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MacIver DH, Dayer MJ. An alternative approach to understanding the pathophysiological mechanisms of chronic heart failure. Int J Cardiol 2012; 154:102-10. [DOI: 10.1016/j.ijcard.2011.05.075] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 03/16/2011] [Accepted: 05/13/2011] [Indexed: 11/29/2022]
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152
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Badran HM, Elnoamany MF, Soltan G, Ezat M, Elsedi M, Abdelfatah RA, Yacoub M. Relationship of mechanical dyssynchrony to QT interval prolongation in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2011; 13:423-32. [DOI: 10.1093/ejechocard/jer290] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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153
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. Circulation 2011; 124:e783-831. [PMID: 22068434 DOI: 10.1161/cir.0b013e318223e2bd] [Citation(s) in RCA: 449] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Bernard J. Gersh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | - Barry J. Maron
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | | | - Joseph A. Dearani
- Society of Thoracic Surgeons Representative
- American Association for Thoracic Surgery Representative
| | - Michael A. Fifer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- Heart Rhythm Society Representative
| | - Srihari S. Naidu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- Society for Cardiovascular Angiography and Interventions Representative
| | | | | | - Harry Rakowski
- ACCF/AHA Representative
- American Society of Echocardiography Representative
| | | | | | - James E. Udelson
- Heart Failure Society of America Representative
- American Society of Nuclear Cardiology Representative
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154
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW, Jacobs AK, Smith SC, Anderson JL, Albert NM, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Krumholz HM, Kushner FG, Nishimura RA, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2011; 142:e153-203. [DOI: 10.1016/j.jtcvs.2011.10.020] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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155
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Wilson MG, Chandra N, Papadakis M, O'Hanlon R, Prasad SK, Sharma S. Hypertrophic cardiomyopathy and ultra-endurance running - two incompatible entities? J Cardiovasc Magn Reson 2011; 13:77. [PMID: 22122802 PMCID: PMC3243082 DOI: 10.1186/1532-429x-13-77] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 11/29/2011] [Indexed: 01/02/2023] Open
Abstract
Regular and prolonged exercise is associated with increased left ventricular wall thickness that can overlap with hypertrophic cardiomyopathy (HCM). Differentiating physiological from pathological hypertrophy has important implications, since HCM is the commonest cause of exercise-related sudden cardiac death in young individuals. Most deaths have been reported in intermittent 'start-stop' sports such as football (soccer) and basketball. The theory is that individuals with HCM are unable to augment stroke volume sufficiently to meet the demands of endurance sports and are accordingly 'selected-out' of participation in such events. We report the case of an ultra-endurance athlete with 25 years of > 50 km competitive running experience, with genetically confirmed HCM; thereby demonstrating that these can be two compatible entities.
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Affiliation(s)
- Mathew G Wilson
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Navin Chandra
- St George's University of London, Division of Cardiac & Vascular Sciences, London, UK
| | - Michael Papadakis
- St George's University of London, Division of Cardiac & Vascular Sciences, London, UK
| | - Rory O'Hanlon
- St Vincent's University Hospital and The Blackrock Clinic, Dublin, Ireland
| | | | - Sanjay Sharma
- St George's University of London, Division of Cardiac & Vascular Sciences, London, UK
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2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e212-60. [PMID: 22075469 DOI: 10.1016/j.jacc.2011.06.011] [Citation(s) in RCA: 825] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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157
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Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2011; 4:1123-37. [DOI: 10.1016/j.jcmg.2011.06.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 05/27/2011] [Accepted: 06/29/2011] [Indexed: 01/19/2023]
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158
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Bilen E, Kurt M, Tanboga IH, Kaya A, Isik T, Ekinci M, Can MM, Karakas MF, Oduncu V, Bayram E, Aksakal E, Sevimli S. Severity of mitral stenosis and left ventricular mechanics: a speckle tracking study. Cardiology 2011; 119:108-15. [PMID: 21912124 DOI: 10.1159/000330404] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been shown that mitral stenosis (MS) impairs left ventricular (LV) systolic function; however, this issue has not been studied comprehensively. We aimed to evaluate the role of 2D strain in the assessment of subclinical LV systolic dysfunction in patients with MS. METHODS Seventy-two patients with isolated MS (mild, moderate and severe) and 31 healthy control subjects constituted the study population. 2D echocardiography images were obtained from LV apical 4-chamber (4C), long axis (LAX), and 2-chamber (2C) views. Peak longitudinal strain and strain rate (Sr) were obtained from 4C, LAX, and 2C views. Global strain and Sr were calculated by averaging the three apical views. RESULTS There were no significant differences in LV ejection fraction and LV systolic or diastolic dimensions between the groups. Patients with MS had significantly lower LV longitudinal strain and Sr measurements than the control group. In addition, there were no significant differences in MS subgroups with respect to LV strain and Sr measurements. CONCLUSION We demonstrated that patients with MS had lower LV functions using 2D strain imaging, and this is independent of the hemodynamic severity of MS. In the detection of subclinical LV dysfunction in patients with MS, 2D strain imaging appears to be useful.
