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Chen W, Li S, Zhao Y, Gao Y, Wang R, Ren Y, Wang H, Xu L. Prognostic Value of Left Atrial Volume and Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Patients with Coronary Artery Disease and Severe Left Ventricular Dysfunction Underwent CABG. Acad Radiol 2024; 31:2695-2703. [PMID: 38704284 DOI: 10.1016/j.acra.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
RATIONALE AND OBJECTIVES This study aims to investigate whether the combination of Left atrial volume (LAV) and late gadolinium enhancement (LGE) is helpful in stratifying the risk in CABG patients with CAD with EF≤ 35%. MATERIALS AND METHODS We conducted a retrospective analysis involving 205 CAD patients with EF≤ 35% who underwent CABG. All patients underwent gadolinium-enhanced CMR before surgery. The CMR images were analyzed for LAV, biventricular function, LGE, and left ventricular myocardial strain. Primary endpoint events included all-cause mortality, revascularization, re-hospitalization due to myocardial infarction or heart failure, and stroke after CABG. Multivariable Cox analysis was performed to identify independent risk factors for adverse outcomes. Kaplan-Meier curve analysis with the log-rank test was employed to evaluate survival estimates. RESULTS A total of 55 patients reached the primary endpoints. Univariate Cox proportional hazard regression analysis showed that LAV index (LAVi), left ventricular EF (LVEF), right ventricular EF, LGE percent, and global longitudinal strain were significantly associated with the primary outcome (all P < 0.05). Multivariable analysis showed that LAVi (hazard ratio [HR] 1.05, [95% confidence interval (CI) 1.02-1.07], P < 0.001) and LGE percent (HR 1.10, [95% CI 1.06-1.15], P < 0.001) were independently associated with the primary outcome. Kaplan-Meier analysis indicated a significant increase in the risk of endpoint occurrence when patients exhibited LAVi≥ 51.0 mL/m2 and LGE≥ 11.6% (both P < 0.05). CONCLUSION For CAD patients with LVEF≤ 35%, the combination of LAVi and LGE percent demonstrated good predictive value for adverse events after CABG. CMR is a helpful tool to risk-stratify patients with severe left ventricular dysfunction undergoing CABG.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - Shuang Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - YiFeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - Yue Ren
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No.2 AnZhen Road, Beijing 100011, PR China.
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2324-2405. [PMID: 38727647 DOI: 10.1016/j.jacc.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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3
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
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4
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Calderon Martinez E, Ortiz-Garcia NY, Herrera Hernandez DA, Arriaga Escamilla D, Diaz Mendoza DL, Othon Martinez D, Ramirez LM, Reyes-Rivera J, Choudhari J, Michel G. Hypertrophic Cardiomyopathy Diagnosis and Treatment in High- and Low-Income Countries: A Narrative Review. Cureus 2023; 15:e46330. [PMID: 37916234 PMCID: PMC10618028 DOI: 10.7759/cureus.46330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a hereditary cardiac condition characterized by unexplained left ventricular hypertrophy without a hemodynamic cause. This condition is prevalent in the United States, resulting in various clinical manifestations, including diastolic dysfunction, left ventricular outflow obstruction, cardiac ischemia, and atrial fibrillation. HCM is associated with several genetic mutations, with sarcomeric mutations being the most common and contributing to a more complex disease course. Early diagnosis of HCM is essential for effective management, as late diagnosis often requires invasive treatments and creates a substantial financial burden. Disparities in HCM diagnosis and treatment exist between high-income and low-income countries. High-income countries have more resources to investigate and implement advanced diagnostic and treatment modalities. In contrast, low-income countries face challenges in accessing diagnostic equipment, trained personnel, and affordable medications, leading to a lower quality of life and life expectancy for affected individuals. Diagnostic tools for HCM include imaging studies such as 2D echocardiography, cardiovascular magnetic resonance (CMR), and electrocardiograms (ECGs). CMR is considered the gold standard but remains inaccessible to a significant portion of the world's population, especially in low-income countries. Genetics plays a crucial role in HCM, with numerous mutations identified in various genes. Genetic counseling is essential but often limited in low-income countries due to resource constraints. Disparities in healthcare access and adherence to treatment recommendations exist between high-income and low-income countries, leading to differences in patient outcomes. Addressing these disparities is essential to improve the overall management of HCM on a global scale. In conclusion, this review highlights the complex nature of HCM, emphasizing the importance of early diagnosis, genetic counseling, and access to appropriate diagnostic and therapeutic interventions. Addressing healthcare disparities is crucial to ensure that all individuals with HCM receive timely and effective care, regardless of their geographic location or socioeconomic status.
