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Genomic findings of hypertrophic and dilated cardiomyopathy characterized in a Thai clinical genetics service. PLoS One 2022; 17:e0267770. [PMID: 36166435 PMCID: PMC9514623 DOI: 10.1371/journal.pone.0267770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are the most common referrals in the Inherited Cardiovascular Condition (ICC) Genetics Service. Several issues must be discussed with patients and their families during the genetic consultation session, including the options for genetic testing and cardiovascular surveillance in family members. We developed an ICC registry and performed next-generation-based DNA sequencing for all patients affected by non-syndromic HCM and idiopathic DCM in our joint specialist genetics service. The target gene sequencing panel relied on the Human Phenotype Ontology with 237 genes for HCM (HP:0001639) and 142 genes for DCM (HP:0001644). All subjects were asked to contact their asymptomatic first-degree relatives for genetic counseling regarding their risks and to initiate cardiovascular surveillance and cascade genetic testing. The study was performed from January 1, 2014, to December 31, 2020, and a total of 62 subjects (31-HCM and 31-DCM) were enrolled. The molecular detection frequency was 48.39% (32.26% pathogenic/likely pathogenic, 16.13% variant of uncertain significance or VUS for HCM, and 25.81% (16.13% pathogenic/likely pathogenic, 9.68% VUS) for DCM. The most prevalent gene associated with HCM was MYBPC3. The others identified in this study included ACTN2, MYL2, MYH7, TNNI3, TPM1, and VCL. Among the DCM subjects, variants were detected in two cases with the TTN nonsense variants, while the others were missense and identified in MYH7, DRSP3, MYBPC3, and SCN5A. Following the echocardiogram surveillance and cascade genetic testing in the asymptomatic first-degree relatives, the detection rate of new cases was 8.82% and 6.25% in relatives of HCM and DCM subjects, respectively. Additionally, a new pre-symptomatic relative belonging to an HCM family was identified, although the genomic finding in the affected case was absent. Thus, ICC service is promising for the national healthcare system, aiming to prevent morbidity and mortality in asymptomatic family members.
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Zanganehfar M, Daniali F, Ansari MA, Diz A. Acute myocardial infarction secondary to left main coronary embolization after the conversion of an unwanted atrial fibrillation to the sinus rhythm. Res Cardiovasc Med 2022. [DOI: 10.4103/rcm.rcm_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Seggewiss H, Batzner A. Surgical myectomy in HOCM: Still gold standard for septal reduction? Int J Cardiol 2021; 331:174-175. [PMID: 33524466 DOI: 10.1016/j.ijcard.2021.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Hubert Seggewiss
- Comprehensive Heart Failure Center (CHFC), University Clinic, Wuerzburg, Germany.
| | - Angelika Batzner
- Comprehensive Heart Failure Center (CHFC), University Clinic, Wuerzburg, Germany
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Mahfouz Badran H, Soltan G, Eltahan E, Yacoub MH, Faheem N. Relation of atrial electromechanical delay to P-wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2021; 26:e12801. [PMID: 32969115 PMCID: PMC7816806 DOI: 10.1111/anec.12801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Heterogeneity of structural and electrophysiologic properties of atrial myocardium is common characteristic in hypertrophic cardiomyopathy (HCM). We assessed the dispersion of atrial refractoriness on surface ECG using P-wave dispersion (PWD) and its relation to atrial electromechanical functions using vector velocity imaging (VVI) in HCM population. METHODS Seventy-nine HCM patients (mean age: 43.7 ± 13 years, 67% male) were compared with 25 healthy individuals as control. P-wave durations, Pmax and Pmin , P-wave dispersion (PWD), and P terminal force (PTF) were measured from 12-lead ECG. LA segmental delay (TTP-d) and dispersion (TTP-SD) of electromechanical activation were derived from atrial strain rate curves. RESULTS HCM patients had longer PR interval, PW duration, higher PWD, PTF, QTc compared to control (p < .001). HCM patients were classified according to presence of PWD into two groups, group I with PWD > 46 ms (n = 25) and group II PWD ≤ 46 ms (n = 54). Group I showed higher prevalence of female gender, higher PTF, QTc interval, left ventricular outflow tract (LVOT) obstruction, p < .01, LVOT gradient (p < .001), LV mass index (p < .01), E/E' (p < .01), and severe mitral regurgitation (p < .001). Moreover, PWD was associated with increased atrial electromechanical delay (TTP-d) and LA mechanical dyssynchrony (TTP-SD), p < .001. LA segmental delay and dispersion of electromechanical activation were distinctly higher among HCM patient. CONCLUSION PWD is simple ECG criterion, and it is associated with more severe HCM phenotype and LA electromechanical delay while PTF is linked only to atrial remodeling.