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Affiliation(s)
- Emine Bilen
- Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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159
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Ashrafian H, McKenna WJ, Watkins H. Disease pathways and novel therapeutic targets in hypertrophic cardiomyopathy. Circ Res 2011; 109:86-96. [PMID: 21700950 DOI: 10.1161/circresaha.111.242974] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As described in earlier reviews in this series on the molecular basis of hypertrophic cardiomyopathy (HCM), HCM is one of the archetypal monogenic cardiovascular disorders to be understood at the molecular level. Twenty years after the discovery of the first HCM disease gene, genetic studies still confirm that HCM is principally a disease of the sarcomere. At the biophysical level, myofilament mutations generally enhance Ca(2+) sensitivity, maximal force production, and ATPase activity. These defects ultimately appear to converge on energy deficiency and altered Ca(2+) handling as major common paths leading to the anatomic (hypertrophy, myofiber disarray, and fibrosis) and functional features (pathological signaling and diastolic dysfunction) characteristic of HCM. In this review, we provide an account of the consequences of HCM mutations and describe how specifically targeting these molecular features has already yielded early promise for novel therapies for HCM. Although substantial efforts are still required to understand the molecular link between HCM mutations and their clinical consequences, HCM endures as an exemplar of how novel insights derived from molecular characterization of Mendelian disorders can inform the understanding of biological processes and translate into rational therapies.
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Affiliation(s)
- Houman Ashrafian
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
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160
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Aletras AH, Tilak GS, Hsu LY, Arai AE. Heterogeneity of intramural function in hypertrophic cardiomyopathy: mechanistic insights from MRI late gadolinium enhancement and high-resolution displacement encoding with stimulated echoes strain maps. Circ Cardiovasc Imaging 2011; 4:425-34. [PMID: 21576279 PMCID: PMC3460377 DOI: 10.1161/circimaging.110.958751] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 05/09/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND In hypertrophic cardiomyopathy (HCM), myocardial abnormalities are commonly heterogeneous. Two patterns of late gadolinium enhancement (LGE) have been reported: a bright "confluent" and an intermediate intensity abnormality termed "diffuse," each representing different degrees of myocardial scarring. We used MRI to study the relation between intramural cardiac function and the extent of fibrosis in HCM. The aim of this study was to determine whether excess collagen or myocardial scarring, as determined by LGE MRI, are the primary mechanisms leading to heterogeneous regional contractile function in patients with HCM. METHODS AND RESULTS Intramural left ventricular strain, transmural left ventricular function, and regions of myocardial fibrosis/scarring were imaged in 22 patients with HCM, using displacement encoding with stimulated echoes (DENSE), cine MRI, and LGE. DENSE systolic strain maps were qualitatively and quantitatively compared with LGE images. Intramural systolic strain by DENSE was significantly depressed within areas of confluent and diffuse LGE but also in the core of the most hypertrophic nonenhanced segment (all P < 0.001 versus nonhypertrophied segments). DENSE demonstrated an unexpected inner rim of largely preserved contractile function and a noncontracting outer wall within hypertrophic segments in 91% of patients. CONCLUSIONS LGE predicted some but not all of the heterogeneity of intramural contractile abnormalities. This indicates that myocardial scarring or excess interstitial collagen deposition does not fully explain the observed contractile heterogeneity in HCM. Thus, myofibril disarray or other nonfibrotic processes affect systolic function in a large number of patients with HCM.
