1016/j.amjcard.2023.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy is a common inherited cardiac condition in which regional myocardial thickening and scarring can lead to a range of symptoms including breathlessness, dizziness, chest pain, and collapse with loss of consciousness. It is vital to be able to understand the mechanisms behind these epiphenomena and to be able to distinguish, for example, between syncope because of arrhythmia versus syncope because of mechanical outflow tract obstruction. Therefore, we require a technique that can characterize anatomy, physiology, and myocardial substrate. Traditionally, this role has been the preserve of cardiac magnetic resonance (CMR) imaging. This review makes the case for cardiac computed tomography (CT) as an alternative imaging method. We review the use of functional CT to identify the components of outflow tract obstruction (and obstruction at other levels, which may be simultaneous), and as an aid to interventional and surgical planning. We demonstrate the added value of multiplanar isotropic reformats in this condition, particularly in cases where the diagnosis may be more challenging or where complications (such as early apical aneurysm) may be difficult to recognize with 2-dimensional techniques. In conclusion, our aim is to convince readers that cardiac CT is a highly valuable and versatile tool, which deserves wider usage and greater recognition in those caring for patients with hypertrophic cardiomyopathy.
Collapse
Affiliation(s)
- Andrew M Crean
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Gary R Small
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zain Saleem
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gyaandeo Maharajh
- Division of Cardiovascular Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
32
|
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 349] [Impact Index Per Article: 349.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
33
|
Peters M, Jan MF, Ashraf M, Sanders H, Roemer S, Schweitzer M, Adefisoye J, Galazka P, Jain R, Jahangir A, Khandheria B, Tajik AJ. Myocardial Work in Apical Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:1043-1054.e3. [PMID: 37406714 DOI: 10.1016/j.echo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pressure-strain loop analysis is a novel echocardiographic technique to calculate myocardial work indices that has not been applied to patients with apical hypertrophic cardiomyopathy (ApHCM). We hypothesized that myocardial work indices differ between patients with ApHCM and those with non-ApHCM. This study aimed to (1) evaluate myocardial work indices in patients with ApHCM compared with those with non-ApHCM, (2) describe associations with relevant clinical variables, and (3) examine associations with significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. METHODS We retrospectively identified 48 patients with ApHCM and 69 with non-ApHCM who had measurements of global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. We evaluated available cardiac magnetic resonance imaging data on 34 patients with ApHCM and 51 with non-ApHCM. Multivariable regression models correcting for traditional cardiac risk factors were used to evaluate the associations of myocardial work indices with relevant clinical variables. RESULTS Median GLS (-11% vs -18%, P < .001), GWI (966 mm Hg% vs 1803 mm Hg%, P < .001), and GCW (1,050 mm Hg% vs 1,988 mm Hg%, P < .001) were significantly impaired in patients with ApHCM compared with those with non-ApHCM. Increasing N-terminal pro b-type natriuretic peptide, abnormal ultrasensitive troponin, and increasing maximal left ventricular wall thickness were significantly associated with reduced GWI and GCW in patients with ApHCM (P < .05). Global constructive work had only modest accuracy (area under the curve [AUC] = 0.70) to predict LGE in patients with ApHCM. However, in patients with non-ApHCM, GLS was the strongest predictor of LGE (AUC = 0.91), with a -17% cutoff yielding 81% sensitivity and 80% specificity. CONCLUSION Myocardial work indices are significantly impaired in patients with ApHCM compared to those with non-ApHCM and correlate with important clinical variables. Global longitudinal strain, GWI, and GCW are more strongly predictive of fibrosis in patients with non-ApHCM than ApHCM.