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Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department Menofia UniversityShebin ElkomEgypt
- The BAHCM National ProgramAswanEgypt
| | - Ghada Soltan
- Cardiology Department Menofia UniversityShebin ElkomEgypt
| | - Eslam Eltahan
- Cardiology Department Menofia UniversityShebin ElkomEgypt
| | - Magdi H. Yacoub
- The BAHCM National ProgramAswanEgypt
- Imperial CollegeLondonUK
| | - Naglaa Faheem
- Cardiology Department Menofia UniversityShebin ElkomEgypt
- The BAHCM National ProgramAswanEgypt
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Liu L, Wu L, Zheng L, Ding L, Chen G, Fan X, Yao Y. Associations Between Multiple Circulating Biomarkers and the Presence of Atrial Fibrillation in Hypertrophic Cardiomyopathy with or Without Left Ventricular Outflow Tract Obstruction. Int Heart J 2019; 60:327-335. [DOI: 10.1536/ihj.18-438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Limin Liu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lingmin Wu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lihui Zheng
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ligang Ding
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Gang Chen
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaohan Fan
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yan Yao
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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WINTERFIELD JEFFREYR, VOSS JAMIE. Silent AF and Hypertrophic Stroke Risk: More Data, More Monitoring. J Cardiovasc Electrophysiol 2016; 27:785-7. [DOI: 10.1111/jce.13012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - JAMIE VOSS
- Loyola University Medical Center; Cardiovascular Institute; Maywood Illinois USA
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WILKE IRIS, WITZEL KATRIN, MÜNCH JULIA, PECHA SIMON, BLANKENBERG STEPHAN, REICHENSPURNER HERMANN, WILLEMS STEPHAN, PATTEN MONICA, AYDIN ALI. High Incidence of De Novo and Subclinical Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy and Cardiac Rhythm Management Device. J Cardiovasc Electrophysiol 2016; 27:779-84. [DOI: 10.1111/jce.12982] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- IRIS WILKE
- Department of Cardiology; Reinbek Hospital; St. Adolf-Stift Reinbek Germany
| | - KATRIN WITZEL
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - JULIA MÜNCH
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - SIMON PECHA
- Department of Cardiac Surgery; University Heart Center Hamburg; Hamburg Germany
| | - STEPHAN BLANKENBERG
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | | | - STEPHAN WILLEMS
- Department of Electrophysiology; University Heart Center Hamburg; Hamburg Germany
| | - MONICA PATTEN
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - ALI AYDIN
- Department of Cardiology; Reinbek Hospital; St. Adolf-Stift Reinbek Germany
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Impact of Genotype on the Occurrence of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 117:1151-9. [PMID: 26869393 DOI: 10.1016/j.amjcard.2015.12.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/26/2015] [Accepted: 12/26/2015] [Indexed: 12/19/2022]
Abstract
Genes associated with hypertrophic cardiomyopathy (HC) are not uniformly expressed in the atrial myocardium. Whether this may impact susceptibility to atrial fibrillation (AF) is unresolved. To analyze the prevalence and clinical correlates of AF in relation to genotype in a large HC cohort, prevalence and clinical profile of AF were assessed in 237 patients with HC, followed for 14 ± 10 years. Patients were divided into 3 genetic subgroups: (1) MYBPC3 (58%), (2) MYH7 (28%), and (3) "other genotypes" (14%; comprising TNNT2, TNNI3, TPM1, MYL2, complex genotypes, Z-line, and E-C coupling genes). Left atrial size was similar in the 3 subsets. AF occurred in 74 patients with HC (31%), with no difference among groups (31% in MYBPC3, 37% in MYH7 and 18% in other genotypes, p = 0.15), paroxysmal/persistent AF (12%, 18%, and 12%, respectively; p = 0.53), paroxysmal/persistent evolved