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Crean AM, Adler A, Arbour L, Chan J, Christian S, Cooper RM, Garceau P, Giraldeau G, Heydari B, Laksman Z, Mital S, Ong K, Overgaard C, Ruel M, Seifer CM, Ward MR, Tadros R. Canadian Cardiovascular Society Clinical Practice Update on Contemporary Management of the Patient With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:1503-1523. [PMID: 38880398 DOI: 10.1016/j.cjca.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024] Open
Abstract
Numerous guidelines on the diagnosis and management of hypertrophic cardiomyopathy (HCM) have been published, by learned societies, over the past decade. Although helpful they are often long and less adapted to nonexperts. This writing panel was challenged to produce a document that grew as much from years of practical experience as it did from the peer-reviewed literature. As such, rather than produce yet another set of guidelines, we aim herein to deliver a concentrate of our own experiential learning and distill for the reader the essence of effective and appropriate HCM care. This Clinical Practice Update on HCM is therefore aimed at general cardiologists and other cardiovascular practitioners rather than for HCM specialists. We set the stage with a description of the condition and its clinical presentation, discuss the central importance of "obstruction" and how to look for it, review the role of cardiac magnetic resonance imaging, reflect on the appropriate use of genetic testing, review the treatment options for symptomatic HCM-crucially including cardiac myosin inhibitors, and deal concisely with practical issues surrounding risk assessment for sudden cardiac death, and management of the end-stage HCM patient. Uniquely, we have captured the pediatric experience on our panel to discuss appropriate differences in the management of younger patients with HCM. We ask the reader to remember that this document represents expert consensus opinion rather than dogma and to use their best judgement when dealing with the HCM patient in front of them.
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Affiliation(s)
- Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; North West Heart Center, Manchester, United Kingdom.
| | - Arnon Adler
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Laura Arbour
- University of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Joyce Chan
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Robert M Cooper
- Liverpool Heart and Chest Hospital, Centre for Cardiovascular Science Liverpool John Moores University, Liverpool, United Kingdom
| | - Patrick Garceau
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Genevieve Giraldeau
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Bobak Heydari
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary Laksman
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seema Mital
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Ong
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marc Ruel
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Colette M Seifer
- St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael R Ward
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Ding WY, Meah MN, Stables R, Cooper RM. Interventions in Hypertrophic Obstructive Cardiomyopathy. Can J Cardiol 2024; 40:833-842. [PMID: 38070769 DOI: 10.1016/j.cjca.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/11/2023] [Accepted: 12/04/2023] [Indexed: 04/02/2024] Open
Abstract
Obstructive hypertrophic cardiomyopathy is the most common genetically transmitted cardiomyopathy that is associated with significant morbidity and mortality. Despite contemporary treatments and interventions, the management of patients with obstructive hypertrophic cardiomyopathy remains poorly defined compared with other branches of cardiology. In this review, we discuss established and novel therapeutic interventions in patients with obstructive hypertrophic cardiomyopathy with a focus on percutaneous and surgical strategies including surgical myectomy, mitral valve repair or replacement, percutaneous alcohol septal ablation, pacemaker and cardioverter-defibrillator implantation, septal embolization, radiofrequency endocardial catheter ablation, and percutaneous intramyocardial septal radiofrequency ablation.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Mohammed N Meah
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Rodney Stables
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Robert M Cooper
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Research Institute of Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom.
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Serraino GF, Jiritano F, Costa D, Ielapi N, Napolitano D, Mastroroberto P, Bracale UM, Andreucci M, Serra R. Metalloproteinases and Hypertrophic Cardiomyopathy: A Systematic Review. Biomolecules 2023; 13:biom13040665. [PMID: 37189412 DOI: 10.3390/biom13040665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic condition determined by an altered collagen turnover of the extracellular matrix. Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) are abnormally released in patients with HCM. The purpose of this systematic review was to thoroughly summarize and discuss the existing knowledge of MMPs profile in patients with HCM. All studies meeting the inclusion criteria (detailed data regarding MMPs in patients with HCM) were selected, after screening the literature from July 1975 to November 2022. Sixteen trials that enrolled a total of 892 participants were included. MMPs-particularly MMP2-levels were found higher in HCM patients compared to healthy subjects. MMPs were used as biomarkers after surgical and percutaneous treatments. Understanding the molecular processes that control the cardiac ECM's collagen turnover allows for a non-invasive evaluation of HCM patients through the monitoring of MMPs and TIMPs.