Collapse
Affiliation(s)
- Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Muddasir Ashraf
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Heather Sanders
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - McKenzie Schweitzer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - James Adefisoye
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Bijoy Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin.
| |
Collapse
|
34
|
Al Samarraie A, Petzl A, Cadrin-Tourigny J, Tadros R. Sudden Death Risk Assessment in Hypertrophic Cardiomyopathy Across the Lifespan: Reconciling the American and European Approaches. Card Electrophysiol Clin 2023; 15:367-378. [PMID: 37558306 DOI: 10.1016/j.ccep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiac disease. Since the modern description of HCM more than seven decades ago, great focus has been placed on preventing its most catastrophic complication: sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICD) have been recognized to provide effective prophylactic therapy. Over the years, two leading societies, the European Society of Cardiology (ESC) and the American Heart Association/American College of Cardiology (AHA/ACC), have proposed risk stratification models to assess SCD in adults. European guidelines rely on a risk calculator, the HCM Risk-SCD, while American guidelines propose a stand-alone risk factor approach. Recently, risk prediction models were also developed in the pediatric population. This article reviews the latest recommendations on the risk stratification of SCD in HCM and summarises current indications for ICD use.
Collapse
Affiliation(s)
- Ahmad Al Samarraie
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Adrian Petzl
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, 5000 Bélanger, Montreal, Quebec H1T 1C8, Canada; Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada.
| |
Collapse
|
35
|
Rouskas P, Zegkos T, Ntelios D, Gossios T, Parcharidou D, Papanastasiou CA, Karamitsos T, Vassilikos V, Kouskouras K, Efthimiadis GK. Prevalence, characteristics, and natural history of apical phenotype in a large cohort of patients with hypertrophic cardiomyopathy. Hellenic J Cardiol 2023; 73:8-15. [PMID: 36775018 DOI: 10.1016/j.hjc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Apical hypertrophic cardiomyopathy (ApHCM) is a variant of hypertrophic cardiomyopathy (HCM) with distinct imaging and clinical characteristics. Data on the prognosis of this HCM subgroup appear conflicting. Our study aims to clarify the natural history of ApHCM and identify predictors of outcomes. MATERIALS AND METHODS A total of 856 patients with HCM were retrospectively examined. ApHCM was defined as asymmetric left ventricular hypertrophy confined predominantly at the apex, either isolated (pure ApHCM type) or with co-existent hypertrophy of the interventricular septum (mixed ApHCM). Echocardiographic, clinical, and survival data were compared between individuals with ApHCM and non-ApHCM. RESULTS A total of 143 (16.7%) patients were diagnosed with ApHCM. Compared with non-ApHCM, subjects with apical HCM were diagnosed at an older age and had better echocardiographic indices and more comorbidities at baseline. Apical aneurysms were more prevalent among the ApHCM phenotype (6.3% vs. 1.7%, p = 0.003). During a mean follow-up of 6 ± 3 years, ApHCM was characterized by lower all-cause, cardiovascular, heart failure-related mortality, and ventricular arrhythmic events compared with non-ApHCM. Multivariate analysis identified atrial fibrillation and HCM risk-sudden cardiac death (SCD) as independent predictors of the composite outcome of overall mortality and hospitalizations for cardiovascular reasons (hazard ratio [HR] 4.3, 95% confidence interval [CI] 1.9-9.5 for atrial fibrillation and HR 1.2, 95% CI 1.02-1.3 for HCM risk-SCD) in ApHCM. CONCLUSIONS ApHCM exhibited a lower rate of all-cause mortality and arrhythmic events in the middle-aged population of patients with HCM. Atrial fibrillation and HCM risk-sudden cardiac death were independent predictors of a composite of overall mortality and cardiovascular hospitalizations among those with ApHCM.
