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Abou Alaiwi S, Roston TM, Marstrand P, Claggett BL, Parikh VN, Helms AS, Ingles J, Lampert R, Lakdawala NK, Michels M, Owens AT, Rossano JW, Saberi S, Abrams DJ, Ashley EA, Semsarian C, Stendahl JC, Ware JS, Miller E, Ryan TD, Russell MW, Day SM, Olivotto I, Vissing CR, Ho CY. Left Ventricular Systolic Dysfunction in Patients Diagnosed With Hypertrophic Cardiomyopathy During Childhood: Insights From the SHaRe Registry. Circulation 2023; 148:394-404. [PMID: 37226762 PMCID: PMC10373850 DOI: 10.1161/circulationaha.122.062517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The development of left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM) is rare but serious and associated with poor outcomes in adults. Little is known about the prevalence, predictors, and prognosis of LVSD in patients diagnosed with HCM as children. METHODS Data from patients with HCM in the international, multicenter SHaRe (Sarcomeric Human Cardiomyopathy Registry) were analyzed. LVSD was defined as left ventricular ejection fraction <50% on echocardiographic reports. Prognosis was assessed by a composite of death, cardiac transplantation, and left ventricular assist device implantation. Predictors of developing incident LVSD and subsequent prognosis with LVSD were assessed using Cox proportional hazards models. RESULTS We studied 1010 patients diagnosed with HCM during childhood (<18 years of age) and compared them with 6741 patients with HCM diagnosed as adults. In the pediatric HCM cohort, median age at HCM diagnosis was 12.7 years (interquartile range, 8.0-15.3), and 393 (36%) patients were female. At initial SHaRe site evaluation, 56 (5.5%) patients with childhood-diagnosed HCM had prevalent LVSD, and 92 (9.1%) developed incident LVSD during a median follow-up of 5.5 years. Overall LVSD prevalence was 14.7% compared with 8.7% in patients with adult-diagnosed HCM. Median age at incident LVSD was 32.6 years (interquartile range, 21.3-41.6) for the pediatric cohort and 57.2 years (interquartile range, 47.3-66.5) for the adult cohort. Predictors of developing incident LVSD in childhood-diagnosed HCM included age <12 years at HCM diagnosis (hazard ratio [HR], 1.72 [CI, 1.13-2.62), male sex (HR, 3.1 [CI, 1.88-5.2), carrying a pathogenic sarcomere variant (HR, 2.19 [CI, 1.08-4.4]), previous septal reduction therapy (HR, 2.34 [CI, 1.42-3.9]), and lower initial left ventricular ejection fraction (HR, 1.53 [CI, 1.38-1.69] per 5% decrease). Forty percent of patients with LVSD and HCM diagnosed during childhood met the composite outcome, with higher rates in female participants (HR, 2.60 [CI, 1.41-4.78]) and patients with a left ventricular ejection fraction <35% (HR, 3.76 [2.16-6.52]). CONCLUSIONS Patients with childhood-diagnosed HCM have a significantly higher lifetime risk of developing LVSD, and LVSD emerges earlier than for patients with adult-diagnosed HCM. Regardless of age at diagnosis with HCM or LVSD, the prognosis with LVSD is poor, warranting careful surveillance for LVSD, especially as children with HCM transition to adult care.
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Affiliation(s)
- Sarah Abou Alaiwi
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Thomas M. Roston
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
- University of British Columbia, Vancouver, Canada (T.M.R.)
| | - Peter Marstrand
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Denmark (P.M.)
| | - Brian Lee Claggett
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Victoria N. Parikh
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Adam S. Helms
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and University of New South Wales, Sydney, Australia (J.I.)
| | - Rachel Lampert
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - Neal K. Lakdawala
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Anjali T. Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (J.W.R.)
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Dominic J. Abrams
- Center for Cardiovascular Genetics, Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, MA (D.J.A.)
| | - Euan A. Ashley
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S.)
| | - John C. Stendahl
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - James S. Ware
- Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK (J.S.W.)
| | - Erin Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Thomas D. Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Mark W. Russell
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Sharlene M. Day
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy (I.O.)
| | - Christoffer R. Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (C.R.V.)