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Affiliation(s)
- Anthony H. Aletras
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, U.S.A
- Department of Computer Science and Biomedical Informatics University of Central Greece, Lamia, Greece
| | - Gauri S. Tilak
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, U.S.A
| | - Li-Yueh Hsu
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, U.S.A
| | - Andrew E. Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, U.S.A
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161
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Relation of coronary microvascular dysfunction in hypertrophic cardiomyopathy to contractile dysfunction independent from myocardial injury. Am J Cardiol 2011; 107:1522-8. [PMID: 21377644 DOI: 10.1016/j.amjcard.2011.01.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 12/26/2022]
Abstract
We studied the spatial relations among hyperemic myocardial blood flow (hMBF), contractile function, and morphologic tissue alterations in 19 patients with hypertrophic cardiomyopathy (HC). All patients were studied with oxygen-15 water positron emission tomography during rest and adenosine administration to assess myocardial perfusion. Cardiovascular magnetic resonance was performed to derive delayed contrast-enhanced images and to calculate contractile function (E(cc)) with tissue tagging. Eleven healthy subjects underwent similar positron emission tomographic and cardiovascular magnetic resonance scanning protocols and served as a control group. In the HC group, hMBF averaged 2.46 ± 0.91 ml/min/g and mean E(cc) was -14.7 ± 3.4%, which were decreased compared to the control group (3.97 ± 1.48 ml/min/g and -17.7 ± 3.2%, respectively, p <0.001 for the 2 comparisons). Delayed contrast enhancement (DCE) was present only in patients with HC, averaging 6.2 ± 10.3% of left ventricular mass. In the HC group, E(cc) and DCE in the septum (-13.7 ± 3.6% and 10.2 ± 13.6%) significantly differed from the lateral wall (-16.0 ± 2.8% and 2.4 ± 5.9%, p <0.001 for the 2 comparisons). In general, hMBF and E(cc) were decreased in segments displaying DCE compared to nonenhanced segments (p <0.001 for the comparisons). In the HC group, univariate analysis revealed relations of hMBF to E(cc) (r = -0.45, p <0.001) and DCE (r = -0.31, p <0.001). Multivariate analysis revealed that E(cc) was independently related to hMBF (beta -0.37, p <0.001) and DCE (beta 0.28, p <0.001). In conclusion, in HC hMBF is impaired and related to contractile function independent from presence of DCE. When present, DCE reflected a progressed disease state as characterized by an increased perfusion deficit and contractile dysfunction.
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162
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Correia E, Rodrigues B, Santos LF, Moreira D, Gama P, Cabral C, Santos O. Longitudinal left ventricular strain in hypertrophic cardiomyopathy: correlation with nonsustained ventricular tachycardia. Echocardiography 2011; 28:709-14. [PMID: 21564281 DOI: 10.1111/j.1540-8175.2011.01427.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS Stratifying risk of sudden death is a major issue in the management of hypertrophic cardiomyopathy (HCM). Existing risk factors have low positive predictive value and new parameters are needed. Determination of myocardial deformation (strain) by 2D Speckle tracking is a new methodology for determining LV regional function and could correlate with myocite disarray and fibrosis. The aim of this study was to assess the relationship between strain analysis and nonsustained ventricular tachycardia (NSVT) in patients with HCM. METHODS Thirty-two consecutive patients with HCM (mean age 55, 17-78) were studied. All underwent standard echocardiographic and two-dimensional strain examination. Twenty-four-hour Holter monitoring was performed and echocardiographic parameters were correlated with NSVT. RESULTS Nine patients (28%) had one or more episodes of NSVT. Patients with NSVT had a higher value of maximal LV thickness (23.6 mm vs. 19.4 mm, P = 0.027). There were no significant associations between NSVT on Holter monitoring and LV outflow gradient left atrial diameter, E/Em or left ventricle ejection fraction. Patients with HCM and NSVT had significant reductions in mid septal, apical-septal, apical-lateral strain, and in mean longitudinal strain. Midseptal strain >-10.5% had a sensitivity of 89% and a specificity of 74% (area under the curve, 0.787; P < 0.0013) for predicting NSVT independently of age or maximum wall thickness. CONCLUSION Lower end-systolic peak longitudinal strain obtained by 2D speckle tracking was a predictor of NSVT in HCM patients. This parameter could become a useful tool in stratifying SCD risk in this population.