Collapse
Affiliation(s)
- Pavlos Rouskas
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Zegkos
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
| | - Dimitris Ntelios
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Gossios
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | | | | | | | - Vassilis Vassilikos
- Third Cardiology Department, HIPPOKRATION University Hospital, Thessaloniki, Greece
| | - Kostantinos Kouskouras
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | |
Collapse
|
36
|
Siontis KC, Ommen SR, Geske JB. Art and science of risk stratification of sudden cardiac death in hypertrophic cardiomyopathy: Current state, unknowns, and future directions. Prog Cardiovasc Dis 2023; 80:25-31. [PMID: 37586655 DOI: 10.1016/j.pcad.2023.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
The progress in the management of hypertrophic cardiomyopathy (HCM) over the last several decades has resulted in great improvements in quality of life and overall survival for HCM patients. Yet, sudden cardiac death (SCD) due to ventricular tachyarrhythmias is among the common causes of HCM-related mortality. SCD risk stratification is a central and often challenging domain in the care of the HCM patient. Distinguishing the individuals most likely to benefit from a primary prevention implantable-cardioverter defibrillator (ICD) from those truly at a low risk of SCD in whom an ICD is not necessary is a nuanced process. Clinicians need to carefully balance the potential benefit and risks of ICDs, particularly in young patients. Because of intense investigations in diverse HCM cohorts globally, two main approaches to SCD risk stratification in HCM have emerged, one based on major SCD risk factors and one based on a mathematically derived risk score. In this overview, we discuss the current state, latest advances and remaining unknowns about established and novel markers of risk of SCD in HCM. We also review how the risk factor- and risk score-based assessments can and should be used in conjunction to enhance rather than contradict each other in facilitating informed ICD decision-making in contemporary clinical practice.
Collapse
Affiliation(s)
- Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
| |
Collapse
|
37
|
Tiemuerniyazi X, Chen L, Song Y, Zhao W, Feng W. Clinical Outcomes After the Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy With Left Ventricular Apical Aneurysm. Heart Lung Circ 2023; 32:1122-1127. [PMID: 37355430 DOI: 10.1016/j.hlc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Left ventricular apical aneurysm (LVAA) is a rare complication of hypertrophic obstructive cardiomyopathy (HOCM). This study aimed to illustrate the clinical characteristics and surgical outcomes of these patients. METHOD Patients with HOCM and LVAA who underwent modified extended Morrow myectomy and surgical left ventricular reconstruction (SLVR) between October 2012 and March 2021 were retrospectively recruited. Patients with coronary artery disease were excluded. Clinical characteristics were summarised. Time-to-event outcomes were calculated using the Kaplan-Meier method and compared by a log-rank test. RESULTS Fifteen eligible patients were identified; the mean age was 39.9±17.2 years and 40.0% of them were female. All patients had dyspnoea, 46.7% presented with syncope and/or chest pain, and 13.3% had a family history of hypertrophic cardiomyopathy. The mean LVAA size was 36.9±12.3 mm in length and 28.5±11.3 mm in width. Echocardiography showed LV outflow tract obstruction in seven (46.7%) patients, mid-cavity LV obstruction in 12 (80.0%), while systolic anterior motion (SAM) was seen in seven (46.7%). The symptoms were resolved in all patients postoperatively. During a median follow-up of 22.0 months, one (6.7%) patient had sudden cardiac death, one (6.7%) had a haemorrhagic stroke, and the LVAA recurrence was 40.0%. Subgroup analysis showed that signs of SAM and larger LVAA (≥30 mm) were associated with an increased tendency for a longer hospital stay. CONCLUSIONS Patients with HOCM and LVAA present with high-risk profiles. Modified extended Morrow myectomy combined with SLVR is useful in relieving the symptoms and improving the prognosis, although there might be recurrent LVAA.
Collapse
Affiliation(s)
- Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangcai Chen
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
38
|
Tfelt-Hansen J, Garcia R, Albert C, Merino J, Krahn A, Marijon E, Basso C, Wilde AAM, Haugaa KH. Risk stratification of sudden cardiac death: a review. Europace 2023; 25:euad203. [PMID: 37622576 PMCID: PMC10450787 DOI: 10.1093/europace/euad203] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Sudden cardiac death (SCD) is responsible for several millions of deaths every year and remains a major health problem. To reduce this burden, diagnosing and identification of high-risk individuals and disease-specific risk stratification are essential. Treatment strategies include treatment of the underlying disease with lifestyle advice and drugs and decisions to implant a primary prevention implantable cardioverter-defibrillator (ICD) and perform ablation of the ventricles and novel treatment modalities such as left cardiac sympathetic denervation in rare specific primary electric diseases such as long QT syndrome and catecholaminergic polymorphic ventricular tachycardia. This review summarizes the current knowledge on SCD risk according to underlying heart disease and discusses the future of SCD prevention.