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Affiliation(s)
- Giuseppe Filiberto Serraino
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Federica Jiritano
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Davide Costa
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, 00185 Roma, Italy
| | - Desirèe Napolitano
- Ph.D. Student "Digital Medicine" Ph.D. Programm-Magna Graecia, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Vascular Surgery Unit, University of Naples "Federico II", 80126 Naples, Italy
| | - Michele Andreucci
- Department of Health Sciences, Nephrology Unit, University of Catanzaro, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
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Junior ADSM, de Oliveira ALV, Maia TA, Botelho SM. A Narrative Review of Emerging Therapies for Hypertrophic Obstructive Cardiomyopathy. Curr Cardiol Rev 2023; 19:e240323214927. [PMID: 36999417 PMCID: PMC10494274 DOI: 10.2174/1573403x19666230324102828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Hypertrophic obstructive cardiomyopathy is a hereditary condition that affects myocardial contraction. In case of failure of pharmacological treatment, alternative approaches might be used that include surgical myectomy, percutaneous transluminal septal myocardial ablation, and radiofrequency ablation. In respect of long-term advantages, surgical septal myectomy remains the therapy of choice for symptomatic hypertrophic obstructive cardiomyopathy. Alcohol septal ablation has been considered an alternative to surgical myectomy, which confers the benefits of a shorter hospital stay, less discomfort, and fewer complications. However, only expert operators should perform it on carefully chosen patients. Further, radiofrequency septal ablation reduces the left ventricular outflow tract gradient and improves the NYHA functional class of patients with hypertrophic obstructive cardiomyopathy, despite complications like cardiac tamponade and atrioventricular block. Further research with a larger sample size is required to compare the radiofrequency approach with established invasive treatment methods for hypertrophic obstructive cardiomyopathy. Septal myectomy has low morbidity and mortality rates, making it the preferred procedure; however, the efficacy and morbidity remain debatable. Advances in invasive techniques, including percutaneous septal radiofrequency ablation and transcatheter myotomy, have provided alternative approaches for reducing left ventricular outflow tract (LVOT) obstruction in patients who are not candidates for traditional surgical septal myectomy. Candidates for alcohol and radiofrequency septal ablation include patients with symptomatic hypertrophic obstructive cardiomyopathy, older adults, and those with multiple comorbidities.
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Affiliation(s)
- Antonio da Silva Menezes Junior
- Internal Medicine Department, Medicine School, Federal University of Goiás, Goiânia, Goiás, Brazil
- Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | | | - Thais Aratak Maia
- Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Silvia Marçal Botelho
- Internal Medicine Department, Medicine School, Federal University of Goiás, Goiânia, Goiás, Brazil
- Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
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Canzi CC, do Prado Júnior ER, da Silva Menezes Júnior A, Rezende AL, Botelho SM, Santos LDR. Radiofrequency ablation in patients with obstructive hypertrophic cardiomyopathy: A systematic review and meta-analysis. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 24:100229. [PMID: 38560638 PMCID: PMC10978412 DOI: 10.1016/j.ahjo.2022.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 04/04/2024]
Abstract
Study objective Hypertrophic cardiomyopathy (HCM) is a genetic disease that can cause left ventricular outflow tract (LVOT) obstruction. This study analyzed the efficacy of radiofrequency ablation (RA) in improving clinical and hemodynamic factors in patients receiving obstructive HCM refractory treatment. This evaluation was necessary because of the small number of studies on the effectiveness of this technique for obstructive HCM in the existing literature. Design We used the PubMed, Embase, and Science Direct databases to identify randomized clinical trials and observational studies addressing the clinical and hemodynamic outcomes before and after RA in patients with HCM. Participants We selected six articles published between 2011 and 2022, comprising 304 patients (mean age: 45 years). Interventions We performed a bias assessment using the ROBINS I tool, and meta-analysis processing was performed using the STATA program (v.16.0). Results The left ventricular outflow tract (LVOT) gradient at rest and with stimulation decreased by 58.78 mmHg (p = 0.001) and 70.38 mmHg (total effect Z = 21.62; p < 0.0001), respectively. Additionally, the New York Heart Association (NYHA) functional class decreased by 0.43 (p = 0.001), indicating symptomatic and hemodynamic improvements. Furthermore, we observed a significant reduction in septal thickness (by 4 mm; p = 0.001). Conclusions RA improved the NYHA functional class and LVOT gradient at rest and with stimulation and reduced septal thickness. These results suggest that RA is effective in patients refractory to pharmacological therapy and unsuitable for alcohol septal ablation or myectomy. However, more studies, including randomized clinical trials, should be conducted to define the role of RA in interventional therapies.
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Affiliation(s)
- Camila Cássia Canzi
- Medicine School, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
| | | | - Antônio da Silva Menezes Júnior
- Medicine School, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
- Internal Medicine Department, Federal University of Goiás, Goiânia, GO, Brazil
| | - Aline Lazara Rezende
- Medicine School, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
- Internal Medicine Department, Federal University of Goiás, Goiânia, GO, Brazil
| | - Silvia Marçal Botelho
- Medicine School, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
- Internal Medicine Department, Federal University of Goiás, Goiânia, GO, Brazil
| | - Luciana da Ressurreição Santos
- Medicine School, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
- Internal Medicine Department, Federal University of Goiás, Goiânia, GO, Brazil
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