to permanent (12%, 12%, and 3%, p = 0.36) or permanent AF (7%, 7%, and 3%, p = 0.82). Age at AF onset was younger in the group with other genotypes (37 ± 10 years) compared to the first 2 groups (53 ± 14 and 51 ± 17, respectively; p = 0.05) because of early onset associated with complex genotypes and a specific JPH2 mutation associated with abnormal intracellular calcium handling. At multivariate analysis, independent predictors of AF were atrial diameter (p ≤0.05) and age at diagnosis (p = 0.09), but not genetic subtype (p = 0.35). In conclusion, in patients with HC, genetic testing cannot be used in clinical decision making with regard to management strategies for AF. Genotype is not predictive of onset or severity of AF, which appears rather driven by hemodynamic determinants of atrial dilatation. Exceptions are represented by rare genes suggesting specific molecular pathways for AF in genetic cardiomyopathies.
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Tuluce K, Yakar Tuluce S, Kahya Eren N, Kocabas U, Akyildiz Akcay F, Gunduz R, Akyildiz ZI, Ergene O. Predictors of Future Atrial Fibrillation Development in Patients with Hypertrophic Cardiomyopathy: A Prospective Follow-Up Study. Echocardiography 2015; 33:379-85. [DOI: 10.1111/echo.13093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kamil Tuluce
- Department of Cardiology; Tepecik Training and Research Hospital; Izmir Turkey
| | - Selcen Yakar Tuluce
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Nihan Kahya Eren
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Ugur Kocabas
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Filiz Akyildiz Akcay
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Ramazan Gunduz
- Department of Cardiology; Merkez Efendi State Hospital; Manisa Turkey
| | - Zehra I. Akyildiz
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Oktay Ergene
- Department of Cardiology; Dokuz Eylul University Faculty of Medicine; Izmir Turkey
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Alpert C, Day SM, Saberi S. Sports and Exercise in Athletes with Hypertrophic Cardiomyopathy. Clin Sports Med 2015; 34:489-505. [DOI: 10.1016/j.csm.2015.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Yashiro B, Minami Y, Terajima Y, Hagiwara N. Prognostic difference between paroxysmal and non-paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. J Cardiol 2013; 63:432-7. [PMID: 24280311 DOI: 10.1016/j.jjcc.2013.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/16/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The association of atrial fibrillation (AF) with sudden death and the difference in prognostic significance between paroxysmal and non-paroxysmal AF remains unclear in patients with hypertrophic cardiomyopathy (HCM). Our aim was to investigate the clinical significance of AF, and to assess the prognostic difference between paroxysmal and non-paroxysmal AF in HCM patients. METHODS The study included 430 HCM patients. Documentation of AF was based on electrocardiograms obtained either after the acute onset of symptoms or fortuitously during routine examination of asymptomatic patients. RESULTS AF was detected in 120 patients (27.9%). In the patients with AF, syncope and non-sustained ventricular tachycardia were more frequent and the left atrial dimension was larger. Multivariate analysis showed that AF was an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 3.57, p<0.001) and sudden death (adjusted hazard ratio 2.61, p=0.038). When patients with AF were divided into subgroups with paroxysmal AF (n=75) or non-paroxysmal AF (n=45), only paroxysmal AF was identified as an independent determinant of the outcome, including the risk of HCM-related death (adjusted hazard ratio 5.24, p<0.001) and sudden death (adjusted hazard ratio 4.67, p=0.002). CONCLUSIONS AF is a common supraventricular arrhythmia in HCM and has an adverse influence on the prognosis. In addition, each type of AF had a different clinical impact, with paroxysmal AF being a significant independent determinant of an adverse outcome, including sudden death.
