101
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Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins! Heart Fail Rev 2018; 22:385-399. [PMID: 28432605 DOI: 10.1007/s10741-017-9609-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.
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Affiliation(s)
- Ahmed Aljizeeri
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulbaset Sulaiman
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Naji Alhulaimi
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, AB, Canada
| | - Ahmed Alsaileek
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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102
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Nakano SJ, Menon SC. Risk stratification in pediatric hypertrophic cardiomyopathy: Insights for bridging the evidence gap? PROGRESS IN PEDIATRIC CARDIOLOGY 2018; 49:31-37. [PMID: 31097901 DOI: 10.1016/j.ppedcard.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Identification of children with hypertrophic cardiomyopathy (HCM) who are at high risk for sudden cardiac death (SCD) remains challenging. Although a large number of risk factors have been implicated in HCM associated SCD, evidence for individual risk factors are not robust. Current risk prediction models are extrapolated from adult HCM and have low positive predictive value when applied to the pediatric HCM population. Clinical factors that are strongly associated with SCD in children with HCM are limited to previous adverse cardiac event, prior syncope and extreme left ventricular hypertrophy; there are variable conclusions regarding the utility of other conventional risk factors. Additionally, while implantable cardioverter defibrillators (ICDs) are effective in aborting malignant arrhythmias, ICD complication rates are higher in children than in adults. Although echocardiography derived parameters like left atrial volume, diastolic function indices, severity of left ventricular outflow tract obstruction and abnormalities in deformation imaging (strain and strain rate) have been associated with SCD risk in childhood HCM, these echocardiographic predictors have low specificity and sensitivity. More recently, cardiac magnetic resonance (CMR) imaging derived perfusion and viability (delayed gadolinium enhancement) abnormalities have been associated with SCD in childhood HCM and warrant further investigation. Given that myocyte disarray and fibrosis are prominent histological features of HCM, novel imaging modalities that allow for improved tissue characterization may provide additional insight into HCM phenotypes that are at higher risk for SCD. T1 mapping, cardiac diffusion tensor imaging (cDTI), and assessment of a phosphocreatine/adenosine triphosphate (PCr/ATP) ratio by 31P magnetic resonance spectroscopy (31P-MRS) are future avenues of myocardial imaging that may provide additional prognostic benefit when used in conjunction with traditional assessments. Further investigations of disease pathogenesis, genotype-phenotype correlations, genetic modifiers and circulating biomarkers specific to children with HCM hold promise for a more effective and refined risk stratification model in pediatric HCM.
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Affiliation(s)
- Stephanie J Nakano
- Department of Pediatrics, Division of Cardiology, University of Colorado, Children's Hospital Colorado, United States
| | - Shaji C Menon
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States
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103
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Borisov KV. Surgery of Hypertrophic Obstructive Cardiomyopathy in Patients With Severe Hypertrophy, Myocardial Fibrosis, and Ventricular Tachycardia. Ann Thorac Surg 2018. [PMID: 29534954 DOI: 10.1016/j.athoracsur.2018.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with hypertrophic obstructive cardiomyopathy (HOCM) myocardial fibrosis is an independent predictor of adverse outcome. A new technique of HOCM surgical correction in patients with severe hypertrophy and septal myocardial fibrosis has been proposed. METHODS The excision of the asymmetrical hypertrophied area of the interventricular septum causing obstruction was performed from the conal part of the right ventricle corresponding to the zone of obstruction of the left ventricle (LV). The areas of septal myocardial fibrosis were removed corresponding to the zone of delayed enhancement imaging. Myocardial fibrosis was detected by cardiovascular magnetic resonance. Eleven patients with HOCM with severe hypertrophy, myocardial fibrosis, and episodes of ventricular tachycardia underwent this procedure. Five patients had biventricular obstruction. The follow-up period was 39 ± 9 months. RESULTS Ten patients were free of symptoms (New York Heart Association class I) and 1 patient had only mild limitations. The mean echocardiographic gradient in the LV decreased from 88.9 ± 10.0 to 9.7 ± 2.1 mm Hg, the mean value of gradient in the right ventricular outflow tract was reduced from 45.2 ± 4.7 to 3.8 ± 1.3 mm Hg. Echocardiographically determined septal thickness was reduced from 34.5 ± 3.8 to 15.5 ± 1.6 mm. Sinus rhythm without block of His bundle right branch was noted in all patients after the operation. Ventricular tachycardia was not registered. CONCLUSIONS The benefits of applying the technique include effective surgical treatment of patients with HOCM with severe hypertrophy and biventricular obstruction. It may be an appropriate choice for patients with HOCM with septal myocardial fibrosis.
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104
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Raza M, Chalfoun N, Wissam A, Hashmi H, McNamara R. Hypertrophic cardiomyopathy with a large apical ventricular aneurysm and mural thrombus. Glob Cardiol Sci Pract 2018; 2018:9. [PMID: 29644236 PMCID: PMC5857068 DOI: 10.21542/gcsp.2018.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular wall thickness in the absence of any other identifiable cause of thickness. It predisposes the patient to increased risk of sudden cardiac death (SCD) due to fatal arrhythmias. Approximately 2% of the HCM patients have left ventricular apical aneurysm. CMR imaging is better in identifying this apical aneurysm as compared to echocardiogram. This apical aneurysm, which can be akinetic or dyskinetic, increases the risk of disease-related adverse events as compared to general HCM. These adverse disease-related events include SCD, thromboembolism, and symptoms of heart failure. We report a rare case of hypertrophic cardiomyopathy in association with Williams-Beuren Syndrome. On CMR imaging, patient was found to have a large apical aneurysm and mid-ventricular obstruction with underlying thrombus. He was started on oral anticoagulation, and ICD was recommended.
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Affiliation(s)
- Munis Raza
- Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, Grand Rapids, Michigan
| | - Nagib Chalfoun
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Abdallah Wissam
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan
| | - Hamza Hashmi
- Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, Grand Rapids, Michigan
| | - Richard McNamara
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan
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105
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Lyon A, Ariga R, Mincholé A, Mahmod M, Ormondroyd E, Laguna P, de Freitas N, Neubauer S, Watkins H, Rodriguez B. Distinct ECG Phenotypes Identified in Hypertrophic Cardiomyopathy Using Machine Learning Associate With Arrhythmic Risk Markers. Front Physiol 2018; 9:213. [PMID: 29593570 PMCID: PMC5859357 DOI: 10.3389/fphys.2018.00213] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/26/2018] [Indexed: 12/24/2022] Open
Abstract
Aims: Ventricular arrhythmia triggers sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM), yet electrophysiological biomarkers are not used for risk stratification. Our aim was to identify distinct HCM phenotypes based on ECG computational analysis, and characterize differences in clinical risk factors and anatomical differences using cardiac magnetic resonance (CMR) imaging. Methods: High-fidelity 12-lead Holter ECGs from 85 HCM patients and 38 healthy volunteers were analyzed using mathematical modeling and computational clustering to identify phenotypic subgroups. Clinical features and the extent and distribution of hypertrophy assessed by CMR were evaluated in the subgroups. Results: QRS morphology alone was crucial to identify three HCM phenotypes with very distinct QRS patterns. Group 1 (n = 44) showed normal QRS morphology, Group 2 (n = 19) showed short R and deep S waves in V4, and Group 3 (n = 22) exhibited short R and long S waves in V4-6, and left QRS axis deviation. However, no differences in arrhythmic risk or distribution of hypertrophy were observed between these groups. Including T wave biomarkers in the clustering, four HCM phenotypes were identified: Group 1A (n = 20), with primary repolarization abnormalities showing normal QRS yet inverted T waves, Group 1B (n = 24), with normal QRS morphology and upright T waves, and Group 2 and Group 3 remaining as before, with upright T waves. Group 1A patients, with normal QRS and inverted T wave, showed increased HCM Risk-SCD scores (1A: 4.0%, 1B: 1.8%, 2: 2.1%, 3: 2.5%, p = 0.0001), and a predominance of coexisting septal and apical hypertrophy (p < 0.0001). HCM patients in Groups 2 and 3 exhibited predominantly septal hypertrophy (85 and 90%, respectively). Conclusion: HCM patients were classified in four subgroups with distinct ECG features. Patients with primary T wave inversion not secondary to QRS abnormalities had increased HCM Risk-SCD scores and coexisting septal and apical hypertrophy, suggesting that primary T wave inversion may increase SCD risk in HCM, rather than T wave inversion secondary to depolarization abnormalities. Computational ECG phenotyping provides insight into the underlying processes captured by the ECG and has the potential to be a novel and independent factor for risk stratification.