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Affiliation(s)
| | | | | | | | | | | | - Luz M Ramirez
- Pulmonology and Critical Care, Benemerita Universidad Autonoma de Puebla, Puebla, MEX
| | - Jonathan Reyes-Rivera
- Medicine, Facultad de Medicina Universidad Autónoma de San Luis Potosí, San Luis Potosi, MEX
| | - Jinal Choudhari
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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5
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Wasserstrum Y, Larrañaga-Moreira JM, Martinez-Veira C, Itelman E, Lotan D, Sabbag A, Kuperstein R, Peled Y, Freimark D, Barriales-Villa R, Arad M. Hypokinetic hypertrophic cardiomyopathy: clinical phenotype, genetics, and prognosis. ESC Heart Fail 2022; 9:2301-2312. [PMID: 35488723 PMCID: PMC9288812 DOI: 10.1002/ehf2.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/12/2022] Open
Abstract
Aims To describe the phenotype, genetics, and events associated with the development of hypertrophic cardiomyopathy (HCM) with reduced ventricular function (HCMr). Heart failure in HCM is usually associated with preserved ejection fraction, yet some HCM patients develop impaired systolic function that is associated with worse outcomes. Methods and results Our registry included 1328 HCM patients from two centres in Spain and Israel. Patients with normal baseline ventricular function were matched, and a competing‐risk analysis was performed to find factors associated with HCMr development. Patient records were reviewed to recognize clinically significant events that occurred closely before the development of HCMr. Genetic data were collected in patients with HCMr. A composite of all‐cause mortality or ventricular assist device (VAD)/heart transplantation was assessed according to ventricular function. Median age was 56, and 34% were female patients. HCMr at evaluation was seen in 37 (2.8%) patients, and 46 (3.5%) developed HCMr during median follow up of 9 years. HCMr was associated with younger age of diagnosis, poor functional class, and ventricular arrhythmia. Atrial fibrillation, pacemaker implantation, and baseline left ventricular ejection fraction (LVEF) of ≤55% were significant predictors of future HCMr development, while LV obstruction predicted a lower risk. Genetic testing performed in 53 HCMr patients, identifying one or more pathogenic variant in 38 (72%): most commonly in myosin binding protein C (n = 20). Six of these patients had an additional pathogenic variant in one of the sarcomere genes. Patients with baseline HCMr had a higher risk (hazard ratio 6.4, 4.1–10.1) for the composite outcome and for the individual components. Patients who developed HCMr in the course of the study had similar mortality but a higher rate of VAD/heart transplantation compared with HCM with normal LVEF. Conclusions Hypertrophic cardiomyopathy with reduced ejection fraction is associated with heart failure and poor outcome. Arrhythmia, cardiac surgery, and device implantation were commonly documented prior to HCMr development, suggesting they may be either a trigger or the result of adverse remodelling. Future studies should focus on prediction and prevention of HCMr.
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Affiliation(s)
- Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - José M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Cristina Martinez-Veira
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Edward Itelman
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Dor Lotan
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Avi Sabbag
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Yael Peled
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Dov Freimark
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Cardiology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, 35 Kalachkin St., Tel-Aviv, 6997801, Israel
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6
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Stachera M, Przybyło P, Sznajder K, Gierlotka M. Cardiac magnetic resonance in the assessment of hypertrophic cardiomyopathy phenotypes and stages - pictorial review. Pol J Radiol 2021; 86:e672-e684. [PMID: 35059060 PMCID: PMC8757040 DOI: 10.5114/pjr.2021.112310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/22/2021] [Indexed: 01/10/2023] Open
Abstract
The aim of this paper is to present recent advances in hypertrophic cardiomyopathy (HCM) diagnosis and treatment based on a literature review. Special emphasis has been placed on the role of cardiac magnetic resonance imaging (CMR) for the assessment of morphological and functional consequences of different stages of HCM including prognostication. The text is illustrated with the images and data of the HCM patients diagnosed with CMR study in our hospital. CMR is an important tool, particularly relevant in novel risk factors and LV dysfunction groups. The HCM group with overt left ventricular dysfunction is underrecognized, often labelled by clinicians as dilated cardiomyopathy. Advanced diagnostic and management strategies effectively influence the natural history of HCM.