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Affiliation(s)
- Bun Yashiro
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yutaka Terajima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Correlation between myocardial fibrosis and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study. Eur J Radiol 2010; 75:e88-91. [PMID: 20079992 DOI: 10.1016/j.ejrad.2009.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 12/11/2009] [Indexed: 01/19/2023]
Abstract
Cardiac magnetic resonance imaging (CMR) in hypertrophic cardiomyopathy (HCM) often shows delayed contrast enhancement (DE) representing regions of focal myocardial fibrosis. Atrial fibrillation (AF) is a commonly reported complication of HCM. We determined the relationship between the presence of left ventricular myocardial fibrosis (LVMF) detected by DE-CMR and the occurrence AF in a series of patients with HCM. 67 patients with HCM (47 males; mean age 50.1+/-18.5 years) were studied by CMR measuring mass of LVMF, left ventricular mass, volume and function, and left atrial (LA) area. AF was present in 17 (25%) patients. LVMF was observed in 57% of patients. AF was significantly more frequent in patients who also showed LVMF, compared with the group without LVMF (42.1% vs. 3.4%, respectively; p<0.0001). LA size was larger in patients showing DE (LA area: 37.4+/-11.1 vs. 25.9+/-6.8 cm(2); respectively, p=0.0001). AF in HCM is related with myocardial fibrosis detected by DE-CMR and dilatation of the LA. This fact adds to the proven adverse prognostic value of myocardial fibrosis in HCM, thus, reinforcing the usefulness of this technique in the assessment of these patients.
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Seggewiss H, Blank C, Pfeiffer B, Rigopoulos A. Hypertrophic cardiomyopathy as a cause of sudden death. Herz 2009; 34:305-14. [PMID: 19575162 DOI: 10.1007/s00059-009-3248-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the main cause of sudden unexpected death in the young and especially in young athletes with an incidence up to 2.3 per 100,000 athletes and year. Risk stratification models including patient history (syncope, familial risk of sudden death) and findings in noninvasive tests (nonsustained ventricular tachycardia, abnormal blood pressure response during exercise, maximum left ventricular wall thickness > or = 30 mm) have been developed in order to estimate the risk of individual patients. Echocardiographic parameters are helpful in distinguishing HCM from athlete's heart. Definitive diagnosis of HCM implicates disqualification from competitive sports resulting in a significant reduction of sudden cardiac death due to HCM during sports competition. This positive development should lead to a widespread preparticipation screening of athletes including historical, clinical, and electrocardiographic examination. At least in borderline findings and symptomatic athletes, an additional echocardiogram should be performed in order to minimize or better exclude the risk of sudden cardiac death.
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Affiliation(s)
- Hubert Seggewiss
- Medical Department 1, Leopoldina Hospital, Schweinfurt, Germany.