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Affiliation(s)
- Aurore Lyon
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Rina Ariga
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ana Mincholé
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Ormondroyd
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pablo Laguna
- Biomedical Signal Interpretation & Computational Simulation Group, CIBER-BBN, University of Zaragoza, Zaragoza, Spain
| | - Nando de Freitas
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
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106
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Baeßler B, Mannil M, Maintz D, Alkadhi H, Manka R. Texture analysis and machine learning of non-contrast T1-weighted MR images in patients with hypertrophic cardiomyopathy-Preliminary results. Eur J Radiol 2018; 102:61-67. [PMID: 29685546 DOI: 10.1016/j.ejrad.2018.03.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE To test in a first proof-of-concept study whether texture analysis (TA) allows for the detection of myocardial tissue alterations in hypertrophic cardiomyopathy (HCM) on non-contrast T1-weighted cardiac magnetic resonance (CMR) images using machine learning based approaches. METHODS This retrospective, IRB-approved study included 32 patients with known HCM. Thirty patients with normal CMR served as controls. Regions-of-interest for TA encompassing the left ventricle were drawn on short-axis non-contrast T1-weighted images using a freely available software package. Step-wise dimension reduction and texture feature selection was performed for selecting features enabling the detection of myocardial tissue alterations in HCM patients on non-contrast T1-weighted CMR images. RESULTS Comparing HCM patients and controls, four texture features were identified showing significant differences between groups (Grey-level Non-uniformity [GLevNonU]: 74 ± 17 vs. 38 ± 9, p < .001; Energy of wavelet coefficients in low-frequency sub-bands [WavEnLL]: 58 ± 5 vs. 48 ± 10, p < .001; Fraction: 0.70 ± 0.07 vs. 0.78 ± 0.05, p < .001; Sum Average: 16.6 ± 0.4 vs. 17.0 ± 0.5, p = .007). A model containing the single parameter GLevNonU proved to be the best for differentiating between HCM patients and controls with a sensitivity/specificity of 91%/93%. A cut-off of GLevNonU ≥46 allowed for distinguishing HCM patients from controls with a sensitivity/specificity of 94%/90%. Even in patients without late gadolinium enhancement (LGE), the defined cut-off led to a differentiation of LGE- patients from healthy controls with 100% sensitivity and 90% specificity. CONCLUSIONS TA on non-contrast T1-weighted images allows for the detection of myocardial tissue alterations in the setting of HCM with excellent accuracy, delivering potential novel parameters for a non-contrast assessment of myocardial texture alterations.
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Affiliation(s)
- Bettina Baeßler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland; Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Manoj Mannil
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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107
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Clinical applications of multiparametric CMR in left ventricular hypertrophy. Int J Cardiovasc Imaging 2018; 34:577-585. [DOI: 10.1007/s10554-018-1320-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/16/2017] [Indexed: 12/22/2022]
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108
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Lu DY, Pozios I, Haileselassie B, Ventoulis I, Liu H, Sorensen LL, Canepa M, Phillip S, Abraham MR, Abraham TP. Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy. J Am Heart Assoc 2018; 7:JAHA.117.006657. [PMID: 29478967 PMCID: PMC5866314 DOI: 10.1161/jaha.117.006657] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disease characterized by varying degrees of left ventricular outflow tract obstruction. In a large cohort, we compare the outcomes among 3 different hemodynamic groups. Methods and Results We prospectively enrolled patients fulfilling standard diagnostic criteria for HCM from January 2005 to June 2015. Detailed phenotypic characterization, including peak left ventricular outflow tract pressure gradients at rest and after provocation, was measured by echocardiography. The primary outcome was a composite cardiovascular end point, which included new‐onset atrial fibrillation, new sustained ventricular tachycardia/ventricular fibrillation, new or worsening heart failure, and death. The mean follow‐up was 3.4±2.8 years. Among the 705 patients with HCM (mean age, 52±15 years; 62% men), 230 with obstructive HCM were older and had a higher body mass index and New York Heart Association class. The 214 patients with nonobstructive HCM were more likely to have a history of sustained ventricular tachycardia/ventricular fibrillation and implantable cardioverter defibrillator implantation. During follow‐up, 121 patients experienced a composite cardiovascular end point. Atrial fibrillation occurred most frequently in the obstructive group. Patients with nonobstructive HCM had more frequent sustained ventricular tachycardia/ventricular fibrillation events. In multivariate analysis, obstructive (hazard ratio, 2.80; 95% confidence interval, 1.64–4.80) and nonobstructive (hazard ratio, 1.94; 95% confidence interval, 1.09–3.45) HCM were associated with more adverse events compared with labile HCM. Conclusions Nonobstructive HCM carries notable morbidity, including a higher arrhythmic risk than the other HCM groups. Patients with labile HCM have a relatively benign clinical course. Our data suggest detailed sudden cardiac death risk stratification in nonobstructive HCM and monitoring with less aggressive management in labile HCM.
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Affiliation(s)
- Dai-Yin Lu
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Iraklis Pozios
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Bereketeab Haileselassie
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD.,Division of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Johns Hopkins University, Baltimore, MD
| | - Ioannis Ventoulis
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Hongyun Liu
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Lars L Sorensen
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Marco Canepa
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Susan Phillip
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - M Roselle Abraham
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Theodore P Abraham
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD .,UCSF HCM Center of Excellence, University of California at San Francisco, San Francisco, CA
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109
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Muehlberg F, Arnhold K, Fritschi S, Funk S, Prothmann M, Kermer J, Zange L, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy - a prospective clinical cardiovascular magnetic resonance trial. J Cardiovasc Magn Reson 2018; 20:13. [PMID: 29458430 PMCID: PMC5819178 DOI: 10.1186/s12968-018-0434-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/05/2018] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Segmented phase-sensitive inversion recovery (PSIR) cardiovascular magnetic resonance (CMR) sequences are reference standard for non-invasive evaluation of myocardial fibrosis using late gadolinium enhancement (LGE). Several multi-slice LGE sequences have been introduced for faster acquisition in patients with arrhythmia and insufficient breathhold capability. The aim of this study was to assess the accuracy of several multi-slice LGE sequences to detect and quantify myocardial fibrosis in patients with ischemic and non-ischemic myocardial disease. METHODS Patients with known or suspected LGE due to chronic infarction, inflammatory myocardial disease and hypertrophic cardiomyopathy (HCM) were prospectively recruited. LGE images were acquired 10-20 min after administration of 0.2 mmol/kg gadolinium-based contrast agent. Three different LGE sequences were acquired: a segmented, single-slice/single-breath-hold fast low angle shot PSIR sequence (FLASH-PSIR), a multi-slice balanced steady-state free precession inversion recovery sequence (bSSFP-IR) and a multi-slice bSSFP-PSIR sequence during breathhold and free breathing. Image quality was evaluated with a 4-point scoring system. Contrast-to-noise ratios (CNR) and acquisition time were evaluated. LGE was quantitatively assessed using a semi-automated threshold method. Differences in size of fibrosis were analyzed using Bland-Altman analysis. RESULTS Three hundred twelve patients were enrolled (n = 212 chronic infarction, n = 47 inflammatory myocardial disease, n = 53 HCM) Of which 201 patients (67,4%) had detectable LGE (n = 143 with chronic infarction, n = 27 with inflammatory heart disease and n = 31 with HCM). Image quality and CNR were best on multi-slice bSSFP-PSIR. Acquisition times were significantly shorter for all multi-slice sequences (bSSFP-IR: 23.4 ± 7.2 s; bSSFP-PSIR: 21.9 ± 6.4 s) as compared to FLASH-PSIR (361.5 ± 95.33 s). There was no significant difference of mean LGE size for all sequences in all study groups (FLASH-PSIR: 8.96 ± 10.64 g; bSSFP-IR: 8.69 ± 10.75 g; bSSFP-PSIR: 9.05 ± 10.84 g; bSSFP-PSIR free breathing: 8.85 ± 10.71 g, p > 0.05). LGE size was not affected by arrhythmia or absence of breathhold on multi-slice LGE sequences. CONCLUSIONS Fast multi-slice and standard segmented LGE sequences are equivalent techniques for the assessment of myocardial fibrosis, independent of an ischemic or non-ischemic etiology. Even in patients with arrhythmia and insufficient breathhold capability, multi-slice sequences yield excellent image quality at significantly reduced scan time and may be used as standard LGE approach. TRIAL REGISTRATION ISRCTN48802295 (retrospectively registered).
