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Yuce K. The Application of Mesenchymal Stem Cells in Different Cardiovascular Disorders: Ways of Administration, and the Effectors. Stem Cell Rev Rep 2024:10.1007/s12015-024-10765-9. [PMID: 39023739 DOI: 10.1007/s12015-024-10765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
The heart is an organ with a low ability to renew and repair itself. MSCs have cell surface markers such as CD45-, CD34-, CD31-, CD4+, CD11a+, CD11b+, CD15+, CD18+, CD25+, CD49d+, CD50+, CD105+, CD73+, CD90+, CD9+, CD10+, CD106+, CD109+, CD127+, CD120a+, CD120b+, CD124+, CD126+, CD140a+, CD140b+, adherent properties and the ability to differentiate into cells such as adipocytes, osteoblasts and chondrocytes. Autogenic, allogeneic, normal, pretreated and genetically modified MSCs and secretomes are used in preclinical and clinical studies. MSCs and their secretomes (the total released molecules) generally have cardioprotective effects. Studies on cardiovascular diseases using MSCs and their secretomes include myocardial infraction/ischemia, fibrosis, hypertrophy, dilated cardiomyopathy and atherosclerosis. Stem cells or their secretomes used for this purpose are administered to the heart via intracoronary (Antegrade intracoronary and retrograde coronary venous injection), intramyocardial (Transendocardial and epicardial injection) and intravenous routes. The protective effects of MSCs and their secretomes on the heart are generally attributed to their differentiation into cardiomyocytes and endothelial cells, their immunomodulatory properties, paracrine effects, increasing blood vessel density, cardiac remodeling, and ejection fraction and decreasing apoptosis, the size of the wound, end-diastolic volume, end-systolic volume, ventricular myo-mass, fibrosis, matrix metalloproteins, and oxidative stress. The present review aims to assist researchers and physicians in selecting the appropriate cell type, secretomes, and technique to increase the chance of success in designing therapeutic strategies against cardiovascular diseases.
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Affiliation(s)
- Kemal Yuce
- Physiology, Department of Basic Medical Sciences, Medicine Faculty, Selcuk University, Konya, Türkiye.
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2
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Goldie FC, Lee MMY, Coats CJ, Nordin S. Advances in Multi-Modality Imaging in Hypertrophic Cardiomyopathy. J Clin Med 2024; 13:842. [PMID: 38337535 PMCID: PMC10856479 DOI: 10.3390/jcm13030842] [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: 12/22/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by abnormal growth of the myocardium with myofilament disarray and myocardial hyper-contractility, leading to left ventricular hypertrophy and fibrosis. Where culprit genes are identified, they typically relate to cardiomyocyte sarcomere structure and function. Multi-modality imaging plays a crucial role in the diagnosis, monitoring, and risk stratification of HCM, as well as in screening those at risk. Following the recent publication of the first European Society of Cardiology (ESC) cardiomyopathy guidelines, we build on previous reviews and explore the roles of electrocardiography, echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging. We examine each modality's strengths along with their limitations in turn, and discuss how they can be used in isolation, or in combination, to facilitate a personalized approach to patient care, as well as providing key information and robust safety and efficacy evidence within new areas of research.
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Affiliation(s)
- Fraser C. Goldie
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
| | - Matthew M. Y. Lee
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
| | - Caroline J. Coats
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Sabrina Nordin
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
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3
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Zhang K, Wang S, Li X, Cui H, Lai Y. Mechanism of Ion Channel Impairment in the Occurrence of Arrhythmia in Patients with Hypertrophic Cardiomyopathy. Cardiol Rev 2023:00045415-990000000-00161. [PMID: 37812010 DOI: 10.1097/crd.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Sudden cardiac death is the most unpredictable and devastating consequence of hypertrophic cardiomyopathy, most often caused by persistent ventricular tachycardia or ventricular fibrillation. Although myocardial hypertrophy, fibrosis, and microvascular disorders are the main mechanisms of persistent reentrant ventricular arrhythmias in patients with advanced hypertrophic cardiomyopathy, the cardiomyocyte mechanism based on ion channel abnormalities may play an important role in the early stages of the disease.
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Affiliation(s)
- Ke Zhang
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shengwei Wang
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaoyan Li
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Hao Cui
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongqiang Lai
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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4
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Filomena D, Vandenberk B, Dresselaers T, Willems R, Van Cleemput J, Olivotto I, Robyns T, Bogaert J. Apical papillary muscle displacement is a prevalent feature and a phenotypic precursor of apical hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:1009-1016. [PMID: 37114736 DOI: 10.1093/ehjci/jead078] [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: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
AIMS Papillary muscle (PM) abnormalities are considered part of the phenotypic spectrum of hypertrophic cardiomyopathy (HCM). The aim of this study was to evaluate the presence and frequency of PM displacement in different HCM phenotypes. METHODS AND RESULTS We retrospectively analysed cardiovascular magnetic resonance (CMR) findings in 156 patients (25% females, median age 57 years). Patients were divided into three groups: septal hypertrophy (Sep-HCM, n = 70, 45%), mixed hypertrophy (Mixed-HCM, n = 48, 31%), and apical hypertrophy (Ap-HCM, n = 38, 24%). Fifty-five healthy subjects were enrolled as controls. Apical PM displacement was observed in 13% of controls and 55% of patients, which was most common in the Ap-HCM group, followed by the Mixed-HCM and Sep-HCM groups (respectively: inferomedial PM 92 vs. 65 vs. 13%, P < 0.001; anterolateral PM 61 vs. 40 vs. 9%, P < 0.001). Significant differences in PM displacement were found when comparing healthy controls with patients with Ap- and Mixed-HCM subtypes but not when comparing them with patients with the Sep-HCM subtype. T-wave inversion in the inferior and lateral leads was more frequent in patients with Ap-HCM (100 and 65%, respectively) when compared with Mixed-HCM (89 and 29%, respectively) and Sep-HCM (57 and 17%, respectively; P < 0.001 for both). Eight patients with Ap-HCM had prior CMR examinations because of T-wave inversion [median interval 7 (3-8) years], and in the first CMR study, none showed apical hypertrophy [median apical wall thickness 8 (7-9) mm], while all of them presented with apical PM displacement. CONCLUSION Apical PM displacement is part of the phenotypic Ap-HCM spectrum and may precede the development of hypertrophy. These observations suggest a potential pathogenetic, mechanical link between apical PM displacement and Ap-HCM.
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Affiliation(s)
- Domenico Filomena
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Bert Vandenberk
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Rik Willems
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Johan Van Cleemput
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Iacopo Olivotto
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Tomas Robyns
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven B-3000, Belgium
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Zampieri M, Salvi S, Fumagalli C, Argirò A, Zocchi C, Del Franco A, Iannaccone G, Giovani S, Ferrantini C, Palinkas ED, Cappelli F, Olivotto I. Clinical scenarios of hypertrophic cardiomyopathy-related mortality: Relevance of age and stage of disease at presentation. Int J Cardiol 2023; 374:65-72. [PMID: 36621577 DOI: 10.1016/j.ijcard.2022.12.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
The evolving epidemiology of hypertrophic cardiomyopathy (HCM) has progressively changed our perception of HCM-related mortality. However, recent studies detailing individual causes of death based on age and clinical setting are lacking. Thus, the present study aimed to describe the modes of death in a consecutive cohort of HCM patients based on presenting clinical features and stage of disease. METHODS By retrospective analysis of a large HCM cohort, we identified 161 patients with >1 year follow-up who died between 2000 and 2020 and thoroughly investigated their modes of death. HCM stage at presentation was defined as "classic", "adverse remodeling" or "overt dysfunction". RESULTS Of the 161 patients, 103 (64%) died of HCM-related causes, whereas 58 (36%) died of non-HCM-related causes. Patients who died of HCM-related causes were younger than those who died of non-HCM related causes. The most common cause of death was heart failure (HF). Sudden cardiac death (SCD) ranked third, after non cardiovascular death, and mostly occurred in young individuals. The proportion of HF related death and SCD per stage of disease was 14% and 27% in "classic", 38% and 21% in "adverse remodeling" and 74% and 10% in "overt dysfunction". CONCLUSIONS Most HCM patients die due to complications of their own disease, mainly in the context of HF. While SCD tends to be juvenile, HF related deaths often occur in age groups no longer amenable to cardiac transplant. Modes of death vary with the stage of disease, with SCD becoming less prevalent in more advanced phases, when competitive risk of HF becomes overwhelming.
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Affiliation(s)
- Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Samuele Salvi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
| | - Chiara Zocchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Annamaria Del Franco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Giulia Iannaccone
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Sara Giovani
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Florencce, Italy
| | - Eszter Dalma Palinkas
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Doctoral School of Clinical Medicine, University of Szeged, Hungary
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florencce, Italy
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Rao SJ, Iqbal SB, Kanwal AS, Aronow WS, Naidu SS. Multi-modality management of hypertrophic cardiomyopathy. Hosp Pract (1995) 2023; 51:2-11. [PMID: 36598161 DOI: 10.1080/21548331.2022.2162297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited condition defined by left ventricular wall thickness greater than 15 mm in the absence of other conditions that could explain that degree of hypertrophy. Obstructive HCM associated with left ventricular outflow tract obstruction is defined by an intraventricular systolic pressure gradient greater than or equal to 30 mm Hg. Over the past couple of decades, there has been an expansion of both invasive and pharmacotherapeutic options for patients with HCM, with recent guidelines calling for a melody of invasive and non-invasive treatment strategies. There are several invasive therapies including proven therapies such as alcohol septal ablation and septal myectomy. Novel invasive therapies such as MitraClip, radiofrequency septal ablation and SESAME procedure have more recently been promoted. Pharmacological therapy has also dramatically evolved and includes conventional medications such as beta-blockers, calcium channel blockers, and disopyramide. Mavacamten, a novel cardiac myosin inhibitor, may significantly change management. Other myosin inhibitors and modulators are also being developed and tested in large clinical trials. Given significant phenotypical variability in patients with HCM, clinical management can be challenging, and often requires an individualized approach with a combination of invasive and non-invasive options.