Collapse
Affiliation(s)
- Jacob Tfelt-Hansen
- Cardiology Department, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V’s Vej 11, Copenhagen 2100, Denmark
| | - Rodrigue Garcia
- Cardiology Department, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
- Centre d'Investigation Clinique 1402, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
| | - Christine Albert
- Cardiology Department, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA, USA
| | - Jose Merino
- Department of Cardiology, La Paz University Hospital, IdiPaz, P. Castellana, 261, Madrid 28046, Spain
- Department of Cardiology, Viamed Santa Elena University Hospital, C/La Granja, 8, Madrid 28003, Spain
| | - Andrew Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova 35121, Italy
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| |
Collapse
|
39
|
Maron BJ, Estes NAM, Rowin EJ, Maron MS, Reynolds MR. Development of the Implantable Cardioverter-Defibrillator: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2023; 82:353-373. [PMID: 37468191 DOI: 10.1016/j.jacc.2023.04.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 07/21/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) represent transformational technology, arguably the most significant advance in cardiovascular medicine in 50 years. The vision and determination of pioneers Mirowski and Mower was fundamental to this monumental achievement, working with limited resources and confronted by skepticism/criticism from medical establishment. The inventors were followed >35 years in which a multitude of innovative clinical scientists and engineers introduced technological advances leading to the sophisticated devices in practice today. A pivotal patient experiment with automated termination of ventricular fibrillation (1980) led to U.S. Food and Drug Administration approval. Transvenous lead systems converted ICDs from thoracotomy-based secondary prevention to primary prevention of sudden death devices in countless patients worldwide. ICD acceptance was solidified by prospective randomized controlled trials showing reduced mortality superior to antiarrhythmic drugs. ICDs eventually expanded from coronary disease to inherited arrhythmia conditions (eg, hypertrophic cardiomyopathy). The ICD breakthrough story demonstrates how significant progress is possible in medicine against all odds, given fearless imagination to pursue novel ideas that conflict with accepted wisdom.
Collapse
Affiliation(s)
- Barry J Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | |
Collapse
|
40
|
Rashdan L, Hodovan J, Masri A. Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis. Curr Opin Cardiol 2023:00001573-990000000-00084. [PMID: 37421401 DOI: 10.1097/hco.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy. RECENT FINDINGS Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM. SUMMARY Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.
Collapse
Affiliation(s)
- Lana Rashdan
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | | | | |
Collapse
|
41
|
Perillo EF, Canciello G, Borrelli F, Todde G, Imbriaco M, Ordine L, Di Napoli S, Lombardi R, Esposito G, Losi MA. Diagnosis and Clinical Implication of Left Ventricular Aneurysm in Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2023; 13:diagnostics13111848. [PMID: 37296698 DOI: 10.3390/diagnostics13111848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease with heterogeneous clinical presentation and prognosis. Within the broad phenotypic expression of HCM, there is a subgroup of patients with a left ventricular (LV) apical aneurysm, which has an estimated prevalence between 2% and 5%. LV apical aneurysm is characterized by an area of apical dyskinesis or akinesis, often associated with regional scarring. To date, the most accepted pathomechanism of this complication is, in absence of coronary artery disease, the high systolic intra-aneurysmal pressure, which, combined with impaired diastolic perfusion from lower stroke volume, results in supply-demand ischemia and myocardial injury. Apical aneurysm is increasingly recognized as a poor prognostic marker; however, the efficacy of prophylactic anticoagulation and/or intracardiac cardioverted defibrillator (ICD) in improving morbidity and mortality is not yet clearly demonstrated. This review aims to elucidate the mechanism, diagnosis and clinical implication of LV aneurysm in patients with HCM.