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Affiliation(s)
- Fabian Muehlberg
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Kristin Arnhold
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Simone Fritschi
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Stephanie Funk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Marcel Prothmann
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Josephine Kermer
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Leonora Zange
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | | | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
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110
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Zhao X, Cai R, Sun L, He L, Sun W, Ma X, Song L. A correlative study of myocardial infarction scar characteristics by DE-MR and the Lown's classification of ventricular premature beats. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:987-996. [PMID: 30223422 DOI: 10.3233/xst-180398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Correlation between myocardial infarction (MI) scar by cardiac magnetic resonance and the Lown's classification of ventricular premature beats (VPBs) is poorly understood. This study aims to investigate the correlation between the MI scar characteristics by delayed-enhancement magnetic resonance imaging (DE-MRI) and the Lown's classification of VPBs. METHODS Sixty-five patients, in the convalescence stage and consolidation phase of MI, were included in this retrospective study. All patient were divided into VPBs group (n = 39) and non-VPBs group (n = 26 patients) according to the clinical diagnostic criteria of Universal Definition of MI scar. VPBs patients were assigned to Lown's I-II group and Lown's III-IV subgroup in accordance with the Lown classification criteria. Cardiac function parameters and MI scar characteristics were detected by cardiac magnetic resonance (CMR) and DE-MRI, respectively. RESULTS Lown's classification was negatively correlated with left ventricular ejection fraction (LVEF), peak ejection rate (PER) and peak filling rate (PFR) (-0.724, -0.628, -0.559), and positively correlated with MI area, MI integral, MI segments number and left ventricular end systolic volume (LVESV) (0.673, 0.655, 0.586, and 0.514), respectively.CONCLUSIONSThe study indicated that MI area and MI integral were strongly associated with Lown's classification.
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Affiliation(s)
- Xinxiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Renhui Cai
- Department of Radiology, Wuhan Asian Heart Hospital, China
| | - Lin Sun
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Liping He
- Department of Epidemiology and Biostatistics, School of Public Health of Kunming Medical University, China
| | - Wenjing Sun
- Biomedical Engineering Research Center, Kunming Medical University, China
| | - Xiaohai Ma
- Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Linsheng Song
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
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111
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Maron BJ, Maron MS. The Remarkable 50 Years of Imaging in HCM and How it Has Changed Diagnosis and Management: From M-Mode Echocardiography to CMR. JACC Cardiovasc Imaging 2017; 9:858-872. [PMID: 27388665 DOI: 10.1016/j.jcmg.2016.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/02/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
The almost 50-year odyssey of cardiac imaging in hypertrophic cardiomyopathy (HCM), revisited and described here, has been remarkable, particularly when viewed in the timeline of advances that occurred during a single generation of investigators. At each step along the way, from M-mode to 2-dimensional echocardiography to Doppler imaging, and finally over the last 10 years with the emergence of high-resolution tomographic cardiac magnetic resonance (CMR), evolution of the images generated by each new technology constituted a paradigm change over what was previously available. Together, these advances have transformed the noninvasive diagnosis and management of HCM in a number of important clinical respects. These changes include a more complete definition of the phenotype, resulting in more reliable clinical identification of patients and family members, defining mechanisms (and magnitude) of left ventricular outflow obstruction, and novel myocardial tissue characterization (including in vivo detection of fibrosis/scarring); notably, these advances afford more precise recognition of at-risk patients who are potential candidates for life-saving primary prevention defibrillator therapy. This evolution in imaging as applied to HCM has indelibly changed cardiovascular practice for this morphologically and clinically complex genetic disease.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Division of Cardiology, Boston, Massachusetts.
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Division of Cardiology, Boston, Massachusetts
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112
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Candan O, Gecmen C, Kalaycı A, Bayam E, Guner A, Gunduz S, Cersit S, Ozkan M. Left ventricular twist in hypertrophic cardiomyopathy : Predictor of nonsustained ventricular tachycardia. Herz 2017; 44:238-246. [PMID: 29038823 DOI: 10.1007/s00059-017-4633-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM). METHODS The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24-72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings. RESULTS NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; -12.8 ± 3.1 vs. -10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087-1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056-1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < -11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027). CONCLUSION Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.
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Affiliation(s)
- O Candan
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey.
| | - C Gecmen
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - A Kalaycı
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - E Bayam
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - A Guner
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - S Gunduz
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - S Cersit
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - M Ozkan
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
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113
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McDiarmid AK, Pellicori P, Cleland JG, Plein S. Taxonomy of segmental myocardial systolic dysfunction. Eur Heart J 2017; 38:942-954. [PMID: 27147609 PMCID: PMC5381597 DOI: 10.1093/eurheartj/ehw140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/10/2016] [Indexed: 12/13/2022] Open
Abstract
The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. In particular, the terms ‘viable’ and ‘hibernating’ are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. The range of inherent differences amongst imaging modalities used to define myocardial health and disease add further challenges to consistent definitions. The results of several large trials have led to renewed discussion about the classification of dysfunctional myocardial segments. This article aims to describe the diverse myocardial pathologies that may affect the myocardium in ischaemic heart disease and cardiomyopathy, and how they may be assessed with non-invasive imaging techniques in order to provide a taxonomy of myocardial dysfunction.
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Affiliation(s)
- Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Pierpaolo Pellicori
- Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon Hull, UK
| | - John G Cleland
- Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon Hull, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
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114
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Abstract
Modern advanced imaging techniques have allowed increasingly more rigorous assessment of the cardiac structure and function of several types of cardiomyopathies. In contemporary cardiology practice, echocardiography and cardiac magnetic resonance imaging are widely used to provide a basic framework in the evaluation and management of cardiomyopathies. Echocardiography is the quintessential imaging technique owing to its unique ability to provide real-time images of the beating heart with good temporal resolution, combined with its noninvasive nature, cost-effectiveness, availability, and portability. Cardiac magnetic resonance imaging provides data that are both complementary and uniquely distinct, thus allowing for insights into the disease process that until recently were not possible. The new catchphrase in the evaluation of cardiomyopathies is multimodality imaging, which is purported to be the efficient integration of various methods of cardiovascular imaging to improve the ability to diagnose, guide therapy, or predict outcomes. It usually involves an integrated approach to the use of echocardiography and cardiac magnetic resonance imaging for the assessment of cardiomyopathies, and, on occasion, single-photon emission computed tomography and such specialized techniques as pyrophosphate scanning.
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Affiliation(s)
- M Fuad Jan
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI
| | - A Jamil Tajik
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI.
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115
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Abstract
Right ventricular (RV) hypertrophy is common in patients with hypertrophic cardiomyopathy (HCM), and is associated with more severe disease. Conventional surgical strategies such as the traditional Morrow procedure pose a particularly high risk to patients with severe hypertrophy and RV obstruction, for whom the most appropriate therapeutic approach has not yet been established. We have proposed a new technique for surgical correction in patients with hypertrophic obstructive cardiomyopathy and severe hypertrophy, which involves approaching the area of obstruction by entering through the conal part of the RV. This novel technique provides effective elimination of biventricular obstruction and the precise removal of the areas of septal fibrosis in patients with hypertrophic obstructive cardiomyopathy. The current literature review analyzes the indications and various techniques for performing a RV myectomy, and presents the results of follow-up assessments in patients with biventricular obstruction and severe hypertrophy.
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Affiliation(s)
- Konstantin V Borisov
- University Paris Descartes, Sorbonne Paris Cite, 75475 Paris, France.,German-Russian Cardiac Clinic, Moscow, Russia
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116
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Incremental benefit of late gadolinium cardiac magnetic resonance imaging for risk stratification in patients with hypertrophic cardiomyopathy. Sci Rep 2017; 7:6336. [PMID: 28740148 PMCID: PMC5524944 DOI: 10.1038/s41598-017-06533-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/14/2017] [Indexed: 01/19/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has a low risk for sudden cardiac death (SCD). The ESC clinical risk prediction model estimates the risk of SCD using clinical and echocardiographical parameters without taking into account cardiac magnetic resonance (CMR) parameters. Therefore, we compared the CMR characteristics of 149 patients with low, intermediate and high ESC risk scores. In these patients left and right ventricular ejection fraction and volumes were comparable. Patients with a high ESC risk score revealed a significantly higher extent of late gadolinium enhancement (LGE) compared to patients with intermediate or a low risk scores. During follow-up of 4 years an extent of LGE ≥20% identified patients at a higher risk for major adverse cardiac arrhythmic events in the low and intermediate ESC risk group whereas an extent of LGE <20% was associated with a low risk of major adverse cardiac arrhythmic events despite a high ESC risk score ≥6%. Hence, we hypothesize that the extent of fibrosis might be an additional risk marker.