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Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Shaikh B Iqbal
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Arjun S Kanwal
- Department of Cardiology, Westchester Medical Center, Valhalla, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, USA
| | - Srihari S Naidu
- Hypertrophic Cardiomyopathy Center, Cardiac Catheterization Laboratory, Department of Cardiology, Westchester Medical Center and Department of Medicine, New York Medical College, Valhalla, USA
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7
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Safety and efficacy of mavacamten for treatment of hypertrophic cardiomyopathy: a systematic review and meta-analysis of randomized clinical trials. Egypt Heart J 2023; 75:4. [PMID: 36633717 PMCID: PMC9837360 DOI: 10.1186/s43044-023-00328-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mavacamten, an allosteric myosin inhibitor, is considered to be a promising drug for the treatment of hypertrophic cardiomyopathy (HCM). This meta-analysis aimed to explore the safety and efficacy of mavacamten in HCM patients. MAIN BODY A total number of 539 patients were enrolled in four randomized clinical trials. The mean age of patients was 57.9 years and was followed for 29.3 weeks. Pooled analysis showed a significant improvement in clinical response (Log OR = 0.65; p = 0.01) and the number of patients with a reduction of ≥ 1 NYHA function class (Log OR = 0.64, p = 0.00). It was found that mavacamten did not significantly affect the Kansas City Cardiomyopathy Questionnaire (KCCQ) (SMD = 0.43, p = 0.08), peak oxygen uptake (PVO2) (SMD = 0.24, p = 0.42), and ejection fraction (EF) (SMD = - 0.65, p = 0.13) as compared with placebo. However, KCCQ (SMD = 0.65, 95% CI 0.44-0.87) and PVO2 (SMD = 0.49, 95% CI 0.24-0.74) improvements were statically significant in the hypertrophic obstructive cardiomyopathy subgroup (HOCM), and a significant decrease in EF (SMD = -- 1.14, 95% CI - 1.86 to - 0.42) was found in the HOCM subgroup. No significant difference was observed in the incidence rate of serious adverse events between mavacamten and placebo group (Log OR = - 0.23, p = 0.56). CONCLUSIONS Mavacamten proved to be effective and well-tolerated for the treatment of HCM. Mavacamten improved the signs and symptoms of HOCM and decreased EF in these patients without serious adverse events in the clinical trials.
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Kim K, Lee SD, Lee HJ, Kim H, Kim HR, Cho YH, Jang JY, Kang MG, Koh JS, Hwang SJ, Hwang JY, Park JR. Role and Clinical Importance of Progressive Changes in Echocardiographic Parameters in Predicting Outcomes in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Imaging 2023; 31:85-95. [PMID: 37096673 PMCID: PMC10133807 DOI: 10.4250/jcvi.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The prognostic utility of follow-up transthoracic echocardiography (FU-TTE) in patients with hypertrophic cardiomyopathy (HCM) is unclear, specifically in terms of whether changes in echocardiographic parameters in routine FU-TTE parameters are associated with cardiovascular outcomes. METHODS From 2010 to 2017, 162 patients with HCM were retrospectively enrolled in this study. Using echocardiography, HCM was diagnosed based on morphological criteria. Patients with other diseases that cause cardiac hypertrophy were excluded. TTE parameters at baseline and FU were analyzed. FU-TTE was designated as the last recorded value in patients who did not develop any cardiovascular event or the latest exam before event development. Clinical outcomes were acute heart failure, cardiac death, arrhythmia, ischemic stroke, and cardiogenic syncope. RESULTS Median interval between the baseline TTE and FU-TTE was 3.3 years. Median clinical FU duration was 4.7 years. Septal trans-mitral velocity/mitral annular tissue Doppler velocity (E/e'), tricuspid regurgitation velocity, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) at baseline were recorded. LVEF, LAVI, and E/e' values were associated with poor outcomes. However, no delta values predicted HCM-related cardiovascular outcomes. Logistic regression models incorporating changes in TTE parameters had no significant findings. Baseline LAVI was the best predictor of a poor prognosis. In survival analysis, an already enlarged or increased size LAVI was associated with poorer clinical outcomes. CONCLUSIONS Changes in echocardiographic parameters extracted from TTE did not assist in predicting clinical outcomes. Cross-sectionally evaluated TTE parameters were superior to changes in TTE parameters between baseline and FU at predicting cardiovascular events.
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Affiliation(s)
- Kyehwan Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Do Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyo Jin Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hangyul Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yun Ho Cho
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital and Gyeongsang National University School of Medicine, Changwon, Korea
| | - Jeong Yoon Jang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital and Gyeongsang National University School of Medicine, Changwon, Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seok-Jae Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
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9
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Pioner JM, Santini L, Palandri C, Langione M, Grandinetti B, Querceto S, Martella D, Mazzantini C, Scellini B, Giammarino L, Lupi F, Mazzarotto F, Gowran A, Rovina D, Santoro R, Pompilio G, Tesi C, Parmeggiani C, Regnier M, Cerbai E, Mack DL, Poggesi C, Ferrantini C, Coppini R. Calcium handling maturation and adaptation to increased substrate stiffness in human iPSC-derived cardiomyocytes: The impact of full-length dystrophin deficiency. Front Physiol 2022; 13:1030920. [PMID: 36419836 PMCID: PMC9676373 DOI: 10.3389/fphys.2022.1030920] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
Cardiomyocytes differentiated from human induced Pluripotent Stem Cells (hiPSC- CMs) are a unique source for modelling inherited cardiomyopathies. In particular, the possibility of observing maturation processes in a simple culture dish opens novel perspectives in the study of early-disease defects caused by genetic mutations before the onset of clinical manifestations. For instance, calcium handling abnormalities are considered as a leading cause of cardiomyocyte dysfunction in several genetic-based dilated cardiomyopathies, including rare types such as Duchenne Muscular Dystrophy (DMD)-associated cardiomyopathy. To better define the maturation of calcium handling we simultaneously measured action potential and calcium transients (Ca-Ts) using fluorescent indicators at specific time points. We combined micropatterned substrates with long-term cultures to improve maturation of hiPSC-CMs (60, 75 or 90 days post-differentiation). Control-(hiPSC)-CMs displayed increased maturation over time (90 vs 60 days), with longer action potential duration (APD), increased Ca-T amplitude, faster Ca-T rise (time to peak) and Ca-T decay (RT50). The progressively increased contribution of the SR to Ca release (estimated by post-rest potentiation or Caffeine-induced Ca-Ts) appeared as the main determinant of the progressive rise of Ca-T amplitude during maturation. As an example of severe cardiomyopathy with early onset, we compared hiPSC-CMs generated from a DMD patient (DMD-ΔExon50) and a CRISPR-Cas9 genome edited cell line isogenic to the healthy control with deletion of a G base at position 263 of the DMD gene (c.263delG-CMs). In DMD-hiPSC-CMs, changes of Ca-Ts during maturation were less pronounced: indeed, DMD cells at 90 days showed reduced Ca-T amplitude and faster Ca-T rise and RT50, as compared with control hiPSC-CMs. Caffeine-Ca-T was reduced in amplitude and had a slower time course, suggesting lower SR calcium content and NCX function in DMD vs control cells. Nonetheless, the inotropic and lusitropic responses to forskolin were preserved. CRISPR-induced c.263delG-CM line recapitulated the same developmental calcium handling alterations observed in DMD-CMs. We then tested the effects of micropatterned substrates with higher stiffness. In control hiPSC-CMs, higher stiffness leads to higher amplitude of Ca-T with faster decay kinetics. In hiPSC-CMs lacking full-length dystrophin, however, stiffer substrates did not modify Ca-Ts but only led to higher SR Ca content. These findings highlighted the inability of dystrophin-deficient cardiomyocytes to adjust their calcium homeostasis in response to increases of extracellular matrix stiffness, which suggests a mechanism occurring during the physiological and pathological development (i.e. fibrosis).
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Affiliation(s)
| | - Lorenzo Santini
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Chiara Palandri
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Marianna Langione
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Bruno Grandinetti
- European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Florence, Italy
| | - Silvia Querceto
- European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Florence, Italy
| | - Daniele Martella
- European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Florence, Italy
- Istituto Nazionale di Ricerca Metrologica (INRiM), Turin, Italy
| | | | - Beatrice Scellini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Flavia Lupi
- European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Florence, Italy
| | - Francesco Mazzarotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Aoife Gowran
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Davide Rovina
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rosaria Santoro
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Chiara Tesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Camilla Parmeggiani
- European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Florence, Italy
- Department of Chemistry “Ugo Schiff”, University of Florence, Florence, Italy
| | - Michael Regnier
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | | | - David L. Mack
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Corrado Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Coppini
- Department of Neurofarba, University of Florence, Florence, Italy
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Abstract
Hypertrophic cardiomyopathy (HCM), the most common inherited heart disease, is still orphan of a specific drug treatment. The erroneous consideration of HCM as a rare disease has hampered the design and conduct of large, randomized trials in the last 50 years, and most of the indications in the current guidelines are derived from small non-randomized studies, case series, or simply from the consensus of experts. Guideline-directed therapy of HCM includes non-selective drugs such as disopyramide, non-dihydropyridine calcium channel blockers, or β-adrenergic receptor blockers, mainly used in patients with symptomatic obstruction of the outflow tract. Following promising preclinical studies, several drugs acting on potential HCM-specific targets were tested in patients. Despite the huge efforts, none of these studies was able to change clinical practice for HCM patients, because tested drugs were proven to be scarcely effective or hardly tolerated in patients. However, novel compounds have been developed in recent years specifically for HCM, addressing myocardial hypercontractility and altered energetics in a direct manner, through allosteric inhibition of myosin. In this paper, we will critically review the use of different classes of drugs in HCM patients, starting from "old" established agents up to novel selective drugs that have been recently trialed in patients.