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Affiliation(s)
- Magdalena Stachera
- Clinical Department of Diagnostic Imaging, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - Paweł Przybyło
- Department of Cardiology, University Hospital in Opole, Poland
| | - Katarzyna Sznajder
- Clinical Department of Diagnostic Imaging, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
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7
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Dixon DL, de Las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e23-e106. [PMID: 33926766 DOI: 10.1016/j.jtcvs.2021.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Gossios TD, Savvatis K, Zegkos T, Parcharidou D, Karvounis HI, Efthimiadis GK. Risk Prediction Models and Scores in Hypertrophic Cardiomyopathy. Curr Pharm Des 2021; 27:1254-1265. [PMID: 33550965 DOI: 10.2174/1381612827666210125121115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) has historically been linked with sudden cardiac death (SCD). Currently, it is well established that only a subset of patients is at the highest risk stratum for such a catastrophic event. Detection of patients belonging to this high-risk category can allow for timely defibrillator implantation, changing the natural history of HCM. Inversely, device implantation in patients deemed at low risk leads to an unnecessary burden of device complications with no apparent protective benefit. Previous studies have identified a series of markers, now considered established risk factors, with genetic testing and newer imaging allowing for the detection of novel, highly promising indices of increased risk for SCD. Despite the identification of a number of risk factors, there is noticeable discrepancy in the utility of such factors for risk stratification between the current American and European guidelines. We sought to systematically review the data available on these two approaches, presenting their rationale and respective predictive capacity, also discussing the potential of novel markers to augment the precision of currently used risk stratification models for SCD in HCM.
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Affiliation(s)
- Thomas D Gossios
- Cardiology Department, St Thomas' Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Konstantinos Savvatis
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Thomas Zegkos
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Despina Parcharidou
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Haralambos I Karvounis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgios K Efthimiadis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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9
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2020; 76:e159-e240. [PMID: 33229116 DOI: 10.1016/j.jacc.2020.08.045] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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10
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy. Circulation 2020; 142:e558-e631. [DOI: 10.1161/cir.0000000000000937] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
- HFSA Representative
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11
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Hua TR, Zhang SY. Cardiomyopathies in China: A 2018-2019 state-of-the-art review. Chronic Dis Transl Med 2020; 6:224-238. [PMID: 33336168 PMCID: PMC7729112 DOI: 10.1016/j.cdtm.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Indexed: 11/02/2022] Open
Abstract
Cardiomyopathies are diseases of the cardiac muscle and are often characterized by ventricular dilation, hypertrophy, and cardiac arrhythmia. Patients with cardiomyopathies often experience sudden death and cardiac failure and require cardiac transplantation during the course of disease progression. Early diagnosis, differential diagnosis, and genetic consultation depend on imaging techniques, genetic testing, and new emerging diagnostic tools such as serum biomarkers. The molecular genetics of cardiomyopathies has been widely studied recently. The discovery of mechanisms underlying heterogeneity and overlapping of the phenotypes of cardiomyopathies has revealed the existence of disease modifiers, and this has led to the emergence of novel disease-modifying therapy. This 2018-2019 state-of-the-art review outlines the pathogenesis, diagnosis, and treatment of cardiomyopathies in China.
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Affiliation(s)
- Tian-Rui Hua
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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12
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Abstract
Hypertrophic cardiomyopathy (HCM) is a common cardiac condition caused primarily by sarcomeric protein mutations with several distinct phenotypes, ranging from asymmetric septal hypertrophy, either with or without left ventricular outflow tract obstruction, to moderate left ventricular dilation with or without apical aneurysm formation and marked, end-stage dilation with refractory heart failure. Sudden cardiac death can occur at any stage. The phenotypic variability observed in HCM is the end-result of many factors, including pre-load, after-load, wall stress and myocardial ischemia stemming from microvascular dysfunction and thrombosis; however, tissue level inflammation to include leukocyte-derived extracellular traps consisting of chromatin and histones, apoptosis, proliferation of matrix proteins and impaired or dysfunctional regulatory pathways contribute as well. Our current understanding of the pathobiology, developmental stages, transition from hypertrophy to dilation and natural history of HCM with emphasis on the role of tissue-level inflammation in myocardial fibrosis and ventricular remodeling is summarized.