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117
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Galati G, Leone O, Pasquale F, Olivotto I, Biagini E, Grigioni F, Pilato E, Lorenzini M, Corti B, Foà A, Agostini V, Cecchi F, Rapezzi C. Histological and Histometric Characterization of Myocardial Fibrosis in End-Stage Hypertrophic Cardiomyopathy: A Clinical-Pathological Study of 30 Explanted Hearts. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.116.003090. [PMID: 27618852 DOI: 10.1161/circheartfailure.116.003090] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although noninvasively detected myocardial fibrosis (MF) has clinical implications in hypertrophic cardiomyopathy, the extent, type, and distribution of ventricular MF have never been extensively pathologically characterized. We assessed the overall amount, apex-to-base, circumferential, epicardial-endocardial distribution, pattern, and type of MF in 30 transplanted hearts of end-stage, hypertrophic cardiomyopathy. METHODS AND RESULTS Visual and morphometric histological analyses at basal, midventricular, and apical levels were performed. Overall MF ranged from 23.1% to 55.9% (mean=37.3±8.4%). Prevalent types of MF were as follows: replacement in 53.3%, interstitial-perimyocyte in 13.3%, and mixed in 33.3%. Considering left ventricular base-to-apex distribution, MF was 31.9%, 43%, and 46.2% at basal, midventricular, and apical level, respectively (P<0.001). Circumferential distributions (mean percentage of MF within the section) were as follows: anterior 11.9%, anterolateral 15.8%, inferolateral 7.0%, inferior 24.3%, anteroseptal 11%, midseptal 10.7%, and posteroseptal 11.4%; circumferential distributions for anterior and inferior right ventricular walls were 3.4% and 4.5%, respectively. Epicardial-endocardial distributions were as follows: trabecular 26.1% and subendocardial 20.2%, midwall 33.4%, and subepicardial 20.3%. Main patterns identified were as follows: midwall in 33.3% of the hearts, transmural in 23.3%, midwall-subepicardial in 23.3%, and midwall-subendocardial in 20%. CONCLUSIONS In end-stage, hypertrophic cardiomyopathy patients undergoing transplantation, more than one-third of the left ventricular myocardium was replaced by fibrosis, mainly of replacement type. MF preferentially involved the left ventricular apex and the midwall. Inferior and anterior walls and septum were maximally involved, whereas inferolateral and right ventricular were usually spared. These observations reflect the complex pathophysiology of hypertrophic cardiomyopathy and may provide clues for the timely recognition of disease progression by imaging techniques capable of quantifying MF.
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Affiliation(s)
- Giuseppe Galati
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Ornella Leone
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Ferdinando Pasquale
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Iacopo Olivotto
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Elena Biagini
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Francesco Grigioni
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Emanuele Pilato
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Massimiliano Lorenzini
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Barbara Corti
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Alberto Foà
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Valentina Agostini
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Franco Cecchi
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.)
| | - Claudio Rapezzi
- From the Units of Cardiology (G.G., F.P., E.B., F.G., M.L., A.F., C.R.), Pathology (O.L., B.C., V.A.), Cardiac Surgery (E.P.), Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, S.Orsola-Malpighi University Hospital, Italy; and Referral Center for Cardiomyopathies, Cardiothoraco-vascular Department, Careggi University Hospital, Florence, Italy (I.O., F.C.).
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118
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Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El-Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm 2017; 14:e55-e96. [DOI: 10.1016/j.hrthm.2017.03.038] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 12/18/2022]
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119
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Arghami A, Dearani JA, Said SM, O'Leary PW, Schaff HV. Hypertrophic cardiomyopathy in children. Ann Cardiothorac Surg 2017; 6:376-385. [PMID: 28944179 DOI: 10.21037/acs.2017.07.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) occurs in 1 of 500 adults and is considered to be one of the most common causes of death in young people under 35 years of age. Children with HCM are usually asymptomatic and the overall annual mortality beyond the first year of life is 1%. Septal myectomy is safe and effective in children with obstructive HCM and published data shows improved late survival compared to untreated HCM. Patient selection and surgical expertise remain critical components to ensuring successful outcomes of septal myectomy, particularly when considering prophylactic myectomy in a seemingly asymptomatic patient.
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Affiliation(s)
- Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick W O'Leary
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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121
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Hinojar R, Zamorano JL, Gonzalez Gómez A, Plaza Martin M, Esteban A, Rincón LM, Portugal JC, Jimenez Nácher JJ, Fernández-Golfín C. ESC sudden-death risk model in hypertrophic cardiomyopathy: Incremental value of quantitative contrast-enhanced CMR in intermediate-risk patients. Clin Cardiol 2017; 40:853-860. [PMID: 28614597 DOI: 10.1002/clc.22735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) remains the most common cause of sudden cardiac death (SCD) in the young; however, current strategies do not identify all HCM patients at risk. A novel validated algorithm was proposed by the last European Society of Cardiology guidelines to guide implantable cardioverter-defibrillator (ICD) therapy. Recently, extensive myocardial fibrosis was independently associated with increased risk of SCD events. This study aimed to establish the relation between myocardial fibrosis (late gadolinium enhancement [LGE] extension) and the novel SCD risk-prediction model in a real population of HCM to evaluate its potential additional value in the different risk groups. HYPOTHESIS There is a significant association between LGE extension and the novel SCD risk calculator that may help conflicting ICD decisions. METHODS Seventy-seven patients with HCM underwent routine clinical evaluation, echocardiography, and cardiac magnetic resonance study. Their SCD risk at 5 years was calculated using the new model. RESULTS Extension of LGE positively correlated with SCD risk prediction (r = 0.7, P < 0.001). Low-, intermediate-, and high-risk groups according to the model showed significantly different extent of LGE (5% ± 6% vs 18% ± 9% vs 17% ± 4%; P < 0.001). Four patients (6%) in the low-risk group and 5 (62%) in the intermediate-risk group showed extensive areas of LGE. All patients except 1 (86%) at highest risk (n = 6) showed extensive areas of LGE. CONCLUSIONS LGE extension is concordant with the novel SCD-risk model defining low- and high-risk groups; it may provide additional information, allowing better discrimination to support implantable cardioverter-defibrillator decision. LGE quantification holds promise for SCD stratification in HCM.
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Affiliation(s)
- Rocio Hinojar
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.,Department of Medicine, University of Alcalá, Madrid, Spain
| | - José Luis Zamorano
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.,Department of Medicine, University of Alcalá, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | | | - Maria Plaza Martin
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Amparo Esteban
- Department of Radiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Luis Miguel Rincón
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.,Department of Medicine, University of Alcalá, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | - Juan Carlos Portugal
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.,Department of Cardiology, University Hospital Dr. Negrín, Gran Canaria, Spain
| | | | - Covadonga Fernández-Golfín
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain.,Department of Medicine, University of Alcalá, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
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122
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Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El‐Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Ann Noninvasive Electrocardiol 2017; 22:e12447. [PMID: 28480632 PMCID: PMC6931745 DOI: 10.1111/anec.12447] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023] Open
Abstract
Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.