Collapse
Affiliation(s)
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Felice Borrelli
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Gaetano Todde
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Leopoldo Ordine
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Salvatore Di Napoli
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Raffaella Lombardi
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| |
Collapse
|
42
|
Lazzeroni D, Crocamo A, Ziveri V, Notarangelo MF, Rizzello D, Spoladori M, Donelli D, Cacciola G, Ardissino D, Niccoli G, Peretto G. Personalized Management of Sudden Death Risk in Primary Cardiomyopathies: From Clinical Evaluation and Multimodality Imaging to Ablation and Cardioverter-Defibrillator Implant. J Pers Med 2023; 13:jpm13050877. [PMID: 37241047 DOI: 10.3390/jpm13050877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Sudden cardiac death represents the leading cause of death worldwide; although the majority of sudden deaths occur in an elderly population with coronary artery disease, some occur in young and otherwise healthy individuals, as is the case of cardiomyopathies. The aim of the present review is to provide a stepwise hierarchical approach for the global sudden death risk estimation in primary cardiomyopathies. Each individual risk factor is analyzed for its contribution to the overall risk of sudden death for each specific cardiomyopathy as well as across all primary myocardial diseases. This stepwise hierarchical and personalized approach starts from the clinical evaluation, subsequently passes through the role of electrocardiographic monitoring and multimodality imaging, and finally concludes with genetic evaluation and electro-anatomical mapping. In fact, the sudden cardiac death risk assessment in cardiomyopathies depends on a multiparametric approach. Moreover, current indications for ventricular arrhythmia ablation and defibrillator implantation are discussed.
Collapse
Affiliation(s)
- Davide Lazzeroni
- Prevention and Rehabilitation Unit of Parma, IRCCS Fondazione Don Gnocchi, 43100 Parma, Italy
| | - Antonio Crocamo
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Valentina Ziveri
- Prevention and Rehabilitation Unit of Parma, IRCCS Fondazione Don Gnocchi, 43100 Parma, Italy
| | | | - Davide Rizzello
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Matteo Spoladori
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Davide Donelli
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Giovanna Cacciola
- Prevention and Rehabilitation Unit of Parma, IRCCS Fondazione Don Gnocchi, 43100 Parma, Italy
| | - Diego Ardissino
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Giampaolo Niccoli
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| |
Collapse
|
43
|
Lo Russo GV, Pepi M, Mushtaq S, Mantegazza V, Celeste F. Is There a Typical Doppler Pattern in Patients With Apical Hypertrophic Cardiomyopathy With Aneurysm? JACC Case Rep 2023; 14:101836. [PMID: 37152703 PMCID: PMC10157147 DOI: 10.1016/j.jaccas.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/26/2023] [Accepted: 03/01/2023] [Indexed: 05/09/2023]
Abstract
Nineteen consecutive patients with apical hypertrophic cardiomyopathy and apical aneurysm underwent a comprehensive echo-Doppler including continuous wave Doppler at midventricular level. Three different flow patterns, pattern A (more frequent), pattern B, and pattern C, and expression of different intracavitary pressure gradients were defined. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Gerardo Vito Lo Russo
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Address for correspondence: Dr Gerardo Vito Lo Russo, Centro Cardiologico Fondazione Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, Milan 20138, Italy.