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Papavassiliu T, Germans T, Flüchter S, Doesch C, Suriyakamar A, Haghi D, Süselbeck T, Wolpert C, Dinter D, Schoenberg SO, van Rossum AC, Borggrefe M. CMR findings in patients with hypertrophic cardiomyopathy and atrial fibrillation. J Cardiovasc Magn Reson 2009; 11:34. [PMID: 19740409 PMCID: PMC2749835 DOI: 10.1186/1532-429x-11-34] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/09/2009] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We sought to evaluate the relation between atrial fibrillation (AF) and the extent of myocardial scarring together with left ventricular (LV) and atrial parameters assessed by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND AF is the most common arrhythmia in HCM. Myocardial scarring is also identified frequently in HCM. However, the impact of myocardial scarring assessed by LGE CMR on the presence of AF has not been evaluated yet. METHODS 87 HCM patients underwent LGE CMR, echocardiography and regular ECG recordings. LV function, volumes, myocardial thickness, left atrial (LA) volume and the extent of LGE, were assessed using CMR and correlated to AF. Additionally, the presence of diastolic dysfunction and mitral regurgitation were obtained by echocardiography and also correlated to AF. RESULTS Episodes of AF were documented in 37 patients (42%). Indexed LV volumes and mass were comparable between HCM patients with and without AF. However, indexed LA volume was significantly higher in HCM patients with AF than in HCM patients without AF (68 +/- 24 ml.m-2 versus 46 +/- 18 ml.m-2, p = 0.0002, respectively). The mean extent of LGE was higher in HCM patients with AF than those without AF (12.4 +/- 14.5% versus 6.0 +/- 8.6%, p = 0.02). When adjusting for age, gender and LV mass, LGE and indexed LA volume significantly correlated to AF (r = 0.34, p = 0.02 and r = 0.42, p < 0.001 respectively). By echocardiographic examination, LV diastolic dysfunction was evident in 35 (40%) patients. Mitral regurgitation greater than II was observed in 12 patients (14%). Multivariate analysis demonstrated that LA volume and presence of diastolic dysfunction were the only independent determinant of AF in HCM patients (p = 0.006, p = 0.01 respectively). Receiver operating characteristic curve analysis indicated good predictive performance of LA volume and LGE (AUC = 0.74 and 0.64 respectively) with respect to AF. CONCLUSION HCM patients with AF display significantly more LGE than HCM patients without AF. However, the extent of LGE is inferior to the LA size for predicting AF prevalence. LA dilation is the strongest determinant of AF in HCM patients, and is related to the extent of LGE in the LV, irrespective of LV mass.
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Affiliation(s)
- Theano Papavassiliu
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Tjeerd Germans
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Stephan Flüchter
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Christina Doesch
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Anton Suriyakamar
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Dariusch Haghi
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Tim Süselbeck
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Christian Wolpert
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
| | - Dietmar Dinter
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Hospital of Mannheim, Mannheim, Germany
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Holmqvist F, Platonov PG, Carlson J, Havmöller R, Waktare JEP, McKenna WJ, Olsson SB, Meurling CJ. Variable interatrial conduction illustrated in a hypertrophic cardiomyopathy population. Ann Noninvasive Electrocardiol 2007; 12:227-36. [PMID: 17617068 PMCID: PMC6932290 DOI: 10.1111/j.1542-474x.2007.00166.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) have a high incidence of atrial fibrillation. They also have a longer P-wave duration than healthy controls, indicating conduction alterations. Previous studies have demonstrated orthogonal P-wave morphology alterations in patients with paroxysmal atrial fibrillation. In the present study, the P-wave morphology of patients with HCM was compared with that of matched controls in order to explore the nature of the atrial conduction alterations. METHODS AND RESULTS A total of 65 patients (45 men, mean age 49 +/- 15) with HCM were included. The control population (n = 65) was age and gender matched (45 men, mean age 49 +/- 15). Five minutes of 12-lead ECG was recorded. The data were subsequently transformed to orthogonal lead data, and unfiltered signal-averaged P-wave analysis was performed. The P-wave duration was longer in the HCM patients compared to the controls (149 +/- 22 vs 130 +/- 16 ms, P < 0.0001). Examination of the P-wave morphology demonstrated changes in conduction patterns compatible with interatrial conduction block of varying severity in both groups, but a higher degree of interatrial block seen in the HCM population. These changes were most prominent in the Leads Y and Z. CONCLUSION The present study suggests that the longer P-wave duration observed in HCM patients may be explained by a higher prevalence of block in one or more of the interatrial conduction routes.