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Affiliation(s)
- Jonathan S. Steinberg
- Heart Research Follow‐up ProgramUniversity of Rochester School of Medicine & DentistryRochesterNYUSA
- The Summit Medical GroupShort HillsNJUSA
| | - Niraj Varma
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | | | - Peter Aziz
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Paweł Balsam
- 1st Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Daniel J. Cantillon
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Polychronis Dilaveris
- 1st Department of CardiologyUniversity of Athens Medical SchoolHippokration HospitalAthensGreece
| | - Sergio J. Dubner
- Arrhythmias and Electrophysiology ServiceClinic and Maternity Suizo Argentina and De Los Arcos Private HospitalBuenos AiresArgentina
| | | | - Jaroslaw Krol
- Department of Cardiology, Hypertension and Internal Medicine2nd Medical Faculty Medical University of WarsawWarsawPoland
| | - Malgorzata Kurpesa
- Department of CardiologyMedical University of LodzBieganski HospitalLodzPoland
| | | | | | - Emanuela T. Locati
- Cardiovascular DepartmentCardiology, ElectrophysiologyOspedale NiguardaMilanoItaly
| | | | | | - Ewa Piotrowicz
- Telecardiology CenterInstitute of CardiologyWarsawPoland
| | - Leslie Saxon
- University of Southern CaliforniaLos AngelesCAUSA
| | - Peter H. Stone
- Vascular Profiling Research GroupCardiovascular DivisionHarvard Medical SchoolBrigham & Women's HospitalBostonMAUSA
| | - Larisa Tereshchenko
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
- Cardiovascular DivisionJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Gioia Turitto
- Weill Cornell Medical CollegeElectrophysiology ServicesNew York Methodist HospitalBrooklynNYUSA
| | - Neil J. Wimmer
- Vascular Profiling Research GroupCardiovascular DivisionHarvard Medical SchoolBrigham & Women's HospitalBostonMAUSA
| | - Richard L. Verrier
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBostonMAUSA
| | - Wojciech Zareba
- Heart Research Follow‐up ProgramUniversity of Rochester School of Medicine & DentistryRochesterNYUSA
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive ElectrocardiologyNational Institute of CardiologyWarsawPoland
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Candan O, Gecmen C, Bayam E, Guner A, Celik M, Doğan C. Mechanical dispersion and global longitudinal strain by speckle tracking echocardiography: Predictors of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy. Echocardiography 2017; 34:835-842. [DOI: 10.1111/echo.13547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Ozkan Candan
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Cetin Gecmen
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Emrah Bayam
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Ahmet Guner
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Mehmet Celik
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Cem Doğan
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
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124
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Morgan RB, Kwong RY. CMR in Phenotyping the Arrhythmic Substrate. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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125
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Nawaito SA, Dingar D, Sahadevan P, Hussein B, Sahmi F, Shi Y, Gillis MA, Gaestel M, Tardif JC, Allen BG. MK5 haplodeficiency attenuates hypertrophy and preserves diastolic function during remodeling induced by chronic pressure overload in the mouse heart. Am J Physiol Heart Circ Physiol 2017; 313:H46-H58. [PMID: 28432058 DOI: 10.1152/ajpheart.00597.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 04/03/2017] [Accepted: 04/15/2017] [Indexed: 11/22/2022]
Abstract
MAPK-activated protein kinase-5 (MK5) is a protein serine/threonine kinase that is activated by p38 MAPK and the atypical MAPKs ERK3 and ERK4. The physiological function(s) of MK5 remains unknown. Here, we examined the effect of MK5 haplodeficiency on cardiac function and myocardial remodeling. At 12 wk of age, MK5 haplodeficient mice (MK5+/-) were smaller than age-matched wild-type littermates (MK5+/+), with similar diastolic function but reduced systolic function. Transverse aortic constriction (TAC) was used to induce chronic pressure overload in 12-wk-old male MK5+/- and MK5+/+ mice. Two weeks post-TAC, heart weight-to-tibia length ratios were similarly increased in MK5+/- and MK5+/+ hearts, as was the abundance of B-type natriuretic peptide and β-myosin heavy chain mRNA. Left ventricular ejection fraction was reduced in both MK5+/+ and MK5+/- mice, whereas regional peak systolic tissue velocities were reduced and isovolumetric relaxation time was prolonged in MK5+/+ hearts but not in MK5+/- hearts. The TAC-induced increase in collagen type 1-α1 mRNA observed in MK5+/+ hearts was markedly attenuated in MK5+/- hearts. Eight weeks post-TAC, systolic function was equally impaired in MK5+/+ and MK5+/- mice. In contrast, the increase in E wave deceleration rate and progression of hypertrophy observed in TAC MK5+/+ mice were attenuated in TAC MK5+/- mice. MK5 immunoreactivity was detected in adult fibroblasts but not in myocytes. MK5+/+, MK5+/-, and MK5-/- fibroblasts all expressed α-smooth muscle actin in culture. Hence, reduced MK5 expression in cardiac fibroblasts was associated with the attenuation of both hypertrophy and development of a restrictive filling pattern during myocardial remodeling in response to chronic pressure overload.NEW & NOTEWORTHY MAPK-activated protein kinase-5 (MK5)/p38-regulated/activated protein kinase is a protein serine/threonine kinase activated by p38 MAPK and/or the atypical MAPKs ERK3 and ERK4. MK5 immunoreactivity was detected in adult ventricular fibroblasts but not in myocytes. MK5 haplodeficiency attenuated the progression of hypertrophy, reduced collagen type 1 mRNA, and protected diastolic function in response to chronic pressure overload.
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Affiliation(s)
- Sherin Ali Nawaito
- Montreal Heart Institute, Montréal, Québec, Canada.,Department of Physiology and Pharmacology, Université de Montréal, Montréal, Québec, Canada
| | - Dharmendra Dingar
- Montreal Heart Institute, Montréal, Québec, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Pramod Sahadevan
- Montreal Heart Institute, Montréal, Québec, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, Québec, Canada
| | | | - Fatiha Sahmi
- Montreal Heart Institute, Montréal, Québec, Canada
| | - Yanfen Shi
- Montreal Heart Institute, Montréal, Québec, Canada
| | | | - Matthias Gaestel
- Institute of Biochemistry, Hannover Medical School, Hannover, Germany; and
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montréal, Québec, Canada.,Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Bruce G Allen
- Montreal Heart Institute, Montréal, Québec, Canada; .,Department of Physiology and Pharmacology, Université de Montréal, Montréal, Québec, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, Québec, Canada.,Department of Medicine, Université de Montréal, Montréal, Québec, Canada
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126
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Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet 2017; 389:1253-1267. [PMID: 27912983 DOI: 10.1016/s0140-6736(16)31321-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/22/2016] [Accepted: 08/02/2016] [Indexed: 12/23/2022]
Abstract
Hypertrophic obstructive cardiomyopathy is an inherited myocardial disease defined by cardiac hypertrophy (wall thickness ≥15 mm) that is not explained by abnormal loading conditions, and left ventricular obstruction greater than or equal to 30 mm Hg. Typical symptoms include dyspnoea, chest pain, palpitations, and syncope. The diagnosis is usually suspected on clinical examination and confirmed by imaging. Some patients are at increased risk of sudden cardiac death, heart failure, and atrial fibrillation. Patients with an increased risk of sudden cardiac death undergo cardioverter-defibrillator implantation; in patients with severe symptoms related to ventricular obstruction, septal reduction therapy (myectomy or alcohol septal ablation) is recommended. Life-long anticoagulation is indicated after the first episode of atrial fibrillation.
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Affiliation(s)
- Josef Veselka
- Department of Cardiology, 2nd Medical School, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Nandan S Anavekar
- Departments of Cardiology and Radiology, Mayo Clinic, Rochester, MN, USA
| | - Philippe Charron
- Université Paris Sud, UVSQ, INSERM U1018, CESP, Boulogne-Billancourt, France; APHP, ICAN, Hôpital de la Pitié Salpêtrière, Paris, France
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127
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Zhu L, Zou Y, Wang Y, Luo X, Sun K, Wang H, Jia L, Liu Y, Zou J, Yuan Z, Hui R, Kang L, Song L, Wang J. Prognostic Significance of Plasma High-Sensitivity C-Reactive Protein in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2017; 6:JAHA.116.004529. [PMID: 28154166 PMCID: PMC5523755 DOI: 10.1161/jaha.116.004529] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Elevated high‐sensitivity C‐reactive protein (hsCRP) has been associated with increased risks of adverse outcomes of various cardiovascular diseases. The relationship between hsCRP and the prognosis of hypertrophic cardiomyopathy remains to be evaluated. Methods and Results The study used an observational cohort methodology. A total of 490 patients were enrolled in the Fuwai Hospital from 2001 to 2011 and were followed for 3.7±2.0 years. According to the risk category of hsCRP, subjects in the high hsCRP group (>3.0 mg/L) had a higher risk of developing adverse events than the low hsCRP group (<1.0 mg/L): cardiovascular death (adjusted hazard ratios[HR] 5.41, 95% CI 1.96–14.93, P=0.001), all‐cause mortality (adjusted HR 4.78, 95% CI 1.99–11.47, P<0.001), sudden cardiac death (adjusted HR 11.29, 95% CI 1.38–92.20, P=0.024), and heart failure–related death (adjusted HR 4.38, 95% CI 1.15–16.60, P=0.030). Similarly, the continuous variable of hsCRP was also an independent predictor for adverse outcomes: cardiovascular death (adjusted HR 1.15, 95% CI 1.06–1.25, P=0.001), all‐cause mortality (adjusted HR 1.17, 95% CI 1.09–1.26, P<0.001), sudden cardiac death (adjusted HR 1.20, 95% CI 1.06–1.36, P=0.003), and heart failure–related death (adjusted HR 1.15, 95% CI 1.02–1.30, P=0.020). Conclusions Our results indicate that elevated plasma hsCRP is associated with increased risk for adverse outcomes in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Ling Zhu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yubao Zou
- Department of Cardiovascular Internal Medicine, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Shaanxi, China
| | - Yilu Wang
- Department of ICU, China Meitan General Hospital, Beijing, China
| | - Xiaoliang Luo
- Department of Cardiovascular Internal Medicine, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Shaanxi, China
| | - Kai Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hu Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Jia
- Department of Cardiovascular Internal Medicine, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Shaanxi, China
| | - Yan Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Juan Zou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Rutai Hui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lianming Kang
- Department of Cardiovascular Internal Medicine, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Shaanxi, China
| | - Lei Song
- Department of Cardiovascular Internal Medicine, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Shaanxi, China
| | - Jizheng Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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The Role of Cardiac MRI in the Diagnosis and Risk Stratification of Hypertrophic Cardiomyopathy. Arrhythm Electrophysiol Rev 2017. [PMID: 28116085 DOI: 10.15420/aer.2016:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM), the most common genetic cardiomyopathy, is a disease characterised by substantial heterogeneity. Although the majority of patients with HCM remain asymptomatic with near-normal longevity, a small, but important, subset remain at risk for a wide range of clinical outcomes including sudden death. Cardiovascular magnetic resonance (CMR), with its high spatial resolution and tomographic imaging capability, has emerged as an imaging modality particularly well suited to characterise the phenotypic expression of HCM. CMR helps in the diagnosis of HCM by identifying areas of hypertrophy not well visualised by echocardiography, providing more accurate wall thickness measurements and differentiating HCM from other causes of left ventricular (LV) hypertrophy. CMR has led to the identification of novel subgroups of patients with HCM, including those with LV apical aneurysms (a subgroup at increased risk for ventricular arrhythmias and thromboembolic stroke), as well as abnormalities that contribute to LV outflow obstruction. Additionally, contrast-enhanced CMR with late-gadolinium enhancement (LGE) has recognised patients with extensive LGE (≥15 % LV myocardium) as individuals who may be at increased risk of sudden death, independent of other high-risk features, with implications on management strategies including consideration for primary prevention implantable cardioverter defibrillator therapy. These observations justify an expanded role of CMR in the routine clinical assessment of patients with HCM.