| | - Mauro Pepi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Valentina Mantegazza
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Fabrizio Celeste
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| |
Collapse
|
44
|
Wang RS, Rowin EJ, Maron BJ, Maron MS, Maron BA. A novel patient-patient network medicine approach to refine hypertrophic cardiomyopathy subgrouping: implications for risk stratification. Cardiovasc Res 2023; 119:e125-e127. [PMID: 37129987 PMCID: PMC10409890 DOI: 10.1093/cvr/cvad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Rui-Sheng Wang
- Division of Cardiovascular Medicine, Department of Medicine, 77 Ave Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine, 77 Ave Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
| |
Collapse
|
45
|
Heydari B, Satriano A, Jerosch-Herold M, Kolm P, Kim DY, Cheng K, Choi YL, Antiochos P, White JA, Mahmod M, Chan K, Raman B, Desai MY, Ho CY, Dolman SF, Desvigne-Nickens P, Maron MS, Friedrich MG, Schulz-Menger J, Piechnik SK, Appelbaum E, Weintraub WS, Neubauer S, Kramer CM, Kwong RY. 3-Dimensional Strain Analysis of Hypertrophic Cardiomyopathy: Insights From the NHLBI International HCM Registry. JACC Cardiovasc Imaging 2023; 16:478-491. [PMID: 36648040 PMCID: PMC10802851 DOI: 10.1016/j.jcmg.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abnormal global longitudinal strain (GLS) has been independently associated with adverse cardiac outcomes in both obstructive and nonobstructive hypertrophic cardiomyopathy. OBJECTIVES The goal of this study was to understand predictors of abnormal GLS from baseline data from the National Heart, Lung, and Blood Institute (NHLBI) Hypertrophic Cardiomyopathy Registry (HCMR). METHODS The study evaluated comprehensive 3-dimensional left ventricular myocardial strain from cine cardiac magnetic resonance in 2,311 patients from HCMR using in-house validated feature-tracking software. These data were correlated with other imaging markers, serum biomarkers, and demographic variables. RESULTS Abnormal median GLS (> -11.0%) was associated with higher left ventricular (LV) mass index (93.8 ± 29.2 g/m2 vs 75.1 ± 19.7 g/m2; P < 0.0001) and maximal wall thickness (21.7 ± 5.2 mm vs 19.3 ± 4.1 mm; P < 0.0001), lower left (62% ± 9% vs 66% ± 7%; P < 0.0001) and right (68% ± 11% vs 69% ± 10%; P < 0.01) ventricular ejection fractions, lower left atrial emptying functions (P < 0.0001 for all), and higher presence and myocardial extent of late gadolinium enhancement (6 SD and visual quantification; P < 0.0001 for both). Elastic net regression showed that adjusted predictors of GLS included female sex, Black race, history of syncope, presence of systolic anterior motion of the mitral valve, reverse curvature and apical morphologies, LV ejection fraction, LV mass index, and both presence/extent of late gadolinium enhancement and baseline N-terminal pro-B-type natriuretic peptide and troponin levels. CONCLUSIONS Abnormal strain in hypertrophic cardiomyopathy is associated with other imaging and serum biomarkers of increased risk. Further follow-up of the HCMR cohort is needed to understand the independent relationship between LV strain and adverse cardiac outcomes in hypertrophic cardiomyopathy.
Collapse
Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | | | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James A White
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Chan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Martin S Maron
- Lahey Hospital & Medical Center, Boston, Massachusetts, USA
| | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Stefan Neubauer
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| |
Collapse
|
46
|
Larriva AM, Uvera SR, Vásquez Z, Fernández B, Azanza DXC. Cardiac magnetic resonance as a risk re-stratification tool in apical hypertrophic cardiomyopathy. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:78-82. [PMID: 37780950 PMCID: PMC10538924 DOI: 10.47487/apcyccv.v4i2.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023]
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) can result in the formation of a left ventricular apical aneurysm and progressive myocardial fibrosis, which is associated with a worse prognosis. We present the case of a 76-year-old man previously diagnosed with ApHCM seven years ago, who has been under clinical follow-up. Serial cardiac magnetic resonance (CMR) imaging was performed in 2013 and 2020 due to suspected apical aneurysm formation based on echocardiographic evaluation. The 2020 CMR imaging revealed an increase in myocardial fibrosis observed through late-gadolinium enhancement images and, for the first time, a small apical aneurysm that was not clearly visualized on two-dimensional echocardiography. The time course leading to the development of an ApHCM aneurysm is not well-defined and may impact the clinical course.