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163
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Di Bella G, Minutoli F, Pingitore A, Zito C, Mazzeo A, Aquaro GD, Di Leo R, Recupero A, Stancanelli C, Baldari S, Vita G, Carerj S. Endocardial and epicardial deformations in cardiac amyloidosis and hypertrophic cardiomyopathy. Circ J 2011; 75:1200-8. [PMID: 21427499 DOI: 10.1253/circj.cj-10-0844] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to analyze epicardial (EPI) and endocardial (ENDO) strain (S) in patients with transthyretin-related cardiac amyloidosis (TTR-CA) and hypertrophic cardiomyopathy (HCM) using echocardiography (TTE) with 2-dimensional feature tracking imaging (FTI). METHODS AND RESULTS Thirty-three subjects (11 with HCM, 11 with TTR-CA, and 11 healthy subjects as controls) with a New York Heart Association functional class ≤ II underwent conventional TTE and FTI. TTE was used for the evaluation of left ventricle (LV) wall thickness, mass, systolic and diastolic function. FTI was used for the evaluation of EPI and ENDO longitudinal, and circumferential, and radial S. LV wall thickness and mass were higher in both TTR-CA and HCM in comparison with controls (P < 0.001), but ejection fraction (EF) was similar among patients with TTR-CA, HCM and controls (63 ± 6%, 64 ± 6%, 61 ± 5%, respectively). ENDO and EPI longitudinal and circumferential S and radial S were significantly lower in HCM and TTR-CA when compared with controls (P < 0.01). No differences in EPI and ENDO longitudinal S, ENDO circumferential S and radial S were found between TTR-CA and HCM groups, while EPI circumferential S was significantly lower in the TTRCA group (6 ± 3.3%) than in the HCM group (8.1 ± 4.3%; P < 0.0001). CONCLUSIONS Longitudinal, circumferential and radial LV deformations are impaired in patients with TTR-CA and HCM with a preserved EF. Impairment of EPI circumferential strain is greater in TTR-CA than in HCM.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy.
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164
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Desai MY, Ommen SR, McKenna WJ, Lever HM, Elliott PM. Imaging Phenotype Versus Genotype in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2011; 4:156-68. [DOI: 10.1161/circimaging.110.957936] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Milind Y. Desai
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - Steve R. Ommen
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - William J. McKenna
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - Harry M. Lever
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - Perry M. Elliott
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
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165
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Myocardial Fibrosis Attenuates the Effect of Cibenzoline on Left Ventricular Diastolic Function in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Pharmacol 2011; 57:207-12. [DOI: 10.1097/fjc.0b013e318203830d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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166
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Left Ventricular Hypertrophy Causes Different Changes in Longitudinal, Radial, and Circumferential Mechanics in Patients with Hypertension: A Two-Dimensional Speckle Tracking Study. J Am Soc Echocardiogr 2011; 24:192-9. [DOI: 10.1016/j.echo.2010.10.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Indexed: 11/18/2022]
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167
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Galderisi M, Lomoriello VS, Santoro A, Esposito R, Olibet M, Raia R, Dario Di Minno MN, Guerra G, Mele D, Lombardi G. Differences of Myocardial Systolic Deformation and Correlates of Diastolic Function in Competitive Rowers and Young Hypertensives: A Speckle-Tracking Echocardiography Study. J Am Soc Echocardiogr 2010; 23:1190-8. [DOI: 10.1016/j.echo.2010.07.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Indexed: 11/28/2022]
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168
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169