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11
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Cardiomyopathies. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00014-1] [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: 11/23/2022] Open
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12
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de Boer RA, Heymans S, Backs J, Carrier L, Coats AJS, Dimmeler S, Eschenhagen T, Filippatos G, Gepstein L, Hulot JS, Knöll R, Kupatt C, Linke WA, Seidman CE, Tocchetti CG, van der Velden J, Walsh R, Seferovic PM, Thum T. Targeted therapies in genetic dilated and hypertrophic cardiomyopathies: From molecular mechanisms to therapeutic targets. Eur J Heart Fail 2021; 24:406-420. [PMID: 34969177 PMCID: PMC9305112 DOI: 10.1002/ejhf.2414] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022] Open
Abstract
Genetic cardiomyopathies are disorders of the cardiac muscle, most often explained by pathogenic mutations in genes encoding sarcomere, cytoskeleton, or ion channel proteins. Clinical phenotypes such as heart failure and arrhythmia are classically treated with generic drugs, but aetiology‐specific and targeted treatments are lacking. As a result, cardiomyopathies still present a major burden to society, and affect many young and older patients. The Translational Committee of the Heart Failure Association (HFA) and the Working Group of Myocardial Function of the European Society of Cardiology (ESC) organized a workshop to discuss recent advances in molecular and physiological studies of various forms of cardiomyopathies. The study of cardiomyopathies has intensified after several new study setups became available, such as induced pluripotent stem cells, three‐dimensional printing of cells, use of scaffolds and engineered heart tissue, with convincing human validation studies. Furthermore, our knowledge on the consequences of mutated proteins has deepened, with relevance for cellular homeostasis, protein quality control and toxicity, often specific to particular cardiomyopathies, with precise effects explaining the aberrations. This has opened up new avenues to treat cardiomyopathies, using contemporary techniques from the molecular toolbox, such as gene editing and repair using CRISPR‐Cas9 techniques, antisense therapies, novel designer drugs, and RNA therapies. In this article, we discuss the connection between biology and diverse clinical presentation, as well as promising new medications and therapeutic avenues, which may be instrumental to come to precision medicine of genetic cardiomyopathies.
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Affiliation(s)
- Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Stephane Heymans
- Department of Cardiology, Maastricht University Medical Center (MUMC+), PO Box 5800, 6202, AZ, Maastricht, the Netherlands.,Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Lucie Carrier
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt, Germany.,Cardio-Pulmonary Institute (CPI), Frankfurt, Germany
| | - Thomas Eschenhagen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Lior Gepstein
- Department of Cardiology, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
| | - Jean-Sebastien Hulot
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,CIC1418 and DMU CARTE, AP- HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Ralph Knöll
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, Stockholm, SE-171 77, Sweden.,Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Christian Kupatt
- Department of Cardiology, University Clinic rechts der Isar, Technical University of Munich, Germany and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance
| | - Wolfgang A Linke
- Institute of Physiology II, University Hospital Muenster, Robert-Koch-Str. 27B, 48149, Muenster, Germany
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Howard Hughes Medical Institute, Harvard University, Boston, MA, USA
| | - C Gabriele Tocchetti
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI); Interdepartmental Center for Clinical and Translational Research (CIRCET); Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roddy Walsh
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Petar M Seferovic
- Serbian Academy of Sciences and Arts, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
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13
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Ion Channel Impairment and Myofilament Ca 2+ Sensitization: Two Parallel Mechanisms Underlying Arrhythmogenesis in Hypertrophic Cardiomyopathy. Cells 2021; 10:cells10102789. [PMID: 34685769 PMCID: PMC8534456 DOI: 10.3390/cells10102789] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Life-threatening ventricular arrhythmias are the main clinical burden in patients with hypertrophic cardiomyopathy (HCM), and frequently occur in young patients with mild structural disease. While massive hypertrophy, fibrosis and microvascular ischemia are the main mechanisms underlying sustained reentry-based ventricular arrhythmias in advanced HCM, cardiomyocyte-based functional arrhythmogenic mechanisms are likely prevalent at earlier stages of the disease. In this review, we will describe studies conducted in human surgical samples from HCM patients, transgenic animal models and human cultured cell lines derived from induced pluripotent stem cells. Current pieces of evidence concur to attribute the increased risk of ventricular arrhythmias in early HCM to different cellular mechanisms. The increase of late sodium current and L-type calcium current is an early observation in HCM, which follows post-translation channel modifications and increases the occurrence of early and delayed afterdepolarizations. Increased myofilament Ca2+ sensitivity, commonly observed in HCM, may promote afterdepolarizations and reentry arrhythmias with direct mechanisms. Decrease of K+-currents due to transcriptional regulation occurs in the advanced disease and contributes to reducing the repolarization-reserve and increasing the early afterdepolarizations (EADs). The presented evidence supports the idea that patients with early-stage HCM should be considered and managed as subjects with an acquired channelopathy rather than with a structural cardiac disease.
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14
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Zampieri M, Argirò A, Marchi A, Berteotti M, Targetti M, Fornaro A, Tomberli A, Stefàno P, Marchionni N, Olivotto I. Mavacamten, a Novel Therapeutic Strategy for Obstructive Hypertrophic Cardiomyopathy. Curr Cardiol Rep 2021; 23:79. [PMID: 34081217 DOI: 10.1007/s11886-021-01508-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Pharmacological treatment options for hypertrophic cardiomyopathy (HCM) are currently limited and comprise non-disease specific therapies such as β-blockers, non-dihydropyridine calcium channel blockers, and disopyramide. These agents that offer a variable degree of symptomatic relief, often suboptimal, are often limited by side-effects and fail to address the key molecular abnormalities of the disease. RECENT FINDINGS Mavacamten is a novel, first-in-class, allosteric inhibitor of cardiac myosin ATPase, which reduces actin-myosin cross-bridge formation, thereby reducing myocardial contractility and improving myocardial energetic consumption in experimental HCM models. Following a successful Phase 2 study, the recently published phase III, placebo-controlled, randomized EXPLORER-HCM trial demonstrated the efficacy and safety of mavacamten in reducing left ventricular outflow tract obstruction and ameliorating exercise capacity, New York Heart Association functional class and health status in patients with obstructive HCM. Mavacamten represents the first agent specifically developed for HCM successfully tested in a Phase III trial, to be registered soon for clinical use, representing a radical change of paradigm in the pharmacological treatment of HCM.
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Affiliation(s)
- Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Marchi
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Martina Berteotti
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of General Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessandra Fornaro
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of General Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessia Tomberli
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Pierluigi Stefàno
- Division of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of General Cardiology, Careggi University Hospital, Florence, Italy
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15
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Pu C, Fei J, Lv S, Wu Y, He C, Guo D, Mabombo PU, Chooah O, Hu H. Global Circumferential Strain by Cardiac Magnetic Resonance Tissue Tracking Associated With Ventricular Arrhythmias in Hypertrophic Cardiomyopathy Patients. Front Cardiovasc Med 2021; 8:670361. [PMID: 34124201 PMCID: PMC8193949 DOI: 10.3389/fcvm.2021.670361] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is prone to myocardial heterogeneity and fibrosis, which are the substrates of ventricular arrhythmias (VAs). Cardiac magnetic resonance tissue tracking (CMR-TT) can quantitatively reflect global and regional left ventricular strain from different directions. It is uncertain whether the change of myocardial strain detected by CMR-TT is associated with VAs. The aim of the study is to explore the differential diagnostic value of VAs in HCM by CMR-TT. Materials and Methods: We retrospectively included 93 HCM patients (38 with VAs and 55 without VAs) and 30 healthy cases. Left ventricular function, myocardial strain parameters and percentage of late gadolinium enhancement (%LGE) were evaluated. Results: Global circumferential strain (GCS) and %LGE correlated moderately (r = 0.51, P < 0.001). HCM patients with VAs had lower left ventricular ejection fraction (LVEF), global radial strain (GRS), GCS, and global longitudinal strain (GLS), but increased %LGE compared with those without VAs (P < 0.01 for all). %LGE and GCS were indicators of VAs in HCM patients by multivariate logistic regression analysis. HCM patients with %LGE >5.35% (AUC 0.81, 95% CI 0.70–0.91, P < 0.001) or GCS >-14.73% (AUC 0.79, 95% CI 0.70–0.89, P < 0.001) on CMR more frequently had VAs. %LGE + GCS were able to better identify HCM patients with VAs (AUC 0.87, 95% CI 0.79–0.95, P < 0.001). Conclusion: GCS and %LGE were independent risk indicators of VAs in HCM. GCS is expected to be a good potential predictor in identifying HCM patients with VAs, which may provide important values to improve risk stratification in HCM in clinical practice.
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Affiliation(s)
- Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingle Fei
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sangying Lv
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danling Guo
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Pierre Umba Mabombo
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Outesh Chooah
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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16
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Cui H, Schaff HV, Lentz Carvalho J, Nishimura RA, Geske JB, Dearani JA, Lahr BD, Lee AT, Bos JM, Ackerman MJ, Ommen SR, Maleszewski JJ. Myocardial Histopathology in Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2021; 77:2159-2170. [PMID: 33926651 DOI: 10.1016/j.jacc.2021.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is characterized by multiple pathological features including myocyte hypertrophy, myocyte disarray, and interstitial fibrosis. OBJECTIVES This study sought to correlate myocardial histopathology with clinical characteristics of patients with obstructive HCM and post-operative outcomes following septal myectomy. METHODS The authors reviewed the pathological findings of the myocardial specimens from 1,836 patients with obstructive HCM who underwent septal myectomy from 2000 to 2016. Myocyte hypertrophy, myocyte disarray, interstitial fibrosis, and endocardial thickening were graded and analyzed. RESULTS The median age at operation was 54.2 years (43.5 to 64.3 years), and 1,067 (58.1%) were men. A weak negative correlation between myocyte disarray and age at surgery was identified (ρ = -0.22; p < 0.001). Myocyte hypertrophy (p < 0.001), myocyte disarray (p < 0.001), and interstitial fibrosis (p < 0.001) were positively associated with implantable cardioverter-defibrillator implantation. Interstitial fibrosis (p < 0.001) and endocardial thickening (p < 0.001) were associated with atrial fibrillation pre-operatively. In the Cox survival model, older age (p < 0.001), lower degree of myocyte hypertrophy (severe vs. mild hazard ratio: 0.41; 95% confidence interval: 0.19 to 0.86; p = 0.040), and lower degree of endocardial thickening (moderate vs. mild hazard ratio: 0.75; 95% confidence interval: 0.58 to 0.97; p = 0.019) were independently associated with worse post-myectomy survival. Among 256 patients who had genotype analysis, patients with pathogenic or likely pathogenic variants (n = 62) had a greater degree of myocyte disarray (42% vs. 15% vs. 20%; p = 0.022). Notably, 13 patients with pathogenic or likely pathogenic genetic variants of HCM had no myocyte disarray. CONCLUSIONS Histopathology was associated with clinical manifestations including the age of disease onset and arrhythmias. Myocyte hypertrophy and endocardial thickening were negatively associated with post-myectomy mortality.