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13
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Bi X, Yang C, Song Y, Yuan J, Cui J, Hu F, Qiao S. Matrix Metalloproteinases Increase Because of Hypoperfusion in Obstructive Hypertrophic Cardiomyopathy. Ann Thorac Surg 2020; 111:915-922. [PMID: 32738221 DOI: 10.1016/j.athoracsur.2020.05.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/02/2020] [Accepted: 05/26/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Myocardial fibrosis (MF) is considered a result of microvascular dysfunction in patients with hypertrophic cardiomyopathy. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), capable of degrading collagen, directly participate in the development of MF. First we investigated the relationships among MF, microvascular rarefaction, and MMPs. Then we assessed the prognostic value of MF-related circulating biomarkers. METHODS Fifty-five obstructive hypertrophic cardiomyopathy (HOCM) patients were enrolled after surgical myectomy. Myocardial samples were performed with Masson's trichrome staining and immunohistochemical procedures for collagen volume fraction and microvascular density, respectively. Enzyme-linked immunosorbent assays were used to assess myocardial and plasma of MMP-2, MMP-9, and TIMP-1 and plasma C-terminal propeptide of procollagen type Ⅰ (PICP) and C-terminal telopeptide of type Ⅰ collagen (ICTP) levels. The composite cardiovascular endpoint consisted of new-onset atrial fibrillation, heart failure requiring hospitalization, and all-cause death. RESULTS In HOCM patients microvascular density was associated with the myocardial MMP-2/TIMP-1 ratio (r = -0.348, P = .009), whereas no correlation was found between collagen volume fraction and myocardial MMPs. During the 44-month follow-up 6 patients experienced a cardiovascular endpoint. The plasma PICP/ICTP ratio and MMP-2/TIMP-1 ratio were the 2 strongest prognostic makers. In multivariable analyses high PICP/ICTP and MMP-2/TIMP-1 ratios remained independent predictors of cardiovascular outcomes after adjusting for clinical confounders (hazard ratios, 12.683 [P = .021] and 17.037 [P = .027], respectively). CONCLUSIONS In HOCM patients the myocardial MMP-2/TIMP-1 ratio was elevated because of microvascular rarefaction but may not be responsible for MF. High plasma PICP/ICTP and MMP-2/TIMP-1 ratios are independent predictors of adverse outcomes in HOCM patients.
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Affiliation(s)
- Xuanye Bi
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengzhi Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunhu Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Cui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenghuan Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Chen S, Huang L, Zhang Q, Wang J, Chen Y. T2-weighted cardiac magnetic resonance image and myocardial biomarker in hypertrophic cardiomyopathy. Medicine (Baltimore) 2020; 99:e20134. [PMID: 32501969 PMCID: PMC7306317 DOI: 10.1097/md.0000000000020134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The phenomenon of high signal intensity on T2-weighted imaging of cardiac magnetic resonance in hypertrophic cardiomyopathy (HCM) has been previously studied. However, the underlying histopathologic mechanism remains unclear. Elevated cardiac troponin can be detected in some HCM patients. A reasonable hypothesis is that high myocardial T2 signal is a potential marker of myocardial injury in HCM. We sought to investigate the association between cardiac troponin and the extent of high T2 signals in HCM patients.Forty-four HCM patients underwent 3.0T cardiac magnetic resonance scanning. On T2-weighted images, the number of segments with high-signal intensity (myocardium-to-skeletal muscle signal intensity ratio >2) and the percentage of high-signal area (>2 standard deviation above the remote tissue) were measured in 16 myocardial segments along the LV mid-myocardial circumference on 3 short-axis images. The level of high-sensitivity cardiac troponin T (hs-cTnT) was also assessed.Myocardial high T2 signals were identified in 33 (75%) patients and 144 (20.5%) segments. Elevated hs-cTnT was observed in 28 (63.6%) patients. The Cochran-Armitage test showed a statistically significant trend of increasing levels of hs-cTnT with elevated number of segments with myocardial high T2 signal (P = .002). Further, the percentage of myocardium with high T2 signal was significantly associated with the hs-cTnT level (Pearson correlation: r = 0.388, P = .009).Myocardium with high T2 signals was very common in patients with HCM.Its extent is related with the level of plasma hs-cTnT.
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Affiliation(s)
- Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University
| | - Liwei Huang
- Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University
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Outcomes in Patients With Hypertrophic Cardiomyopathy and Left Ventricular Systolic Dysfunction. J Am Coll Cardiol 2020; 75:3033-3043. [DOI: 10.1016/j.jacc.2020.04.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
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Reiber JHC, Pereira GTR, Bezerra HG, De Sutter J, Schoenhagen P, Stillman AE, Van de Veire NRL. Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2019; 35:1175-1188. [DOI: 10.1007/s10554-019-01579-9] [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: 12/01/2022]
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Brenes JC, Doltra A, Prat S. Cardiac magnetic resonance imaging in the evaluation of patients with hypertrophic cardiomyopathy. Glob Cardiol Sci Pract 2018; 2018:22. [PMID: 30393634 PMCID: PMC6209443 DOI: 10.21542/gcsp.2018.22] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Adelina Doltra
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Susanna Prat
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
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