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Roşca M, Popescu BA, Beladan CC, Călin A, Muraru D, Popa EC, Lancellotti P, Enache R, Coman IM, Jurcuţ R, Ghionea M, Ginghină C. Left Atrial Dysfunction as a Correlate of Heart Failure Symptoms in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2010; 23:1090-8. [DOI: 10.1016/j.echo.2010.07.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Indexed: 11/25/2022]
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170
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Chelliah RK, Senior R. Pathological and physiological left ventricular hypertrophy: echocardiography for differentiation. Future Cardiol 2010; 5:495-502. [PMID: 19715413 DOI: 10.2217/fca.09.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Distinguishing physiological left ventricular hypertrophy of an athlete's heart from that of pathological left ventricular (hypertrophic cardiomyopathy) can be difficult despite the advent of new imaging techniques. Nevertheless, the final diagnosis is of utmost importance as it will have a profound impact on an individual's life. A diagnosis of hypertrophic cardiomyopathy essentially excludes an individual from sport and strenuous exertion and necessitates the need for further tests and treatment, as well as the screening of family members. Hypertrophic cardiomyopathy remains the most common cause of a pathologically hypertrophied heart in young athletes, with a prevalence of one in 500. The issue of sudden death in athletes due to pathological left ventricular hypertrophy and hypertrophic cardiomyopathy has recently gained recognition owing to the death of several word class athletes during sporting participation. What compounds this further is the fact that a proportion of athletes fall into the 'grey zone' (ventricular wall thickness of 13-16 mm) where the increase in cardiac size overlaps with the phenotypic variation of hypertrophic cardiomyopathy - making echocardiographic differentiation of the two entities challenging. This review discusses the echocardiographic differentiation of the athlete's heart, including physiological left ventricular hypertrophy from pathological left ventricular hypertrophy. Although several of the cardiomyopathies cause pathological left ventricular hypertrophy, focus will be given to hypertrophic cardiomyopathy, for reasons mentioned above. Discussion will also focus on the newer and emerging echocardiographic techniques for this purpose. The term 'hypertrophic cardiomyopathy' is used to describe the nonobstuctive form of hypertrophic cardiomyopathy as this review article focuses on distinguishing the 'mild' form of hypertrophic cardiomyopathy from an athlete's heart. When the more severe obstructive form is being described, the term 'hypertrophic obstructive cardiomyopathy' is used.
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Affiliation(s)
- Rajesh K Chelliah
- Department of Cardiac Research, Northwick Park Hospital, Middlesex, Harrow, London HA1 3UJ, UK
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171
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Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 2010; 23:351-69; quiz 453-5. [PMID: 20362924 DOI: 10.1016/j.echo.2010.02.015] [Citation(s) in RCA: 757] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors summarize the recent developments in speckle-tracking echocardiography (STE), a relatively new technique that can be used in conjunction with two-dimensional or three-dimensional echocardiography for resolving the multidirectional components of left ventricular (LV) deformation. The tracking system is based on grayscale B-mode images and is obtained by automatic measurement of the distance between 2 pixels of an LV segment during the cardiac cycle, independent of the angle of insonation. The integration of STE with real-time cardiac ultrasound imaging overcomes some of the limitations of previous work in the field and has the potential to provide a unified framework to more accurately quantify the regional and global function of the left ventricle. STE holds promise to reduce interobserver and intraobserver variability in assessing regional LV function and to improve patient care while reducing health care costs through the early identification of subclinical disease. Following a brief overview of the approach, the authors pool the initial observations from clinical studies on the development, validation, merits, and limitations of STE.