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Nistri S, Olivotto I, Betocchi S, Losi MA, Valsecchi G, Pinamonti B, Conte MR, Casazza F, Galderisi M, Maron BJ, Cecchi F. Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy (from the Italian Registry for Hypertrophic Cardiomyopathy). Am J Cardiol 2006; 98:960-5. [PMID: 16996883 DOI: 10.1016/j.amjcard.2006.05.013] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 11/30/2022]
Abstract
This study assessed left atrial (LA) dimension as a potential predictor of outcome in hypertrophic cardiomyopathy (HC). From the Italian Registry for Hypertrophic Cardiomyopathy, 1,491 patients (mean age 47 +/- 17 years; 61% men; 19% obstructive), followed for 9.4 +/- 7.4 years after the initial echocardiographic evaluation, constituted the study group. The mean LA transverse dimension was 43 +/- 9 mm and was larger in patients with severe symptoms (48 +/- 9 mm for New York Heart Association classes III and IV vs 42 +/- 9 mm for classes I and II, p <0.001), atrial fibrillation (47 +/- 9 vs 42 +/- 8 mm in sinus rhythm, p <0.001), and left ventricular outflow obstruction (46 +/- 9 mm for >or=30 mm Hg at rest vs 42 +/- 9 mm for <30 mm Hg at rest, p <0.001). On univariate analysis, each 5-mm increase in LA size was associated with a hazard ratio (HR) of 1.2 for all-cause mortality (p <0.0001). On multivariate analysis, a LA dimension >48 mm (the 75th percentile) had a HR of 1.9 for all-cause mortality (p = 0.008), 2.0 for cardiovascular death (p = 0.014), and 3.1 for death related to heart failure (p = 0.008) but was unassociated with sudden death (p = 0.81). Similar results were obtained after the exclusion of patients with atrial fibrillation (HR 1.7, p = 0.008) or outflow obstruction (HR 1.8, p = 0.003). The predictive power of LA dimension >48 mm was also validated in an independent HC cohort from the United States, with similar HRs (1.8 for all-cause mortality, p = 0.019). In conclusion, in a large cohort of patients with HC from a nationwide registry, a marked increase in LA dimension were predictive of long-term outcome, independent of co-existent atrial fibrillation or outflow obstruction. LA dimension is a novel and independent marker of prognosis in HC, particularly relevant to the identification of patients at risk for death related to heart failure.
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Abstract
All patients with hypertrophic cardiomyopathy (HCM) should have five aspects of care addressed. An attempt should be made to detect the presence or absence of risk factors for sudden arrhythmic death. If the patient appears to be at high risk, discussion of the benefits and risks of ICD are indicated, and many such patients will be implanted. Symptoms are appraised and treated. Bacterial endocarditis prophylaxis is recommended. Patients are advised to avoid athletic competition and extremes of physical exertion. First degree family members should be screened with echocardiography and ECG.
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Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program and Echocardiography Laboratory, Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Shizukuda Y, Sachdev V, Fananapazir L, Tripodi D, Mohiddin SA, Arai AE, Waclawiw MA, Plehn JF. Is Functional Capacity Related to Left Atrial Contractile Function in Nonobstructive Hypertrophic Cardiomyopathy? ACTA ACUST UNITED AC 2005; 11:234-40. [PMID: 16230864 DOI: 10.1111/j.1527-5299.2005.04457.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The mechanisms underlying reduced exercise capacity in patients with nonobstructive hypertrophic cardiomyopathy (NHCM) could include perturbations of ventricular relaxation, diastolic compliance, or compensatory atrial systolic function. We hypothesized that a loss of atrial contractility in NHCM patients leads to reduced functional capacity. To test this hypothesis, we compared resting noninvasive left atrial ejection phase indices in 49 consecutive patients with NHCM (ages 36+/-10 years; 41% female) and normal left ventricular ejection fraction (mean, 68%+/-8%) with objective metabolic exercise parameters. Left atrial active emptying fraction, ejection force, and kinetic energy failed to predict exercise capacity. Only left atrial total and active emptying volumes correlated weakly with minute volume/CO2 production slope (r=0.31 and r=0.33; p<0.05 for both). Furthermore, when subjects were stratified by New York Heart Association symptomatology, exercise parameters--but not atrial contractility--differed between groups. These data, obtained at rest, fail to suggest that NHCM-related heart failure symptoms are due to an atrial myopathy.
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Affiliation(s)
- Yukitaka Shizukuda
- Cardiovascular Branch, National, Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
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