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Affiliation(s)
- Hao Cui
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | | | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander T Lee
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - J Martijn Bos
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Left Ventricular Remodeling in Hypertrophic Cardiomyopathy: An Overview of Current Knowledge. J Clin Med 2021; 10:jcm10081547. [PMID: 33916967 PMCID: PMC8067545 DOI: 10.3390/jcm10081547] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/02/2022] Open
Abstract
While most patients with hypertrophic cardiomyopathy (HCM) show a relatively stable morphologic and clinical phenotype, in some others, progressive changes in the left ventricular (LV) wall thickness, cavity size, and function, defined, overall, as “LV remodeling”, may occur. The interplay of multiple pathophysiologic mechanisms, from genetic background to myocardial ischemia and fibrosis, is implicated in this process. Different patterns of LV remodeling have been recognized and are associated with a specific impact on the clinical course and management of the disease. These findings underline the need for and the importance of serial multimodal clinical and instrumental evaluations to identify and further characterize the LV remodeling phenomenon. A more complete definition of the stages of the disease may present a chance to improve the management of HCM patients.
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18
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T-tubule remodeling in human hypertrophic cardiomyopathy. J Muscle Res Cell Motil 2020; 42:305-322. [PMID: 33222034 PMCID: PMC8332592 DOI: 10.1007/s10974-020-09591-6] [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: 03/11/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
The highly organized transverse T-tubule membrane system represents the ultrastructural substrate for excitation–contraction coupling in ventricular myocytes. While the architecture and function of T-tubules have been well described in animal models, there is limited morpho-functional data on T-tubules in human myocardium. Hypertrophic cardiomyopathy (HCM) is a primary disease of the heart muscle, characterized by different clinical presentations at the various stages of its progression. Most HCM patients, indeed, show a compensated hypertrophic disease (“non-failing hypertrophic phase”), with preserved left ventricular function, and only a small subset of individuals evolves into heart failure (“end stage HCM”). In terms of T-tubule remodeling, the “end-stage” disease does not differ from other forms of heart failure. In this review we aim to recapitulate the main structural features of T-tubules during the “non-failing hypertrophic stage” of human HCM by revisiting data obtained from human myectomy samples. Moreover, by comparing pathological changes observed in myectomy samples with those introduced by acute (experimentally induced) detubulation, we discuss the role of T-tubular disruption as a part of the complex excitation–contraction coupling remodeling process that occurs during disease progression. Lastly, we highlight how T-tubule morpho-functional changes may be related to patient genotype and we discuss the possibility of a primitive remodeling of the T-tubule system in rare HCM forms associated with genes coding for proteins implicated in T-tubule structural integrity, formation and maintenance.
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19
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac condition and highly heterogeneous. Echocardiography and genetic and clinical screening have led to detection in women of childbearing age. Maternal and fetal outcomes among women with HCM are favorable. Genetic counseling is recommended. Prepregnancy clinical evaluation and risk assessment are paramount in ensuring optimal outcomes. Most women carry moderate risk of morbidity, have clinical evaluations and echocardiography each trimester, and deliver vaginally. Those who are symptomatic or have significant left ventricular outflow obstruction or recurrent arrhythmias prior to pregnancy are at higher risk and should be monitored at least monthly.
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Affiliation(s)
- Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, CVC Suite 2364, Ann Arbor, MI 48109-5853, USA.
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20
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Wang J, Li Y, Yang F, Bravo L, Wan K, Xu Y, Cheng W, Sun J, Zhu Y, Zhu T, Gkoutos GV, Han Y, Chen Y. Fractal Analysis: Prognostic Value of Left Ventricular Trabecular Complexity Cardiovascular MRI in Participants with Hypertrophic Cardiomyopathy. Radiology 2020; 298:71-79. [PMID: 33078997 DOI: 10.1148/radiol.2020202261] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The prognostic value of myocardial trabecular complexity in patients with hypertrophic cardiomyopathy (HCM) is unknown. Purpose To explore the prognostic value of myocardial trabecular complexity using fractal analysis in participants with HCM. Materials and Methods The authors prospectively enrolled participants with HCM who underwent 3.0-T cardiovascular MRI from August 2011 to October 2017. The authors also enrolled 100 age- and sex-matched healthy participants to form a comparison group. Trabeculae were quantified with fractal analysis of cine slices to estimate the fractal dimension (FD). Participants with HCM were divided into normal and high FD groups according to the upper limit of normal reference value from the healthy group. The primary end point was defined as all-cause mortality and aborted sudden cardiac death. The secondary end point was the composite of the primary end point and readmission to the hospital owing to heart failure. Internal validation was performed using the bootstrapping method. Results A total of 378 participants with HCM (median age, 50 years; age range, 40-61 years; 207 men) and 100 healthy participants (median age, 46 years; age range, 36-59 years; 55 women) were included in this study. During the median follow-up of 33 months ± 18 (standard deviation), the increased maximal apical FD (≥1.325) had a higher risk of the primary and secondary end points than those with a normal FD (<1.325) (P = .01 and P = .04, respectively). Furthermore, Cox analysis revealed that left ventricular maximal apical FD (hazard ratio range, 1.001-1.008; all P < .05) provided significant prognostic value to predict the primary and secondary end points after adjustment for the European Society of Cardiology predictors and late gadolinium enhancement. Internal validation showed that left ventricular maximal apical FD retained a good performance in predicting the primary end points with an area under the curve of 0.70 ± 0.03. Conclusion Left ventricular apical fractal dimension, which reflects myocardial trabecular complexity, was an independent predictor of the primary and secondary end points in patients with hypertrophic cardiomyopathy. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Captur and Moon in this issue.
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Affiliation(s)
- Jie Wang
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuancheng Li
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Fuyao Yang
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Laura Bravo
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Ke Wan
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuanwei Xu
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Wei Cheng
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Jiayu Sun
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yanjie Zhu
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Tingxi Zhu
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Georgios V Gkoutos
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuchi Han
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yucheng Chen
- From the Department of Cardiology (J.W., Y.L., F.Y., Y.X., Y.C.), Department of Radiology (W.C., J.S., Y.C.), Department of Geriatrics (K.W.), Center of Rare Diseases (Y.C.), and Medical Big Data Center (T.Z.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China; Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China (Y.Z.); College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England (J.W., L.B., G.V.G.); Medical Research Council Health Data Research, Midlands Site, Birmingham, England (G.V.G.); and Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pa (Y.H.)
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21
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An Investigation of Fibulin-2 in Hypertrophic Cardiomyopathy. Int J Mol Sci 2020; 21:ijms21197176. [PMID: 33003281 PMCID: PMC7583916 DOI: 10.3390/ijms21197176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart muscle disease, with a prevalence of at least 1 in 500 in the general population. The disease is pleiotropic and is characterized by an increased stiffness of the myocardium, partly due to changes in the extracellular matrix (ECM), with elevated levels of interstitial fibrosis. Myocardial fibrosis is linked to impaired diastolic function and possibly phenotypic heterogeneity of HCM. The ECM consists of a very large number of proteins, which actively interact with each other as well as with myocardial cells. The role of other multiple components of the ECM in HCM has not been defined. Fibulin-2 is a glycoprotein component of the ECM, which plays an important role during embryogenesis of the heart; however, its role in adult myocardium has not been adequately studied. We here describe, for the first time, abnormal expression of fibulin-2 in the myocardium in patients with HCM as compared to normal controls. This abnormal expression was localized in the cytoplasm of myocardial cells and in the interstitial fibroblasts. In addition, fibulin-2 levels, measured by ELISA, were significantly elevated in the serum of patients with HCM as compared to normal controls.
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22
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Huang J, Yang C, Ni CF, Yan ZN, Fan L, Song XT. Right atrial function assessed by volume-derived values and speckle tracking echocardiography in patients with hypertrophic cardiomyopathy. BMC Cardiovasc Disord 2020; 20:335. [PMID: 32660422 PMCID: PMC7359225 DOI: 10.1186/s12872-020-01610-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022] Open
Abstract
Background To detect the right atrial (RA) functions in hypertrophic cardiomyopathy (HCM) patients by using volume-derived values and two-dimensional strain. Methods Thirty-two HCM patients and 34 age and gender matched normal controls were enrolled for this study. RA volume-derived values were measured by using 2D ultrasonic images. RA strain (S-reservoir, S-conduit, S-booster pump) and strain rate (SR-reservoir, SR-conduit, SR-booster pump), representing the reservoir, conduit and booster pump functions, respectively, were measured by EchoPAC. Results Total RA emptying fraction (RAEF) and RA expansion index in HCM patients were significantly lower than normal controls (p < 0.05). The values of S-reservoir, S-conduit, Sr-reservoir and Sr-conduit in HCM patients were significantly lower than normal controls (p < 0.001). Although there were no significant differences in S-booster pump and Sr-booster pump between HCM patients and normal controls, the absolute values in HCM patients were lower than normal controls. Conclusions In this study, we concluded that RA dysfunctions, including the reservoir and conduit functions were impaired in HCM patients.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China. .,Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Chao Yang
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Cai-Fang Ni
- Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Zi-Ning Yan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China
| | - Li Fan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China
| | - Xiang-Ting Song
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China
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23
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and defined by unexplained isolated progressive myocardial hypertrophy, systolic and diastolic ventricular dysfunction, arrhythmias, sudden cardiac death and histopathologic changes, such as myocyte disarray and myocardial fibrosis. Mutations in genes encoding for proteins of the contractile apparatus of the cardiomyocyte, such as β-myosin heavy chain and myosin binding protein C, have been identified as cause of the disease. Disease is caused by altered biophysical properties of the cardiomyocyte, disturbed calcium handling, and abnormal cellular metabolism. Mutations in sarcomere genes can also activate other signaling pathways via transcriptional activation and can influence non-cardiac cells, such as fibroblasts. Additional environmental, genetic and epigenetic factors result in heterogeneous disease expression. The clinical course of the disease varies greatly with some patients presenting during childhood while others remain asymptomatic until late in life. Patients can present with either heart failure symptoms or the first symptom can be sudden death due to malignant ventricular arrhythmias. The morphological and pathological heterogeneity results in prognosis uncertainty and makes patient management challenging. Current standard therapeutic measures include the prevention of sudden death by prohibition of competitive sport participation and the implantation of cardioverter-defibrillators if indicated, as well as symptomatic heart failure therapies or cardiac transplantation. There exists no causal therapy for this monogenic autosomal-dominant inherited disorder, so that the focus of current management is on early identification of asymptomatic patients at risk through molecular diagnostic and clinical cascade screening of family members, optimal sudden death risk stratification, and timely initiation of preventative therapies to avoid disease progression to the irreversible adverse myocardial remodeling stage. Genetic diagnosis allowing identification of asymptomatic affected patients prior to clinical disease onset, new imaging technologies, and the establishment of international guidelines have optimized treatment and sudden death risk stratification lowering mortality dramatically within the last decade. However, a thorough understanding of underlying disease pathogenesis, regular clinical follow-up, family counseling, and preventative treatment is required to minimize morbidity and mortality of affected patients. This review summarizes current knowledge about molecular genetics and pathogenesis of HCM secondary to mutations in the sarcomere and provides an overview about current evidence and guidelines in clinical patient management. The overview will focus on clinical staging based on disease mechanism allowing timely initiation of preventative measures. An outlook about so far experimental treatments and potential for future therapies will be provided.