Collapse
Affiliation(s)
- Ana María Larriva
- Servicio de Cardiología, Clínica Santa Ana, Cuenca, Ecuador. Servicio de Cardiología Clínica Santa Ana Cuenca Ecuador
| | - Sandra Rosales Uvera
- Servicio de Imagen Cardiovascular, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Cuidad de México, Mexico. Servicio de Imagen Cardiovascular Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán Cuidad de México Mexico
| | - Zuilma Vásquez
- Servicio de Imagen Cardiovascular, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Cuidad de México, Mexico. Servicio de Imagen Cardiovascular Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán Cuidad de México Mexico
| | - Beatriz Fernández
- Servicio de Imagen Cardiovascular, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Cuidad de México, Mexico. Servicio de Imagen Cardiovascular Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán Cuidad de México Mexico
| | - Diego Xavier Chango Azanza
- Servicio de Cardiología, Clínica Santa Ana, Cuenca, Ecuador. Servicio de Cardiología Clínica Santa Ana Cuenca Ecuador
| |
Collapse
|
47
|
Maron MS, Rowin E, Spirito P, Maron BJ. Differing strategies for sudden death prevention in hypertrophic cardiomyopathy. Heart 2023; 109:589-594. [PMID: 36270782 PMCID: PMC10086464 DOI: 10.1136/heartjnl-2020-316693] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 11/04/2022] Open
Abstract
Sudden death (SD) has traditionally been the most visible and feared complication of hypertrophic cardiomyopathy (HCM). Substantial progress in reducing the occurrence of these catastrophic events represents a new paradigm in disease management. Prevention of SD in HCM has resulted from introduction of primary prevention ICDs that reliably terminate life-threatening ventricular tachyarrhythmias, as well as a matured risk stratification algorithm capable of reliably identifying those patients at highest risk. This initiative has been a major determinant of reducing HCM-related mortality to a low rate of 0.5%/year. In such a heterogeneous heart disease as HCM, no perfect risk stratification strategy is possible, and available approaches differ in terms of sensitivity and specificity for identifying patients with SD risk. Major cardiovascular societies, American Heart Association/American College of Cardiology in the USA and European Society of Cardiology in Europe have promoted different risk stratification guidelines creating the potential for judging SD risk in a given HCM patient differently based on commitment to a particular societal guideline or country of residence. In this review, we provide a critical but balanced assessment of these two divergent SD prevention strategies with regard to their respective strengths and weaknesses, as a guide to clinicians directly engaged in this important management issue.
Collapse
MESH Headings
- Humans
- Risk Assessment
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Defibrillators, Implantable/adverse effects
- Tachycardia, Ventricular/etiology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Risk Factors
Collapse
Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Paolo Spirito
- Divisione di Cardiologia, Ospedali Galliera, Genoa, Italy
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
48
|
Refractory electrical storm in a patient with hypertrophic cardiomyopathy and an implantable cardioverter-defibrillator. J Cardiol Cases 2023; 27:233-236. [PMID: 37180214 PMCID: PMC10173388 DOI: 10.1016/j.jccase.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
A 63-year-old man with hypertrophic cardiomyopathy (HCM), mid-ventricular obstruction, and an apical aneurysm had an episode of cardiac arrest due to sustained ventricular tachycardia (VT). He was resuscitated and an implantable cardioverter-defibrillator (ICD) was implanted. In the following years, several episodes of VT and ventricular fibrillation were successfully terminated by antitachycardia pacing or ICD shocks. Three years after ICD implantation, he was re-admitted because of refractory electrical storm (ES). Since aggressive pharmacological treatments, direct current cardioversions, and deep sedation were not effective, he underwent epicardial catheter ablation which was successful to terminate ES. However, because of the recurrence of refractory ES after one year, he proceeded to surgical left ventricular myectomy with apical aneurysmectomy which provided him a relatively stable clinical course for six years. Although epicardial catheter ablation may be an acceptable option, surgical resection of apical aneurysm seems to be most efficacious for ES in patients with HCM and an apical aneurysm. Learning objectives In patients with hypertrophic cardiomyopathy (HCM), implantable cardioverter-defibrillators (ICDs) are the gold standard of therapy for prophylaxis against sudden death. Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia can cause sudden death even in patients with ICDs. Although epicardial catheter ablation may be an acceptable option, surgical resection of apical aneurysm is most efficacious for ES in patients with HCM, mid-ventricular obstruction, and an apical aneurysm.