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129
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Choudhury L, Rigolin VH, Bonow RO. Integrated Imaging in Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 119:328-339. [PMID: 27816114 DOI: 10.1016/j.amjcard.2016.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/27/2022]
Abstract
Hypertrophic cardiomyopathy (HC) has a very heterogeneous clinical spectrum and lends itself to multimodality imaging for evaluation and management. This review addresses clinical applications of cardiac imaging in patients with HC. Integrating various techniques of echocardiography and cardiac magnetic resonance (CMR) is discussed in the clinical context such as diagnosis, evaluation, management, risk stratification, and family screening of patients with HC. The utility of periprocedural imaging techniques is highlighted for guiding surgical and transcatheter septal reduction procedures. More limited roles of invasive or computed tomography coronary angiography are discussed for patients with HC with chest pain and risk factors for coronary artery disease. Nuclear techniques although available for decades play a more limited role in contemporary routine management but may assist in risk assessment. Newer CMR and echo imaging techniques are discussed in their emerging roles for further characterization of patients with HC and family members with prospects of preclinical diagnosis. The strengths of the different imaging modalities are presented as well as a flow diagram summarizing integrated imaging in this disease. In conclusion, integrated imaging using the various imaging techniques predominantly echocardiography and CMR based on the clinical picture plays an essential role in the management of patients with HC.
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130
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Relationship of Nonseptal Late Gadolinium Enhancement to Ventricular Tachyarrhythmia in Hypertrophic Cardiomyopathy. J Comput Assist Tomogr 2017; 41:768-771. [DOI: 10.1097/rct.0000000000000599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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131
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Echocardiography as a Screening Test for Myocardial Scarring in Children with Hypertrophic Cardiomyopathy. Int J Pediatr 2016; 2016:1980636. [PMID: 27974896 PMCID: PMC5126423 DOI: 10.1155/2016/1980636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/04/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction. Hypertrophic cardiomyopathy (HCM) is burdened with morbidity and mortality including tachyarrhythmias and sudden cardiac death. These complications are attributed in part to the formation of proarrhythmic scars in the myocardium. The presence of extensive LGE is a risk factor for adverse outcomes in HCM. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (cMRI) is the standard for the noninvasive evaluation of myocardial scars. However, echocardiography represents an attractive screening tool for myocardial scarring. The aim of this study was to compare the suitability of echocardiography to detect myocardial scars to the standard of cMRI-LGE. Methods. The cMRI studies and echocardiograms from 56 consecutive children with HCM were independently evaluated for the presence of cMRI-LGE and echocardiographic evidence of scarring by expert readers. Results. Echocardiography had a high sensitivity (93%) and negative predictive value (94%) in comparison to LGE. The false positive rate was high, leading to a low specificity (37%) and a low positive predictive value (35%). Conclusions. Given the poor specificity and positive predictive value, echocardiography is not a suitable screening test for the presence of myocardial scarring in children with HCM. However, children without echocardiographic evidence of myocardial scarring may not need to undergo cardiac magnetic resonance imaging to “rule in” LGE.
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132
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Applications of Advanced Imaging in Cardiac Electrophysiology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:66. [DOI: 10.1007/s11936-016-0491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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133
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Kato S, Nakamori S, Bellm S, Jang J, Basha T, Maron M, Manning WJ, Nezafat R. Myocardial Native T1 Time in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 118:1057-62. [PMID: 27567135 DOI: 10.1016/j.amjcard.2016.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 01/07/2023]
Abstract
In hypertrophic cardiomyopathy (HC), there are significant variations in left ventricular (LV) wall thickness and fibrosis, which necessitates a volumetric coverage. Slice-interleaved T1 (STONE) mapping sequence allows for the assessment of native T1 time with complete coverage of LV myocardium. The aims of this study were to evaluate spatial heterogeneity of native T1 time in patients with HC. Twenty-nine patients with HC (55 ± 16 years) and 15 healthy adult control subjects (46 ± 19 years) were studied. Native T1 mapping was performed using STONE sequence which enables acquisition of 5 slices in the short-axis plane within a 90 seconds free-breathing scan. We measured LV native T1 time and maximum LV wall thickness in each 16 segments from 3 slices (basal, midventricular and apical slice). Late gadolinium enhanced (LGE) magnetic resonance imaging was acquired to assess the presence of myocardial enhancement. In patients with HC, LV native T1 time was significantly elevated compared with healthy controls, regardless of the presence or absence of LGE (mean native T1 time; LGE positive segments from HC, 1,141 ± 46 ms; LGE negative segments from HC, 1,114 ± 56 ms; segments from healthy controls, 1,065 ± 35 ms, p <0.001). Elevation of native T1 time was defined as >1,135 ms, which was +2SD of native T1 time by STONE sequence in healthy controls. A total of 120 of 405 (30%) LGE negative segments from patients with HC showed elevated native T1 time. Prevalence of segments with elevated native T1 time for basal, midventricular, and apical slice was 29%, 25%, 38%, respectively. Significant correlation was found between LV wall thickness and LV native T1 time (y = 0.029 × -22.6, p <0.001 by Spearman's correlation coefficient). In conclusion, substantial number of segments without LGE showed elevation of native T1 time, and whole-heart T1 mapping revealed heterogeneity of myocardial native T1 time in patients with HC.
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134
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Parekh K, Markl M, Deng J, de Freitas RA, Rigsby CK. T1 mapping in children and young adults with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2016; 33:109-117. [PMID: 27659477 DOI: 10.1007/s10554-016-0979-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/14/2016] [Indexed: 01/19/2023]
Abstract
To assess the global and segmental left ventricular (LV) native T1 and extracellular volume fraction (ECV) in children and young adults with hypertrophic cardiomyopathy (HCM) compared to a control cohort. The study population included 21 HCM patients (mean 14.1 ± 4.6 years) and 21 controls (mean 15.7 ± 1.5 years). Native modified Look-Locker inversion recovery sequence was performed before and after contrast injection in 3 short axis planes. Global and segmental LV native T1 and ECV were quantified and compared between HCM patients and controls. Mean native T1 in HCM patients and controls was 1020.4 ± 41.2 and 965.6 ± 30.2 ms respectively (p < 0.0001). Hypertrophied myocardium had significantly higher native global T1 and global ECV compared to non-hypertrophied myocardium in HCM (p < 0.0001, = 0.14 and 0.048, = 0.01 respectively). In a subset of patients, ECV was higher in LV segments with LGE compared to no LGE (p < 0.0001). No significant correlation was identified between global native T1 and ECV and parameters of LV structure and function. Native T1 cut-off of 987 ms provided the highest sensitivity (95 %) and specificity (91 %) to separate HCM patients from controls. Global and segmental native T1 are elevated in HCM patients. LV segments with hypertrophy and/or LGE had higher ECV in a subset of HCM patients. LV native T1 and ECV do not correlate with parameters of LV structure and function. T1 in children and young adults may be used as a non-invasive tool to assess for HCM and related fibrosis.