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Affiliation(s)
- Cordula Maria Wolf
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
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24
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Seferović PM, Polovina M, Bauersachs J, Arad M, Gal TB, Lund LH, Felix SB, Arbustini E, Caforio AL, Farmakis D, Filippatos GS, Gialafos E, Kanjuh V, Krljanac G, Limongelli G, Linhart A, Lyon AR, Maksimović R, Miličić D, Milinković I, Noutsias M, Oto A, Oto Ö, Pavlović SU, Piepoli MF, Ristić AD, Rosano GM, Seggewiss H, Ašanin M, Seferović JP, Ruschitzka F, Čelutkiene J, Jaarsma T, Mueller C, Moura B, Hill L, Volterrani M, Lopatin Y, Metra M, Backs J, Mullens W, Chioncel O, Boer RA, Anker S, Rapezzi C, Coats AJ, Tschöpe C. Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:553-576. [DOI: 10.1002/ejhf.1461] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Petar M. Seferović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Marija Polovina
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Johann Bauersachs
- Department of Cardiology and AngiologyMedical School Hannover Hannover Germany
| | - Michael Arad
- Cardiomyopathy Clinic and Heart Failure Institute, Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tuvia Ben Gal
- Department of CardiologyRabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Lars H. Lund
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo Pavia Italy
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiological, Thoracic and Vascular SciencesUniversity of Padua Padua Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Gerasimos S. Filippatos
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Elias Gialafos
- Second Department of CardiologyHeart Failure and Preventive Cardiology Section, Henry Dunant Hospital Athens Greece
| | | | - Gordana Krljanac
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe Limongelli
- Department of Cardiothoracic Sciences, Università della Campania ‘Luigi VanvitellI’Monaldi Hospital, AORN Colli, Centro di Ricerca Cardiovascolare, Ospedale Monaldi, AORN Colli, Naples, Italy, and UCL Institute of Cardiovascular Science London UK
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular MedicineGeneral University Hospital, Charles University in Prague Prague Czech Republic
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London UK
| | - Ružica Maksimović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia Belgrade Serbia
| | - Davor Miličić
- Department of Cardiovascular DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Michel Noutsias
- Mid‐German Heart Center, Department of Internal Medicine III, Division of CardiologyAngiology and Intensive Medical Care, University Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Ali Oto
- Department of CardiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Öztekin Oto
- Department of Cardiovascular SurgeryDokuz Eylül University Faculty of Medicine İzmir Turkey
| | - Siniša U. Pavlović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Pacemaker Center, Clinical Center of Serbia Belgrade Serbia
| | | | - Arsen D. Ristić
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe M.C. Rosano
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele Pisana Rome Italy
| | - Hubert Seggewiss
- Medizinische Klinik, Kardiologie & Internistische Intensivmedizin, Klinikum Würzburg‐Mitte Würzburg Germany
| | - Milika Ašanin
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Jelena P. Seferović
- Cardiovascular DivisionBrigham and Women's Hospital, Harvard Medical School Boston MA USA
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center Serbia and Faculty of MedicineUniversity of Belgrade Belgrade Serbia
| | - Frank Ruschitzka
- Department of CardiologyUniversity Heart Center Zürich Switzerland
| | - Jelena Čelutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius University Vilnius Lithuania
- State Research Institute Centre for Innovative Medicine Vilnius Lithuania
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health ScienceLinköping University Linköping Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology DepartmentCentro Hospitalar São João Porto Portugal
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Belfast UK
| | | | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd Volgograd Russia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Johannes Backs
- Department of Molecular Cardiology and EpigeneticsUniversity of Heidelberg Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim Heidelberg Germany
| | - Wilfried Mullens
- BIOMED ‐ Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt University Diepenbeek Belgium
- Department of CardiologyZiekenhuis Oost‐Limburg Genk Belgium
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucharest Romania
- Emergency Institute for Cardiovascular Diseases, ‘Prof. C. C. Iliescu’ Bucharest Romania
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Stefan Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT) Berlin Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Charité Berlin Germany
| | - Claudio Rapezzi
- Cardiology, Department of ExperimentalDiagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna Bologna Italy
| | - Andrew J.S. Coats
- Monash University, Australia, and University of Warwick Coventry UK
- Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy, and St George's University of London London UK
| | - Carsten Tschöpe
- Berlin‐Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) Berlin, Department of CardiologyCampus Virchow Klinikum, Charite ‐ Universitaetsmedizin Berlin Berlin Germany
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Calculated Risk for Sudden Cardiac Death in Patients with Apical Versus Nonobstructive Nonapical Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 122:1551-1556. [PMID: 30197054 DOI: 10.1016/j.amjcard.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 02/02/2023]
Abstract
There are limited and conflicting data regarding the prognosis of patients with apical hypertrophic cardiomyopathy (HC) and their risk for sudden cardiac death (SCD). We used data from a single tertiary center for comparing the clinical course and the calculated risk for SCD in patients with nonobstructive apical HC (apical HC) versus patients with nonobstructive, nonapical HC (NONA HC). The 5-year SCD risk was calculated based on the HC risk-SCD tool. A total of 109 patients were included in the cohort of whom 44 (40%) patients were diagnosed with apical HC. The majority of patients were males with a median age at diagnosis of 40 years (interquartile range 26, 59 years). Patients with apical HC had a significant lower calculated 5-year risk for SCD compared with patients with NONA HC (2.65 ± 2.2% vs 4.00 ± 3.5%, respectively, p = 0.017), primarily due to a lower incidence of familial SCD (20% vs 43% respectively, p = 0.014). Only 9% of patients with apical HC had a calculated risk of >6% (implantable cardioverter-defibrillator recommended), as compared with 23% of patients with NONA HC. During a median follow-up of 1,018 days (interquartile range 546, 1449 days), apical HC patients tended to develop less malignant ventricular arrhythmia episodes compared with NONA HC patients (0% vs 7.7%, respectively, p = 0.060). In conclusion, apical HC patients have a lower calculated risk of SCD compared with NONA HC patients, mainly due to a lower incidence of family history of SCD. Thus, apical HC should be considered a form of HC less prone to SCD.
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26
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Coppini R, Ferrantini C, Mugelli A, Poggesi C, Cerbai E. Altered Ca 2+ and Na + Homeostasis in Human Hypertrophic Cardiomyopathy: Implications for Arrhythmogenesis. Front Physiol 2018; 9:1391. [PMID: 30420810 PMCID: PMC6215954 DOI: 10.3389/fphys.2018.01391] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common mendelian heart disease, with a prevalence of 1/500. HCM is a primary cause of sudden death, due to an heightened risk of ventricular tachyarrhythmias that often occur in young asymptomatic patients. HCM can slowly progress toward heart failure, either with preserved or reduced ejection fraction, due to worsening of diastolic function. Accumulation of intra-myocardial fibrosis and replacement scars underlies heart failure progression and represents a substrate for sustained arrhythmias in end-stage patients. However, arrhythmias and mechanical abnormalities may occur in hearts with little or no fibrosis, prompting toward functional pathomechanisms. By studying viable cardiomyocytes and trabeculae isolated from inter-ventricular septum samples of non-failing HCM patients with symptomatic obstruction who underwent myectomy operations, we identified that specific abnormalities of intracellular Ca2+ handling are associated with increased cellular arrhytmogenesis and diastolic dysfunction. In HCM cardiomyocytes, diastolic Ca2+ concentration is increased both in the cytosol and in the sarcoplasmic reticulum and the rate of Ca2+ transient decay is slower, while the amplitude of Ca2+-release is preserved. Ca2+ overload is the consequence of an increased Ca2+ entry via L-type Ca2+-current [due to prolongation the action potential (AP) plateau], combined with a reduced rate of Ca2+-extrusion through the Na+/Ca2+ exchanger [due to increased cytosolic (Na+)] and a lower expression of SERCA. Increased late Na+ current (INaL) plays a major role, as it causes both AP prolongation and Na+ overload. Intracellular Ca2+ overload determines an higher frequency of Ca2+ waves leading to delayed-afterdepolarizations (DADs) and premature contractions, but is also linked with the increased diastolic tension and slower relaxation of HCM myocardium. Sustained increase of intracellular [Ca2+] goes hand-in-hand with the increased activation of Ca2+/calmodulin-dependent protein-kinase-II (CaMKII) and augmented phosphorylation of its targets, including Ca2+ handling proteins. In transgenic HCM mouse models, we found that Ca2+ overload, CaMKII and increased INaL drive myocardial remodeling since the earliest stages of disease and underlie the development of hypertrophy, diastolic dysfunction and the arrhythmogenic substrate. In conclusion, diastolic dysfunction and arrhythmogenesis in human HCM myocardium are driven by functional alterations at cellular and molecular level that may be targets of innovative therapies.