| | - Carolyn Y. Ho
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
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4
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Yang S, Ji K, Chen X, Li F, Yang K, Yu S, Zheng Y, Song Y, Zhao K, Lu M, Wang S, Wang S, Zhao S. Left Ventricular Myocardial Remodeling and Prognostic Marker Derived from Postmyectomy Cardiac MRI Feature Tracking in Hypertrophic Obstructive Cardiomyopathy. Radiol Cardiothorac Imaging 2022; 4:e210172. [PMID: 35506138 PMCID: PMC9059098 DOI: 10.1148/ryct.210172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Abstract
Purpose To investigate myocardial remodeling using cardiac MRI (CMR) feature tracking (FT) and to explore the relationship between CMR parameters with outcomes in hypertrophic obstructive cardiomyopathy (HOCM) after myectomy. Materials and Methods In this single-center retrospective study, patients with HOCM undergoing myectomy between 2011 and 2019 were included. Pre- and postmyectomy global and regional strains were compared. Healthy participants were included for comparison. Composite events were recorded at follow-up performed after a minimum of 12 months. The paired-samples t test was utilized to compare pre- and postmyectomy variables. Results A total of 73 patients (44 years ± 14 [SD]; 45 men) were evaluated. Compared with preoperative parameters, global circumferential strain (CS) (-17.6% ± 4.4 vs -16.7% ± 3.9, P = .02) was impaired, but global longitudinal strain (LS) was improved (-9.3% ± 2.8 vs -10.8% ± 3.3, P < .001). Septal CS (-14.2% ± 4.0 vs -11.0% ± 4.4, P < .001) and septal radial strain (RS) (16.4% ± 10.6 vs 13.7% ± 9.5, P = .007) worsened, while septal LS (-8.1% ± 3.5 vs -10.2% ± 3.4, P < .001), lateral RS (40.1% ± 16.6 vs 54.4% ± 22.6, P < .001), lateral CS (-20.2% ± 4.1 vs -23.1% ± 4.8, P < .001), and lateral LS (-5.6% ± 5.6 vs -8.4% ± 5.2, P = .001) were improved. Sixteen of 73 patients (22%) experienced composite events after median follow-up of 39.1 months. Postoperative global CS provided the highest discrimination for composite event occurrence (area under the receiver operating characteristic curve, 0.73; 95% CI: 0.61, 0.83) with a cutoff of -16.7%. Patients with postoperative global CS greater than -16.7% had reduced event-free survival compared with those with postoperative global CS less than or equal to -16.7% (log-rank P = .002). Conclusion CMR-FT analysis demonstrated longitudinal and lateral restorations, but impaired global CS, after myectomy in patients with HOCM; furthermore, increased global CS was associated with poorer outcomes.Keywords: MR Imaging, Cardiac, Outcomes Analysis, Comparative Studies, Surgery© RSNA, 2022 Supplemental material is available for this article.
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Affiliation(s)
| | | | - Xiuyu Chen
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Fei Li
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Kai Yang
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shiqin Yu
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Yucong Zheng
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Yanyan Song
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Kankan Zhao
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Minjie Lu
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shengwei Wang
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shuiyun Wang
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shihua Zhao
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
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5
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Marstrand P, Han L, Day SM, Olivotto I, Ashley EA, Michels M, Pereira AC, Wittekind SG, Helms A, Saberi S, Jacoby D, Ware JS, Colan SD, Semsarian C, Ingles J, Lakdawala NK, Ho CY. Hypertrophic Cardiomyopathy With Left Ventricular Systolic Dysfunction: Insights From the SHaRe Registry. Circulation 2020; 141:1371-1383. [PMID: 32228044 PMCID: PMC7182243 DOI: 10.1161/circulationaha.119.044366] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. The term “end stage” has been used to describe hypertrophic cardiomyopathy (HCM) with left ventricular systolic dysfunction (LVSD), defined as occurring when left ventricular ejection fraction is <50%. The prognosis of HCM-LVSD has reportedly been poor, but because of its relative rarity, the natural history remains incompletely characterized.
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Affiliation(s)
- Peter Marstrand
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.M., N.K.L., C.Y.H.).,Department of Cardiology, Herlev-Gentofte Hospital, University Hospital of Copenhagen, Denmark (P.M.)
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (L.H.)
| | - Sharlene M Day
- Department of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (A.C.P.)
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, OH (S.G.W.)
| | - Adam Helms
- Department of Internal Medicine, University of Michigan, Ann Arbor (A.H., S.S.)
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor (A.H., S.S.)
| | | | - James S Ware
- National Heart and Lung Institute and Royal Brompton Cardiovascular Research Centre, Imperial College London, United Kingdom (J.S.W.)
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, MA (S.D.C.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S., J.I.)
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S., J.I.)
| | - Neal K Lakdawala
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.M., N.K.L., C.Y.H.)
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.M., N.K.L., C.Y.H.)
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