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Affiliation(s)
- Keyur Parekh
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA.
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Chicago, IL, 60611, USA.
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, 737 N Michigan Avenue, Chicago, IL, 60611, USA
| | - Jie Deng
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Roger A de Freitas
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Chicago, IL, 60611, USA
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Jalanko M, Tarkiainen M, Sipola P, Jääskeläinen P, Lauerma K, Laine M, Nieminen MS, Laakso M, Heliö T, Kuusisto J. Left ventricular mechanical dispersion is associated with nonsustained ventricular tachycardia in hypertrophic cardiomyopathy. Ann Med 2016; 48:417-427. [PMID: 27249556 DOI: 10.1080/07853890.2016.1186826] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE We assessed the value of speckle tracking two-dimensional (2D) strain echocardiography (2DSE) measured mechanical dispersion (MD) with other imaging and electrocardiographic parameters in differentiating hypertrophic cardiomyopathy (HCM) patients with and without nonsustained ventricular tachycardia (NSVT) on 24-h ambulatory ECG monitoring. METHODS AND RESULTS We studied 31 patients with HCM caused by the Finnish founder mutation MYBPC3-Q1061X and 20 control subjects with comprehensive 2DSE echocardiography and cardiac magnetic resonance imaging (CMRI). The presence of NSVT was assessed from ambulatory 24-h ECG monitoring. NSVT episodes were recorded in 11 (35%) patients with HCM. MD was significantly higher in HCM patients with NSVT (93 ± 41 ms) compared to HCM patients without NSVT (50 ± 18 ms, p = 0.012) and control subjects (41 ± 16 ms, p < 0.001). MD was the only variable independently associated with the presence of NSVT (OR: 1.60, 95% CI: 1.05-2.45, p = 0.030). Assessed by ROC curves, MD performed best in differentiating between HCM patients with and without NSVT (AUC = 0.81). CONCLUSIONS Increased mechanical dispersion was associated with NSVT in HCM patients on 24-h ambulatory ECG monitoring. Key messages The prediction of sudden cardiac death in hypertrophic cardiomyopathy remains a challenge and novel imaging methods are required to identify individuals at risk of malignant ventricular arrhythmias. Mechanical dispersion by speckle tracking echocardiography is associated with NSVT on 24-h ambulatory ECG monitoring in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Mikko Jalanko
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Mika Tarkiainen
- b Department of Clinical Radiology , Kuopio University Hospital , Kuopio , Finland
| | - Petri Sipola
- b Department of Clinical Radiology , Kuopio University Hospital , Kuopio , Finland
| | | | - Kirsi Lauerma
- d HUS Medical Imaging Center, Radiology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mika Laine
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Markku S Nieminen
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Markku Laakso
- e Institute of Clinical Medicine, Internal Medicine and Kuopio University Hospital , Kuopio , Finland
| | - Tiina Heliö
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Johanna Kuusisto
- e Institute of Clinical Medicine, Internal Medicine and Kuopio University Hospital , Kuopio , Finland
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137
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Pozo E, Viliani D, Aguirre N, Agudo-Quilez P, Olivera MJ, Caballero P, Jiménez-Borreguero LJ, Alfonso F. Early gadolinium enhancement in hypertrophic cardiomyopathy: a potential premature marker of myocardial damage. Int J Cardiovasc Imaging 2016; 32:1635-1643. [PMID: 27503551 DOI: 10.1007/s10554-016-0954-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Abstract
Early gadolinium enhancement (EGE), one CMR diagnostic criteria in acute myocarditis, has been related with hyperemia and capillary leakage. The value of EGE in hypertrophic cardiomyopathy (HCM) remains unknown. Our aim was to determine the prevalence of EGE in patients with HCM, and its relation with late gadolinium enhancement (LGE). The association of EGE with morphological and clinical parameters was also evaluated. Sixty consecutive patients with HCM and CMR from our center were included. All the clinical and complementary test information was collected prospectively in our HCM clinic. Left ventricular (LV) measurements were calculated from cine sequences. EGE and LGE were quantified with a dedicated software. Clinical events were collected from medical records. A slow wash-out pattern on EGE was detected in up to 68 % of the patients, being an isolated finding without LGE in 10 (16 %). This cohort showed a greater maximal LV wall thickness (20.1 ± 4 vs. 18.1 ± 3.5 mm, p = 0.010) and asymmetry ratio (1.86 ± 0.42 vs. 1.62 ± 0.46; p = 0.039). The percentage of EGE/slice and the difference with the percentage LGE/slice demonstrated a significant positive correlation with the maximal LV wall thickness (Rho 0.450 and 0.386 respectively). EGE also correlated with number of segments with LVH (LV hypertrophy) and the asymmetry ratio. Neither EGE nor LGE were associated with classical risk factors, the risk score for sudden cardiac death, or with major clinical events. EGE was a frequent finding in HCM, even in absence of LGE. This phenomenon showed a positive correlation with morphological markers of disease burden.
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Affiliation(s)
- Eduardo Pozo
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain.
| | - Dafne Viliani
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain
| | - Norma Aguirre
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain
| | - Pilar Agudo-Quilez
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain
| | - María José Olivera
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Paloma Caballero
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Jesús Jiménez-Borreguero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Calle de Diego León, 62, 28006, Madrid, Spain
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138
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Quantitative comparison of 2D and 3D late gadolinium enhancement MR imaging in patients with Fabry disease and hypertrophic cardiomyopathy. Int J Cardiol 2016; 217:167-73. [DOI: 10.1016/j.ijcard.2016.04.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/20/2016] [Accepted: 04/30/2016] [Indexed: 11/21/2022]
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139
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Maron BJ, Maron MS. LGE Means Better Selection of HCM Patients for Primary Prevention Implantable Defibrillators. JACC Cardiovasc Imaging 2016; 9:1403-1406. [PMID: 27450875 DOI: 10.1016/j.jcmg.2016.01.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/14/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
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140
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Guglielmi V, Maresca L, Lanzillo C, Marinoni GM, D’Adamo M, Di Roma M, Preziosi P, Bellia A, Calò L, Sbraccia P. Relationship between Regional Fat Distribution and Hypertrophic Cardiomyopathy Phenotype. PLoS One 2016; 11:e0158892. [PMID: 27388274 PMCID: PMC4936675 DOI: 10.1371/journal.pone.0158892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/23/2016] [Indexed: 01/27/2023] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM), the most common genetic heart disease, is characterized by heterogeneous phenotypic expression. Body mass index has been associated with LV mass and heart failure symptoms in HCM. The aim of our study was to investigate whether regional (trunk, appendicular, epicardial) fat distribution and extent could be related to hypertrophy severity and pattern in HCM. Methods Cardiovascular magnetic resonance was performed in 32 subjects with echocardiography-based diagnosis of HCM (22M/10F, 57.2±12.6 years) characterized by predominant hypertrophy at the interventricular septum (IVS). Regional fat distribution was assessed by dual-energy X-ray absorptiometry. Results Gender differences were detected in maximum IVS thickness (M: 18.3±3.8 mm vs. F: 14.3±4 mm, p = 0.012), right ventricle (RV) systolic function (M: 61.3±6.7%; F: 67.5±6.3%, p = 0.048), indexed RV end-diastolic (M: 64.8±16.3 ml/m2; F: 50.7±15.5 ml/m2, p = 0.04) and end-systolic volumes (M: 24.3±8.3 ml/m2; F: 16.7±7.4 ml/m2, p = 0.04). After adjusting for age and gender, maximum IVS thickness was associated with truncal fat (Tr-FAT) (β = 0.43, p = 0.02), but not with either appendicular or epicardial fat. Epicardial fat resulted independently associated with NT-proBNP levels (β = 0.63, p = 0.04). Late Gadolinium Enhancement-positive subjects displayed greater maximum IVS thickness (p = 0.02), LV mass index (p = 0.015) and NT-proBNP levels (p = 0.04), but no associations with fat amount or distribution were observed. Conclusion Truncal, but not appendicular or epicardial fat amount, seems to be related with maximum IVS thickness, the hallmark feature in our cohort of HCM patients. Further prospective researches are needed to assess a potential causative effect of central adiposity on HCM phenotype.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Luciano Maresca
- Diagnostic Imaging Department, Policlinico Casilino, Rome, Italy
| | | | | | - Monica D’Adamo
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mauro Di Roma
- Diagnostic Imaging Department, Policlinico Casilino, Rome, Italy
| | - Paolo Preziosi
- Diagnostic Imaging Department, Policlinico Casilino, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Leonardo Calò
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- * E-mail:
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141
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Silbiger JJ. Abnormalities of the Mitral Apparatus in Hypertrophic Cardiomyopathy: Echocardiographic, Pathophysiologic, and Surgical Insights. J Am Soc Echocardiogr 2016; 29:622-39. [DOI: 10.1016/j.echo.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/30/2022]
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142
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143
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Markman TM, Nazarian S. Arrhythmia and Electrophysiological Effects of Chemotherapy: A Review. Oncology 2016; 91:61-8. [DOI: 10.1159/000446374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
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144