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Affiliation(s)
- Raffaele Coppini
- Department of Neuroscience, Psychology, Drug Sciences and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Mugelli
- Department of Neuroscience, Psychology, Drug Sciences and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Corrado Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisabetta Cerbai
- Department of Neuroscience, Psychology, Drug Sciences and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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27
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Ferrantini C, Coppini R, Pioner JM, Gentile F, Tosi B, Mazzoni L, Scellini B, Piroddi N, Laurino A, Santini L, Spinelli V, Sacconi L, De Tombe P, Moore R, Tardiff J, Mugelli A, Olivotto I, Cerbai E, Tesi C, Poggesi C. Pathogenesis of Hypertrophic Cardiomyopathy is Mutation Rather Than Disease Specific: A Comparison of the Cardiac Troponin T E163R and R92Q Mouse Models. J Am Heart Assoc 2017; 6:JAHA.116.005407. [PMID: 28735292 PMCID: PMC5586279 DOI: 10.1161/jaha.116.005407] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background In cardiomyocytes from patients with hypertrophic cardiomyopathy, mechanical dysfunction and arrhythmogenicity are caused by mutation‐driven changes in myofilament function combined with excitation‐contraction (E‐C) coupling abnormalities related to adverse remodeling. Whether myofilament or E‐C coupling alterations are more relevant in disease development is unknown. Here, we aim to investigate whether the relative roles of myofilament dysfunction and E‐C coupling remodeling in determining the hypertrophic cardiomyopathy phenotype are mutation specific. Methods and Results Two hypertrophic cardiomyopathy mouse models carrying the R92Q and the E163R TNNT2 mutations were investigated. Echocardiography showed left ventricular hypertrophy, enhanced contractility, and diastolic dysfunction in both models; however, these phenotypes were more pronounced in the R92Q mice. Both E163R and R92Q trabeculae showed prolonged twitch relaxation and increased occurrence of premature beats. In E163R ventricular myofibrils or skinned trabeculae, relaxation following Ca2+ removal was prolonged; resting tension and resting ATPase were higher; and isometric ATPase at maximal Ca2+ activation, the energy cost of tension generation, and myofilament Ca2+ sensitivity were increased compared with that in wild‐type mice. No sarcomeric changes were observed in R92Q versus wild‐type mice, except for a large increase in myofilament Ca2+ sensitivity. In R92Q myocardium, we found a blunted response to inotropic interventions, slower decay of Ca2+ transients, reduced SERCA function, and increased Ca2+/calmodulin kinase II activity. Contrarily, secondary alterations of E‐C coupling and signaling were minimal in E163R myocardium. Conclusions In E163R models, mutation‐driven myofilament abnormalities directly cause myocardial dysfunction. In R92Q, diastolic dysfunction and arrhythmogenicity are mediated by profound cardiomyocyte signaling and E‐C coupling changes. Similar hypertrophic cardiomyopathy phenotypes can be generated through different pathways, implying different strategies for a precision medicine approach to treatment.
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MESH Headings
- Animals
- Calcium Signaling
- Calcium-Calmodulin-Dependent Protein Kinases/metabolism
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/metabolism
- Cardiomyopathy, Hypertrophic/physiopathology
- Disease Models, Animal
- Excitation Contraction Coupling
- Fibrosis
- Genetic Markers
- Genetic Predisposition to Disease
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/genetics
- Hypertrophy, Left Ventricular/metabolism
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Mice, Inbred C57BL
- Mice, Transgenic
- Mutation
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Myofibrils/metabolism
- Myofibrils/pathology
- Phenotype
- Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism
- Troponin T/genetics
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
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Affiliation(s)
- Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Josè Manuel Pioner
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesca Gentile
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Benedetta Tosi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Luca Mazzoni
- Department of NeuroFarBa, University of Florence, Italy
| | - Beatrice Scellini
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Nicoletta Piroddi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | | | | | - Leonardo Sacconi
- LENS, University of Florence & National Institute of Optics (INO-CNR), Florence, Italy
| | - Pieter De Tombe
- Loyola University Medical Center Department of Physiology, Chicago, IL
| | | | | | - Alessandro Mugelli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | | | - Chiara Tesi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Corrado Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
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Yacoub MH, Afifi A, Saad H, Aguib H, ElGuindy A. Current state of the art and future of myectomy. Ann Cardiothorac Surg 2017; 6:307-317. [PMID: 28944171 DOI: 10.21037/acs.2017.06.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Surgical relief of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) requires more than septal myectomy. The procedure is currently the gold standard for all symptomatic HCM patients except those with comorbidities. The operation requires an individualized approach to restore the sophisticated functions of the left ventricular outflow tract (LVOT) without injury to the surrounding vital structures. The procedure should be tailored to deal with all the varied components of the obstruction including fibrous trigones, accessory tissues, and papillary muscle fusion. Preoperative multimodality imaging and numerical modeling combined with intraoperative transesophageal echocardiography (TEE) are essential to define existing anomalies as well as assess the adequacy of the repair. The mitral valve can be conserved in virtually all patients. The operation can be conducted with very low mortality and morbidity with predictable good outcomes both in the short and long term. Nevertheless, surgical relief of LVOTO is still grossly underused.
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Affiliation(s)
- Magdi H Yacoub
- National Heart and Lung Institute, Imperial College London, London, UK.,Aswan Heart Centre, Aswan Governorate, Egypt
| | - Ahmed Afifi
- Aswan Heart Centre, Aswan Governorate, Egypt
| | - Hesham Saad
- Aswan Heart Centre, Aswan Governorate, Egypt
| | - Heba Aguib
- National Heart and Lung Institute, Imperial College London, London, UK.,Aswan Heart Centre, Aswan Governorate, Egypt
| | - Ahmed ElGuindy
- National Heart and Lung Institute, Imperial College London, London, UK.,Aswan Heart Centre, Aswan Governorate, Egypt
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29
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Limongelli G, Masarone D, Frisso G, Iacomino M, Ferrara I, Rea A, Gravino R, Bossone E, Salvatore F, Calabro R, Elliott P, Pacileo G. Clinical and genetic characterization of patients with hypertrophic cardiomyopathy and right atrial enlargement. J Cardiovasc Med (Hagerstown) 2017; 18:249-254. [DOI: 10.2459/jcm.0000000000000361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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30
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Bonou M, Papadimitraki ED, Dalianis N, Alexopoulos N, Karali M, Zerva K, Barbetseas J. Apical aneurysm with thrombus in an elderly patient with hypertrophic obstructive cardiomyopathy. Aging Clin Exp Res 2017; 29:341-344. [PMID: 26971964 DOI: 10.1007/s40520-016-0551-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Bonou
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | | | | | | | - Maria Karali
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - Kanella Zerva
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - John Barbetseas
- Department of Cardiology, Laiko General Hospital, Athens, Greece
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31
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Pseudophosphorylation of cardiac myosin regulatory light chain: a promising new tool for treatment of cardiomyopathy. Biophys Rev 2017; 9:57-64. [PMID: 28510043 DOI: 10.1007/s12551-017-0248-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/05/2017] [Indexed: 12/21/2022] Open
Abstract
Many genetic mutations in sarcomeric proteins, including the cardiac myosin regulatory light chain (RLC) encoded by the MYL2 gene, have been implicated in familial cardiomyopathies. Yet, the molecular mechanisms by which these mutant proteins regulate cardiac muscle mechanics in health and disease remain poorly understood. Evidence has been accumulating that RLC phosphorylation has an influential role in striated muscle contraction and, in addition to the conventional modulation via Ca2+ binding to troponin C, it can regulate cardiac muscle function. In this review, we focus on RLC mutations that have been reported to cause cardiomyopathy phenotypes via compromised RLC phosphorylation and elaborate on pseudo-phosphorylation rescue mechanisms. This new methodology has been discussed as an emerging exploratory tool to understand the role of phosphorylation as well as a genetic modality to prevent/rescue cardiomyopathy phenotypes. Finally, we summarize structural effects post-phosphorylation, a phenomenon that leads to an ordered shift in the myosin S1 and RLC conformational equilibrium between two distinct states.
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32
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Quarta G, Papadakis M, Donna PD, Maurizi N, Iacovoni A, Gavazzi A, Senni M, Olivotto I. Grey zones in cardiomyopathies: defining boundaries between genetic and iatrogenic disease. Nat Rev Cardiol 2016; 14:102-112. [DOI: 10.1038/nrcardio.2016.175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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33
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van de Schoor FR, Aengevaeren VL, Hopman MTE, Oxborough DL, George KP, Thompson PD, Eijsvogels TMH. Myocardial Fibrosis in Athletes. Mayo Clin Proc 2016; 91:1617-1631. [PMID: 27720455 DOI: 10.1016/j.mayocp.2016.07.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/17/2022]
Abstract
Myocardial fibrosis (MF) is a common phenomenon in the late stages of diverse cardiac diseases and is a predictive factor for sudden cardiac death. Myocardial fibrosis detected by magnetic resonance imaging has also been reported in athletes. Regular exercise improves cardiovascular health, but there may be a limit of benefit in the exercise dose-response relationship. Intense exercise training could induce pathologic cardiac remodeling, ultimately leading to MF, but the clinical implications of MF in athletes are unknown. For this comprehensive review, we performed a systematic search of the PubMed and MEDLINE databases up to June 2016. Key Medical Subject Headings terms and keywords pertaining to MF and exercise (training) were included. Articles were included if they represented primary MF data in athletes. We identified 65 athletes with MF from 19 case studies/series and 14 athletic population studies. Myocardial fibrosis in athletes was predominantly identified in the intraventricular septum and where the right ventricle joins the septum. Although the underlying mechanisms are unknown, we summarize the evidence for genetic predisposition, silent myocarditis, pulmonary artery pressure overload, and prolonged exercise-induced repetitive micro-injury as contributors to the development of MF in athletes. We also discuss the clinical implications and potential treatment strategies of MF in athletes.
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Affiliation(s)
- Freek R van de Schoor
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent L Aengevaeren
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Thijs M H Eijsvogels
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Division of Cardiology, Hartford Hospital, Hartford, CT.