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172
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Wess G, Sarkar R, Hartmann K. Assessment of Left Ventricular Systolic Function by Strain Imaging Echocardiography in Various Stages of Feline Hypertrophic Cardiomyopathy. J Vet Intern Med 2010; 24:1375-82. [DOI: 10.1111/j.1939-1676.2010.0586.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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173
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Weidemann F, Niemann M, Ertl G, Störk S. The Different Faces of Echocardiographic Left Ventricular Hypertrophy: Clues to the Etiology. J Am Soc Echocardiogr 2010; 23:793-801. [DOI: 10.1016/j.echo.2010.05.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Indexed: 01/02/2023]
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174
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Butz T, van Buuren F, Mellwig KP, Langer C, Plehn G, Meissner A, Trappe HJ, Horstkotte D, Faber L. Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2010; 27:91-100. [DOI: 10.1007/s10554-010-9665-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
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175
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Di Salvo G, Pacileo G, Limongelli G, Baldini L, Rea A, Verrengia M, D'Andrea A, Russo MG, Calabrò R. Non Sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy and New Ultrasonic Derived Parameters. J Am Soc Echocardiogr 2010; 23:581-90. [DOI: 10.1016/j.echo.2010.02.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Indexed: 01/19/2023]
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176
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Maron MS, Pandian NG. Risk Stratification in Hypertrophic Cardiomyopathy: Is Two-Dimensional Echocardiographic Strain Ready for Prime Time? J Am Soc Echocardiogr 2010; 23:591-4. [DOI: 10.1016/j.echo.2010.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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177
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Kwon DH, Desai MY. Cardiac magnetic resonance in hypertrophic cardiomyopathy: current state of the art. Expert Rev Cardiovasc Ther 2010; 8:103-11. [PMID: 20014937 DOI: 10.1586/erc.09.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hypertrophic cardiomyopathy is a complex disorder with significant heterogeneity in clinical characteristics and natural history. Traditionally, the diagnosis has been based on clinical assessment and echocardiography; however, persistent challenges in its noninvasive evaluation remain. Hence, improved diagnostic techniques could lead to better risk stratification of patients, which would potentially identify patients likely to benefit from effective therapies. Recent studies have demonstrated the increasing utility of cardiac magnetic resonance in the management of this disease. With the increasing utilization of genetics, cardiac magnetic resonance is likely to play an even more important role in discerning the subtle morphologic differences seen in such patients with similar genotypic profiles.
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Affiliation(s)
- Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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178
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Affiliation(s)
- Javier Díez
- From the Division of Cardiovascular Sciences (J.D.), Centre of Applied Medical Research, University of Navarra, Pamplona, Spain; Ochsner Clinic Foundation (E.D.F.), New Orleans, La
| | - Edward D. Frohlich
- From the Division of Cardiovascular Sciences (J.D.), Centre of Applied Medical Research, University of Navarra, Pamplona, Spain; Ochsner Clinic Foundation (E.D.F.), New Orleans, La
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179
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Aguilar-Torres R, Gómez de Diego JJ, Forteza-Albert JF, Vivancos-Delgado R. Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada. Rev Esp Cardiol 2010; 63 Suppl 1:116-31. [DOI: 10.1016/s0300-8932(10)70145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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180
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Fuster V, van der Zee S, Miller MA. Evolving anatomic, functional, and molecular imaging in the early detection and prognosis of hypertrophic cardiomyopathy. J Cardiovasc Transl Res 2009; 2:398-406. [PMID: 20559998 DOI: 10.1007/s12265-009-9133-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 09/21/2009] [Indexed: 12/27/2022]
Abstract
Evolving imaging modalities in hypertrophic cardiomyopathy (HCM), such as tissue Doppler, speckle tracking, measures of myocardial blood flow, and cardiac magnetic resonance with gadolinium enhancement, have advanced our understanding of the pathogenesis of myocardial dysfunction in hypertrophic cardiomyopathy. These modalities have the potential to differentiate HCM from other causes of left ventricular hypertrophy when there is uncertainty about the diagnosis and to identify affected individuals in the pre-clinical phase of the disease process. Furthermore, preliminary data suggests that functional imaging techniques may add incremental value to conventional risk stratification tools to identify individuals at high risk for sudden death or progression to congestive heart failure.
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Affiliation(s)
- Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, and the Marie-Josee and Henry R. Kravis Cardiovascular Health Center, Mount Sinai Medical Center, The Mount Sinai School of Medicine, New York, NY, 10029, USA.