Collapse
|
49
|
Wang L, Wang Y, Wang J, Xiao M, Xi XY, Chen BX, Su Y, Zhang Y, Xie B, Dong Z, Zhao S, Yang MF. Myocardial Activity at 18F-FAPI PET/CT and Risk for Sudden Cardiac Death in Hypertrophic Cardiomyopathy. Radiology 2023; 306:e221052. [PMID: 36219116 DOI: 10.1148/radiol.221052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Myocardial fibrosis contributes to adverse cardiovascular events in hypertrophic cardiomyopathy (HCM). Purpose To explore the characteristics of cardiac fibroblast activation protein inhibitor (FAPI) PET/CT imaging and its relationship with the risk of sudden cardiac death (SCD) in HCM. Materials and Methods In this prospective study from July 2021 to January 2022, participants with HCM and healthy control participants underwent cardiac fluorine 18 (18F)-labeled FAPI PET/CT imaging. Myocardial FAPI activity was quantified as intensity (target-to-background uptake ratio), extent (the percent of FAPI-avid myocardium of the left ventricle [LV]), and amount (the percent of FAPI-avid myocardium of LV × target-to-background ratio). Regional wall thickness was analyzed at cardiac MRI. The 5-year SCD risk score was calculated from the 2014 European Society of Cardiology guidelines. Univariable and multivariable linear regression analyses were used to identify factors related to the FAPI amount. The correlation between FAPI amount and 5-year SCD risk was explored. Results Fifty study participants with HCM (mean age, 43 years ± 13 [SD]; 32 men) and 22 healthy control participants (mean age, 45 years ± 17; 14 men) were included. All participants with HCM had intense and inhomogeneous cardiac FAPI activity in the LV myocardium that was higher than that in healthy control participants (median target-to-background ratio, 8.8 vs 2.1, respectively; P < .001). In HCM, more segments with FAPI activity were detected than the number of hypertrophic segments (median, 14 vs five, respectively; P < .001); 84% of nonhypertrophic segments showed FAPI activity. Log-transformed FAPI amount had a positive relationship with log-transformed N-terminal probrain natriuretic peptide, high-sensitive troponin I, and left atrial diameter and a negative relationship with LV ejection fraction z-score. Degree of FAPI activity positively correlated with the 5-year SCD risk score (r = 0.32; P = .03). Conclusion Fibroblast activation protein inhibitor (FAPI) PET/CT imaging indicated intense and heterogeneous activity in hypertrophic cardiomyopathy, and FAPI uptake was associated with 5-year risk of sudden cardiac death. © RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Li Wang
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yilu Wang
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Wang
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghu Xiao
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Ying Xi
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bi-Xi Chen
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Su
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Zhang
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boqia Xie
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Dong
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min-Fu Yang
- From the Department of Nuclear Medicine (L.W., X.Y.X., B.X.C., Y.S., Y.Z., M.F.Y.) and Cardiac Center (B.X.), Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China; Intensive Care Unit, Emergency General Hospital, Beijing, China (Y.W.); and Emergency and Critical Care Center (J.W.), Department of Echocardiography (M.X.), and Department of Magnetic Resonance Imaging (Z.D., S.Z.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
50
|
Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
| | | |
Collapse
|