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Kim JH, Baggish AL. Differentiating Exercise-Induced Cardiac Adaptations From Cardiac Pathology: The “Grey Zone” of Clinical Uncertainty. Can J Cardiol 2016; 32:429-37. [DOI: 10.1016/j.cjca.2015.11.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/20/2015] [Accepted: 11/08/2015] [Indexed: 01/09/2023] Open
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145
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Everett RJ, Stirrat CG, Semple SIR, Newby DE, Dweck MR, Mirsadraee S. Assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 2016; 71:768-78. [PMID: 27005015 DOI: 10.1016/j.crad.2016.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
Myocardial fibrosis can arise from a range of pathological processes and its presence correlates with adverse clinical outcomes. Cardiac magnetic resonance (CMR) can provide a non-invasive assessment of cardiac structure, function, and tissue characteristics, which includes late gadolinium enhancement (LGE) techniques to identify focal irreversible replacement fibrosis with a high degree of accuracy and reproducibility. Importantly the presence of LGE is consistently associated with adverse outcomes in a range of common cardiac conditions; however, LGE techniques are qualitative and unable to detect diffuse myocardial fibrosis, which is an earlier form of fibrosis preceding replacement fibrosis that may be reversible. Novel T1 mapping techniques allow quantitative CMR assessment of diffuse myocardial fibrosis with the two most common measures being native T1 and extracellular volume (ECV) fraction. Native T1 differentiates normal from infarcted myocardium, is abnormal in hypertrophic cardiomyopathy, and may be particularly useful in the diagnosis of Anderson-Fabry disease and amyloidosis. ECV is a surrogate measure of the extracellular space and is equivalent to the myocardial volume of distribution of the gadolinium-based contrast medium. It is reproducible and correlates well with fibrosis on histology. ECV is abnormal in patients with cardiac failure and aortic stenosis, and is associated with functional impairment in these groups. T1 mapping techniques promise to allow earlier detection of disease, monitor disease progression, and inform prognosis; however, limitations remain. In particular, reference ranges are lacking for T1 mapping values as these are influenced by specific CMR techniques and magnetic field strength. In addition, there is significant overlap between T1 mapping values in healthy controls and most disease states, particularly using native T1, limiting the clinical application of these techniques at present.
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Affiliation(s)
- R J Everett
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK.
| | - C G Stirrat
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S I R Semple
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - D E Newby
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - M R Dweck
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S Mirsadraee
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
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146
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McLELLAN AJA, Ellims AH, Prabhu S, Voskoboinik A, Iles LM, Hare JL, Kaye DM, Macciocca I, Mariani JA, Kalman JM, Taylor AJ, Kistler PM. Diffuse Ventricular Fibrosis on Cardiac Magnetic Resonance Imaging Associates With Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2016; 27:571-80. [PMID: 26840595 DOI: 10.1111/jce.12948] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/28/2015] [Accepted: 01/12/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Non-sustained ventricular tachycardia (NSVT) is a risk factor for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess whether diffuse ventricular fibrosis on cardiac magnetic resonance (CMR) imaging could be a surrogate marker for ventricular arrhythmias in patients with HCM. METHODS A total of 100 patients with HCM (mean age 51 ± 13 years, septal wall thickness 20 ± 5 mm) underwent CMR with a 1.5 T scanner to determine the presence of ventricular late gadolinium enhancement (LGE) for focal fibrosis, and post-contrast T1 mapping for diffuse ventricular fibrosis. The presence of NSVT was determined by Holter monitoring and a subset of high risk patients received an implantable cardioverter-defibrillator (ICD). RESULTS NSVT was detected in 23 of 100 patients with HCM. Focal ventricular fibrosis (by LGE) was observed in 87%, with no significant difference between patients with (96%) or without NSVT (86%, P = 0.19). However, LGE mass was greater in patients with (16.5 ± 19.1 g) versus without NSVT (7.6 ± 10.2 g, P < 0.01). NSVT was associated with a significant reduction in ventricular T1 relaxation time (422 ± 54 milliseconds) versus patients without NSVT (512 ± 115 milliseconds; P < 0.001). There was significant reduction in ventricular T1 relaxation time in patients with (430 ± 48 milliseconds) versus without aborted SCD (495 ± 113 milliseconds; P = 0.01) over a mean follow-up of 40 ± 10 months. On multivariate analysis post-contrast ventricular T1 relaxation time and septal wall thickness were the only predictors of NSVT. CONCLUSION Post-contrast T1 relaxation time on CMR is associated with ventricular arrhythmias in patients with HCM. Diffuse ventricular fibrosis may be an important marker of arrhythmic risk in patients with HCM.
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Affiliation(s)
- Alex J A McLELLAN
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andris H Ellims
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Voskoboinik
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Leah M Iles
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - James L Hare
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David M Kaye
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ivan Macciocca
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Justin A Mariani
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J Taylor
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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147
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Kalisz K, Rajiah P. Impact of cardiac magnetic resonance imaging in non-ischemic cardiomyopathies. World J Cardiol 2016; 8:132-145. [PMID: 26981210 PMCID: PMC4766265 DOI: 10.4330/wjc.v8.i2.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/23/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Non-ischemic cardiomyopathies include a wide spectrum of disease states afflicting the heart, whether a primary process or secondary to a systemic condition. Cardiac magnetic resonance imaging (CMR) has established itself as an important imaging modality in the evaluation of non-ischemic cardiomyopathies. CMR is useful in the diagnosis of cardiomyopathy, quantification of ventricular function, establishing etiology, determining prognosis and risk stratification. Technical advances and extensive research over the last decade have resulted in the accumulation of a tremendous amount of data with regards to the utility of CMR in these cardiomyopathies. In this article, we review CMR findings of various non-ischemic cardiomyopathies and focus on current literature investigating the clinical impact of CMR on risk stratification, treatment, and prognosis.
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148
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Maron MS. The role of cardiovascular magnetic resonance in sudden death risk stratification in hypertrophic cardiomyopathy. Card Electrophysiol Clin 2016; 7:187-93. [PMID: 26002385 DOI: 10.1016/j.ccep.2015.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in young patients, but current risk stratification strategies do not identify all patients at risk. Contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can identify areas of abnormal myocardial substrate comprising fibrosis, the structural nidus for potentially life-threatening ventricular arrhythmias. More recently, follow-up studies have demonstrated a strong relationship between extent of LGE in patients with HCM and increased risk of adverse disease-related events, including sudden death.
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Affiliation(s)
- Martin S Maron
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, #70, 800 Washington Street, Boston, MA 02111, USA.
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149
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Abstract
Left ventricular hypertrophy (LVH) is growth in left ventricular mass caused by increased cardiomyocyte size. LVH can be a physiological adaptation to strenuous physical exercise, as in athletes, or it can be a pathological condition, which is either genetic or secondary to LV overload. Physiological LVH is usually benign and regresses upon reduction/cessation of physical activity. Pathological LVH is a compensatory phenomenon, which eventually may become maladaptive and evolve towards progressive LV dysfunction and heart failure (HF). Both interstitial and replacement fibrosis play a major role in the progressive decompensation of the hypertrophied LV. Coronary microvascular dysfunction (CMD) and myocardial ischemia, which have been demonstrated in most forms of pathological LVH, have an important pathogenetic role in the formation of replacement fibrosis and both contribute to the evolution towards LV dysfunction and HF. Noninvasive imaging allows detection of myocardial fibrosis and CMD, thus providing unique information for the stratification of patients with LVH. (Circ J 2016; 80: 555-564).
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Affiliation(s)
- Davide Lazzeroni
- Prevention and Rehabilitation Unit, Don Gnocchi Foundation & University of Parma
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150
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de Gregorio C, Di Bella G. Merging strain-echo measurements with late gadolinium enhancement at cardiac MRI: An upcoming chance for advanced functional assessment of fibrosis in hypertrophic cardiomyopathy? Int J Cardiol 2016; 203:632-4. [PMID: 26590884 DOI: 10.1016/j.ijcard.2015.10.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Cardiology Unit, Messina University Hospital, Messina, Italy.
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, Messina University Hospital, Messina, Italy
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