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Guglielmi V, Maresca L, Lanzillo C, Marinoni GM, D’Adamo M, Di Roma M, Preziosi P, Bellia A, Calò L, Sbraccia P. Relationship between Regional Fat Distribution and Hypertrophic Cardiomyopathy Phenotype. PLoS One 2016; 11:e0158892. [PMID: 27388274 PMCID: PMC4936675 DOI: 10.1371/journal.pone.0158892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/23/2016] [Indexed: 01/27/2023] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM), the most common genetic heart disease, is characterized by heterogeneous phenotypic expression. Body mass index has been associated with LV mass and heart failure symptoms in HCM. The aim of our study was to investigate whether regional (trunk, appendicular, epicardial) fat distribution and extent could be related to hypertrophy severity and pattern in HCM. Methods Cardiovascular magnetic resonance was performed in 32 subjects with echocardiography-based diagnosis of HCM (22M/10F, 57.2±12.6 years) characterized by predominant hypertrophy at the interventricular septum (IVS). Regional fat distribution was assessed by dual-energy X-ray absorptiometry. Results Gender differences were detected in maximum IVS thickness (M: 18.3±3.8 mm vs. F: 14.3±4 mm, p = 0.012), right ventricle (RV) systolic function (M: 61.3±6.7%; F: 67.5±6.3%, p = 0.048), indexed RV end-diastolic (M: 64.8±16.3 ml/m2; F: 50.7±15.5 ml/m2, p = 0.04) and end-systolic volumes (M: 24.3±8.3 ml/m2; F: 16.7±7.4 ml/m2, p = 0.04). After adjusting for age and gender, maximum IVS thickness was associated with truncal fat (Tr-FAT) (β = 0.43, p = 0.02), but not with either appendicular or epicardial fat. Epicardial fat resulted independently associated with NT-proBNP levels (β = 0.63, p = 0.04). Late Gadolinium Enhancement-positive subjects displayed greater maximum IVS thickness (p = 0.02), LV mass index (p = 0.015) and NT-proBNP levels (p = 0.04), but no associations with fat amount or distribution were observed. Conclusion Truncal, but not appendicular or epicardial fat amount, seems to be related with maximum IVS thickness, the hallmark feature in our cohort of HCM patients. Further prospective researches are needed to assess a potential causative effect of central adiposity on HCM phenotype.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Luciano Maresca
- Diagnostic Imaging Department, Policlinico Casilino, Rome, Italy
| | | | | | - Monica D’Adamo
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mauro Di Roma
- Diagnostic Imaging Department, Policlinico Casilino, Rome, Italy
| | - Paolo Preziosi
- Diagnostic Imaging Department, Policlinico Casilino, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Leonardo Calò
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- * E-mail:
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35
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Passini E, Mincholé A, Coppini R, Cerbai E, Rodriguez B, Severi S, Bueno-Orovio A. Mechanisms of pro-arrhythmic abnormalities in ventricular repolarisation and anti-arrhythmic therapies in human hypertrophic cardiomyopathy. J Mol Cell Cardiol 2016; 96:72-81. [PMID: 26385634 PMCID: PMC4915817 DOI: 10.1016/j.yjmcc.2015.09.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/05/2015] [Accepted: 09/11/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is a cause of sudden arrhythmic death, but the understanding of its pro-arrhythmic mechanisms and an effective pharmacological treatment are lacking. HCM electrophysiological remodelling includes both increased inward and reduced outward currents, but their role in promoting repolarisation abnormalities remains unknown. The goal of this study is to identify key ionic mechanisms driving repolarisation abnormalities in human HCM, and to evaluate anti-arrhythmic effects of single and multichannel inward current blocks. METHODS Experimental ionic current, action potential (AP) and Ca(2+)-transient (CaT) recordings were used to construct populations of human non-diseased and HCM AP models (n=9118), accounting for inter-subject variability. Simulations were conducted for several degrees of selective and combined inward current block. RESULTS Simulated HCM cardiomyocytes exhibited prolonged AP and CaT, diastolic Ca(2+) overload and decreased CaT amplitude, in agreement with experiments. Repolarisation abnormalities in HCM models were consistently driven by L-type Ca(2+) current (ICaL) re-activation, and ICaL block was the most effective intervention to normalise repolarisation and diastolic Ca(2+), but compromised CaT amplitude. Late Na(+) current (INaL) block partially abolished repolarisation abnormalities, with small impact on CaT. Na(+)/Ca(2+) exchanger (INCX) block effectively restored repolarisation and CaT amplitude, but increased Ca(2+) overload. Multichannel block increased efficacy in normalising repolarisation, AP biomarkers and CaT amplitude compared to selective block. CONCLUSIONS Experimentally-calibrated populations of human AP models identify ICaL re-activation as the key mechanism for repolarisation abnormalities in HCM, and combined INCX, INaL and ICaL block as effective anti-arrhythmic therapies also able to partially reverse the HCM electrophysiological phenotype.
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Affiliation(s)
- Elisa Passini
- Department of Computer Science, University of Oxford, Oxford OX13QD, United Kingdom; Department of Electrical, Electronic and Information Engineering, University of Bologna, Cesena 47521, Italy
| | - Ana Mincholé
- Department of Computer Science, University of Oxford, Oxford OX13QD, United Kingdom
| | - Raffaele Coppini
- Department NEUROFARBA, University of Florence, Florence 50139, Italy
| | - Elisabetta Cerbai
- Department NEUROFARBA, University of Florence, Florence 50139, Italy
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford OX13QD, United Kingdom
| | - Stefano Severi
- Department of Electrical, Electronic and Information Engineering, University of Bologna, Cesena 47521, Italy
| | - Alfonso Bueno-Orovio
- Department of Computer Science, University of Oxford, Oxford OX13QD, United Kingdom.
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Weissler-Snir A, Crean A, Rakowski H. The role of imaging in the diagnosis and management of hypertrophic cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 14:51-74. [PMID: 26567960 DOI: 10.1586/14779072.2016.1113130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, affecting approximately 1:500 people. As the yield of genetic testing is only about 35-60%, the diagnosis of HCM is still clinical and based on the demonstration of unexplained and usually asymmetric left ventricular (LV) hypertrophy by imaging modalities. In the past, echocardiography was the sole imaging modality used for the diagnosis and management of HCM. However, in recent years other imaging modalities such as cardiac magnetic resonance have played a major role in the diagnosis, management and risk stratification of HCM, particularly when the location of left ventricular hypertrophy is atypical (apex, lateral wall) and when the echocardiographic imaging is sub-optimal. However, the most unique contribution of cardiac magnetic resonance is the quantification of myocardial fibrosis. Exercise stress echocardiography is the preferred provocative test for the assessment of LV outflow tract obstruction, which is detected only on provocation in one-third of the patients.
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Affiliation(s)
| | - Andrew Crean
- a Department of Cardiology , Toronto General Hospital , Toronto , Canada
| | - Harry Rakowski
- a Department of Cardiology , Toronto General Hospital , Toronto , Canada
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MicroRNAs Based Therapy of Hypertrophic Cardiomyopathy: The Road Traveled So Far. BIOMED RESEARCH INTERNATIONAL 2015; 2015:983290. [PMID: 26504850 PMCID: PMC4609405 DOI: 10.1155/2015/983290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/19/2015] [Indexed: 01/01/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease characterized by variable expressivity, age penetrance, and a high heterogeneity. The transcriptional profile (miRNAs, mRNAs), epigenetic modifications, and posttranslational modifications seem to be highly relevant for the onset of the disease. miRNAs, small noncoding RNAs with 22 nucleotides, have been implicated in the regulation of cardiomyocyte function, being differentially expressed in several heart diseases, including HCM. Moreover, a different miRNA expression profile in the various stages of HCM development is also observed. This review summarizes the current knowledge of the profile of miRNAs characteristic of asymptomatic to overt HCM patients, discussing alongside their potential use for diagnosis and therapy. Indeed, the stability and specificity of miRNAs make them suitable targets for use as biomarkers for diagnosis and prognosis and as therapeutical targets.
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40
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Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Freitas A, Habib G, Kitsiou A, Petersen SE, Schroeder S, Lancellotti P, Camici P, Dulgheru R, Hagendorff A, Lombardi M, Muraru D, Sicari R. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging 2015; 16:280. [PMID: 25650407 DOI: 10.1093/ehjci/jeu291] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.
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MESH Headings
- Cardiac Imaging Techniques/methods
- Cardiac Imaging Techniques/standards
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Consensus
- Echocardiography, Doppler/methods
- Echocardiography, Doppler/standards
- Europe
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine/methods
- Magnetic Resonance Imaging, Cine/standards
- Male
- Multimodal Imaging/methods
- Multimodal Imaging/standards
- Positron-Emission Tomography/methods
- Positron-Emission Tomography/standards
- Practice Guidelines as Topic/standards
- Role
- Saudi Arabia
- Societies, Medical/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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Tardiff JC, Carrier L, Bers DM, Poggesi C, Ferrantini C, Coppini R, Maier LS, Ashrafian H, Huke S, van der Velden J. Targets for therapy in sarcomeric cardiomyopathies. Cardiovasc Res 2015; 105:457-70. [PMID: 25634554 DOI: 10.1093/cvr/cvv023] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
To date, no compounds or interventions exist that treat or prevent sarcomeric cardiomyopathies. Established therapies currently improve the outcome, but novel therapies may be able to more fundamentally affect the disease process and course. Investigations of the pathomechanisms are generating molecular insights that can be useful for the design of novel specific drugs suitable for clinical use. As perturbations in the heart are stage-specific, proper timing of drug treatment is essential to prevent initiation and progression of cardiac disease in mutation carrier individuals. In this review, we emphasize potential novel therapies which may prevent, delay, or even reverse hypertrophic cardiomyopathy caused by sarcomeric gene mutations. These include corrections of genetic defects, altered sarcomere function, perturbations in intracellular ion homeostasis, and impaired myocardial energetics.
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Affiliation(s)
- Jil C Tardiff
- Department of Medicine and Cellular and Molecular Medicine, University of Arizona, 1656 East Mabel Street, MRB 312, Tucson, AZ 85724-5217, USA
| | - Lucie Carrier
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis, CA, USA
| | - Corrado Poggesi
- Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, Florence, Italy
| | - Cecilia Ferrantini
- Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, Florence, Italy
| | - Raffaele Coppini
- Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, Florence, Italy
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum, Regensburg, Germany
| | - Houman Ashrafian
- Experimental Therapeutics and Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sabine Huke
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolanda van der Velden
- Department of Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
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Muthu P, Liang J, Schmidt W, Moore JR, Szczesna-Cordary D. In vitro rescue study of a malignant familial hypertrophic cardiomyopathy phenotype by pseudo-phosphorylation of myosin regulatory light chain. Arch Biochem Biophys 2014; 552-553:29-39. [PMID: 24374283 PMCID: PMC4043912 DOI: 10.1016/j.abb.2013.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/02/2013] [Accepted: 12/16/2013] [Indexed: 11/18/2022]
Abstract
Pseudo-phosphorylation of cardiac myosin regulatory light chain (RLC) has never been examined as a rescue method to alleviate a cardiomyopathy phenotype brought about by a disease causing mutation in the myosin RLC. This study focuses on the aspartic acid to valine substitution (D166V) in the myosin RLC shown to be associated with a malignant phenotype of familial hypertrophic cardiomyopathy (FHC). The mutation has also been demonstrated to cause severe functional abnormalities in transgenic mice expressing D166V in the heart. To explore this novel rescue strategy, pseudo-phosphorylation of D166V was used to determine whether the D166V-induced detrimental phenotype could be brought back to the level of wild-type (WT) RLC. The S15D substitution at the phosphorylation site of RLC was inserted into the recombinant WT and D166V mutant to mimic constitutively phosphorylated RLC proteins. Non-phosphorylatable (S15A) constructs were used as controls. A multi-faceted approach was taken to determine the effect of pseudo-phosphorylation on the ability of myosin to generate force and motion. Using mutant reconstituted porcine cardiac muscle preparations, we showed an S15D-induced rescue of both the enzymatic and binding properties of D166V-myosin to actin. A significant increase in force production capacity was noted in the in vitro motility assays for S15D-D166V vs. D166V reconstituted myosin. A similar pseudo-phosphorylation induced effect was observed on the D166V-elicited abnormal Ca(2+) sensitivity of force in porcine papillary muscle strips reconstituted with phosphomimic recombinant RLCs. Results from this study demonstrate a novel in vitro rescue strategy that could be utilized in vivo to ameliorate a malignant cardiomyopathic phenotype. We show for the first time that pseudo-RLC phosphorylation can reverse the majority of the mutation-induced phenotypes highlighting the importance of RLC phosphorylation in combating cardiac disease.