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181
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Menon SC, Eidem BW, Dearani JA, Ommen SR, Ackerman MJ, Miller D. Diastolic dysfunction and its histopathological correlation in obstructive hypertrophic cardiomyopathy in children and adolescents. J Am Soc Echocardiogr 2009; 22:1327-34. [PMID: 19815379 DOI: 10.1016/j.echo.2009.08.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Histopathologic hallmarks of hypertrophic cardiomyopathy (HCM) include myocyte hypertrophy and disarray as well as interstitial and endocardial fibrosis. Published correlations between echocardiographic parameters and histopathologic findings are scarce. METHODS All patients aged <20 years (n = 45; 15 female patients; median age, 14 years) with obstructive HCM undergoing septal myectomy at the Mayo Clinic from 2003 to 2007 were identified. A retrospective review of echocardiographic data was performed, and these data were compared with the histologic findings from the myectomy specimens. RESULTS Histopathologic analysis of myectomy specimens revealed significant myocyte hypertrophy (100%), myocyte disarray (98%), interstitial fibrosis (95%), and subendocardial fibrosis (97%). On multivariate regression analysis, there was a significant relationship between the degree of myocyte disarray and echocardiographic markers of left ventricular diastolic dysfunction. CONCLUSION The results of this study suggest that myocyte disarray is a key factor responsible for diastolic dysfunction in pediatric patients with obstructive HCM. These findings provide novel insights into the mechanism of diastolic dysfunction in HCM that warrant further study.
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Affiliation(s)
- Shaji C Menon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
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182
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Assenza GE, Spirito P, Musumeci MB, Lombardi M, Quarta G, Autore C. Severe Left Ventricular Wall Thinning and Extensive Fibrosis Without Evolution to End Stage Disease in a Patient With Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2009; 22:1196.e1-2. [DOI: 10.1016/j.echo.2009.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Indexed: 11/16/2022]
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183
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Ghio S, Revera M, Mori F, Klersy C, Raisaro A, Raineri C, Serio A, Pasotti M, Visconti LO. Regional abnormalities of myocardial deformation in patients with hypertrophic cardiomyopathy: correlations with delayed enhancement in cardiac magnetic resonance. Eur J Heart Fail 2009; 11:952-7. [PMID: 19789398 DOI: 10.1093/eurjhf/hfp122] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stefano Ghio
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Miriam Revera
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Francesca Mori
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Service; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Arturo Raisaro
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Claudia Raineri
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Alessandra Serio
- Centre for Inherited Cardiovascular Diseases; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Michele Pasotti
- Centre for Inherited Cardiovascular Diseases; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
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184
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Boonyasirinant T, Rajiah P, Setser RM, Lieber ML, Lever HM, Desai MY, Flamm SD. Aortic Stiffness Is Increased in Hypertrophic Cardiomyopathy With Myocardial Fibrosis. J Am Coll Cardiol 2009; 54:255-62. [PMID: 19589439 DOI: 10.1016/j.jacc.2009.03.060] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/10/2009] [Accepted: 03/23/2009] [Indexed: 11/20/2022]
Affiliation(s)
- Thananya Boonyasirinant
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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185
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Pearlman AS. What's Your Rejection Fraction? J Am Soc Echocardiogr 2009; 22:314-5. [DOI: 10.1016/j.echo.2009.01.026] [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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186
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Carasso S, Rakowski H. Myocardial fibrosis and regional function in hypertrophic cardiomyopathy: may the force be with you. J Am Soc Echocardiogr 2009; 21:1306-8. [PMID: 19041573 DOI: 10.1016/j.echo.2008.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Shemy Carasso
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
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187
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Rawlins J, Bhan A, Sharma S. Left ventricular hypertrophy in athletes. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:350-6. [PMID: 19246500 DOI: 10.1093/ejechocard/jep017] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Participation in regular intensive exercise is associated with a modest increase in left ventricular wall thickness (LVWT) and cavity size. The magnitude of these physiological changes is predominantly determined by a variety of demographic factors which include age, gender, size, ethnicity, and sporting discipline. A small minority of male athletes participating in sporting disciplines involving intensive isotonic and isometric exercise may exhibit substantial increases in cardiac size that overlap with the phenotypic manifestation of the cardiomyopathies. The most challenging clinical dilemma incorporates the differentiation between physiological left ventricular hypertrophy (LVH) (athlete's heart) and hypertrophic cardiomyopathy (HCM), which is recognized as the commonest cause of non-traumatic exercise related sudden cardiac death in young (<35 years old) athletes. This review aims to highlight the distribution and physiological upper limits of LVWT in athletes, determinants of LVH in athletes, and echocardiographic methods of differentiating athlete's heart from HCM.
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Affiliation(s)
- John Rawlins
- King's College Hospital, Denmark Hill, London, UK
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