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Affiliation(s)
- Priya Muthu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jingsheng Liang
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - William Schmidt
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jeffrey R Moore
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA 02118, USA
| | - Danuta Szczesna-Cordary
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Coppini R, Ferrantini C, Aiazzi A, Mazzoni L, Sartiani L, Mugelli A, Poggesi C, Cerbai E. Isolation and functional characterization of human ventricular cardiomyocytes from fresh surgical samples. J Vis Exp 2014. [PMID: 24798397 DOI: 10.3791/51116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cardiomyocytes from diseased hearts are subjected to complex remodeling processes involving changes in cell structure, excitation contraction coupling and membrane ion currents. Those changes are likely to be responsible for the increased arrhythmogenic risk and the contractile alterations leading to systolic and diastolic dysfunction in cardiac patients. However, most information on the alterations of myocyte function in cardiac diseases has come from animal models. Here we describe and validate a protocol to isolate viable myocytes from small surgical samples of ventricular myocardium from patients undergoing cardiac surgery operations. The protocol is described in detail. Electrophysiological and intracellular calcium measurements are reported to demonstrate the feasibility of a number of single cell measurements in human ventricular cardiomyocytes obtained with this method. The protocol reported here can be useful for future investigations of the cellular and molecular basis of functional alterations of the human heart in the presence of different cardiac diseases. Further, this method can be used to identify novel therapeutic targets at cellular level and to test the effectiveness of new compounds on human cardiomyocytes, with direct translational value.
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Affiliation(s)
- Raffaele Coppini
- Department NeuroFarBa, Division of Pharmacology, University of Florence;
| | - Cecila Ferrantini
- Department of Clinical and Experimental Medicine, Division of Physiology, University of Florence
| | - Alessandro Aiazzi
- Department of Clinical and Experimental Medicine, Division of Physiology, University of Florence
| | - Luca Mazzoni
- Department NeuroFarBa, Division of Pharmacology, University of Florence
| | - Laura Sartiani
- Department NeuroFarBa, Division of Pharmacology, University of Florence
| | | | - Corrado Poggesi
- Department of Clinical and Experimental Medicine, Division of Physiology, University of Florence
| | - Elisabetta Cerbai
- Department NeuroFarBa, Division of Pharmacology, University of Florence
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Captur G, Lopes LR, Patel V, Li C, Bassett P, Syrris P, Sado DM, Maestrini V, Mohun TJ, McKenna WJ, Muthurangu V, Elliott PM, Moon JC. Abnormal cardiac formation in hypertrophic cardiomyopathy: fractal analysis of trabeculae and preclinical gene expression. ACTA ACUST UNITED AC 2014; 7:241-8. [PMID: 24704860 DOI: 10.1161/circgenetics.113.000362] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Mutations in genes coding for sarcomeric proteins cause hypertrophic cardiomyopathy. Subtle abnormalities of the myocardium may be present in mutation carriers without left ventricular hypertrophy (G+LVH-) but are difficult to quantify. Fractal analysis has been used to define trabeculae in left ventricular noncompaction and to identify normal racial variations. We hypothesized that trabeculae measured by fractal analysis of cardiovascular magnetic resonance images are abnormal in G+LVH- patients, providing a preclinical marker of disease in hypertrophic cardiomyopathy. METHODS AND RESULTS Cardiovascular magnetic resonance was performed on 40 G+LVH- patients (33±15 years, 38% men), 67 patients with a clinical diagnosis of hypertrophic cardiomyopathy (53±15 years, 76% men; 31 with a pathogenic mutation [G+LVH+]), and 69 matched healthy volunteers (44±15 years, 57% men). Trabeculae were quantified by fractal analysis of cine slices to calculate the fractal dimension, a unitless index of endocardial complexity calculated from endocardial contours after segmentation. In G+LVH- patients, apical left ventricular trabeculation was increased compared with controls (maximal apical fractal dimension, 1.249±0.07 versus 1.199±0.05; P=0.001). In G+LVH+ and G-LVH+ cohorts, maximal apical fractal dimension was greater than in controls (P<0.0001) irrespective of gene status (G+LVH+: 1.370±0.08; G-LVH+: 1.380±0.09). Compared with controls, G+LVH- patients also had a higher frequency of clefts (28% versus 8%; P=0.02), longer anterior mitral valve leaflets (23.5±3.0 versus 19.7±3.1 mm; P<0.0001), greater septal systolic wall thickness (12.6±3.2 versus 11.2±2.1 mm; P=0.03), higher ejection fraction (71±4% versus 69±4%; P=0.03), and smaller end-systolic volumes (38±9 versus 43±12 mL; P=0.03). CONCLUSIONS Increased myocardial trabecular complexity is one of several preclinical abnormalities in hypertrophic cardiomyopathy sarcomere gene mutation carriers without LVH.
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Affiliation(s)
- Gabriella Captur
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Luis R Lopes
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Vimal Patel
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Chunming Li
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Paul Bassett
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Petros Syrris
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Daniel M Sado
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Viviana Maestrini
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Timothy J Mohun
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - William J McKenna
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Vivek Muthurangu
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Perry M Elliott
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - James C Moon
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu).
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Coppini R, Ferrantini C, Mazzoni L, Sartiani L, Olivotto I, Poggesi C, Cerbai E, Mugelli A. Regulation of intracellular Na(+) in health and disease: pathophysiological mechanisms and implications for treatment. Glob Cardiol Sci Pract 2013; 2013:222-42. [PMID: 24689024 PMCID: PMC3963757 DOI: 10.5339/gcsp.2013.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/01/2013] [Indexed: 12/19/2022] Open
Abstract
Transmembrane sodium (Na+) fluxes and intracellular sodium homeostasis are central players in the physiology of the cardiac myocyte, since they are crucial for both cell excitability and for the regulation of the intracellular calcium concentration. Furthermore, Na+ fluxes across the membrane of mitochondria affect the concentration of protons and calcium in the matrix, regulating mitochondrial function. In this review we first analyze the main molecular determinants of sodium fluxes across the sarcolemma and the mitochondrial membrane and describe their role in the physiology of the healthy myocyte. In particular we focus on the interplay between intracellular Ca2+ and Na+. A large part of the review is dedicated to discuss the changes of Na+ fluxes and intracellular Na+ concentration([Na+]i) occurring in cardiac disease; we specifically focus on heart failure and hypertrophic cardiomyopathy, where increased intracellular [Na+]i is an established determinant of myocardial dysfunction. We review experimental evidence attributing the increase of [Na+]i to either decreased Na+ efflux (e.g. via the Na+/K+ pump) or increased Na+ influx into the myocyte (e.g. via Na+ channels). In particular, we focus on the role of the “late sodium current” (INaL), a sustained component of the fast Na+ current of cardiac myocytes, which is abnormally enhanced in cardiac diseases and contributes to both electrical and contractile dysfunction. We analyze the pathophysiological role of INaL enhancement in heart failure and hypertrophic cardiomyopathy and the consequences of its pharmacological modulation, highlighting the clinical implications. The central role of Na+ fluxes and intracellular Na+ physiology and pathophysiology of cardiac myocytes has been highlighted by a large number of recent works. The possibility of modulating Na+ inward fluxes and [Na+]i with specific INaL inhibitors, such as ranolazine, has made Na+a novel suitable target for cardiac therapy, potentially capable of addressing arrhythmogenesis and diastolic dysfunction in severe conditions such as heart failure and hypertrophic cardiomyopathy.
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Affiliation(s)
- Raffaele Coppini
- Department NeuroFarBa, Division of Pharmacology, University of Florence, Italy
| | - Cecilia Ferrantini
- Department of Clinical and Experimental Medicine, division of Physiology, University of Florence, Italy
| | - Luca Mazzoni
- Department NeuroFarBa, Division of Pharmacology, University of Florence, Italy
| | - Laura Sartiani
- Department NeuroFarBa, Division of Pharmacology, University of Florence, Italy
| | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Corrado Poggesi
- Department of Clinical and Experimental Medicine, division of Physiology, University of Florence, Italy
| | - Elisabetta Cerbai
- Department NeuroFarBa, Division of Pharmacology, University of Florence, Italy
| | - Alessandro Mugelli
- Department NeuroFarBa, Division of Pharmacology, University of Florence, Italy
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D'Amato R, Tomberli B, Castelli G, Spoladore R, Girolami F, Fornaro A, Caldini A, Torricelli F, Camici P, Gensini GF, Cecchi F, Olivotto I. Prognostic value of N-terminal pro-brain natriuretic Peptide in outpatients with hypertrophic cardiomyopathy. Am J Cardiol 2013; 112:1190-6. [PMID: 23871673 DOI: 10.1016/j.amjcard.2013.06.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 11/24/2022]
Abstract
In hypertrophic cardiomyopathy, the plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) correlate with functional capacity. However, their prognostic relevance remains unresolved. We followed up 183 stable outpatients with hypertrophic cardiomyopathy (age 50 ± 17 years, 64% men) for 3.9 ± 2.8 years after NT-proBNP measurement. The primary end point included cardiovascular death, heart transplantation, resuscitated cardiac arrest, and appropriate implantable cardioverter-defibrillator intervention. The secondary end point (SE) included heart failure-related death or hospitalization, progression to end-stage disease, and stroke. The median NT-proBNP level was 615 pg/ml (intertertile range 310 to 1,025). The incidence of the primary end point in the lower, middle, and upper tertiles was 0%, 1.3%, and 2.1% annually, respectively (overall p = 0.01). On multivariate analysis, the only independent predictors of the primary end point were NT-proBNP (hazard ratio for log-transformed values 5.8, 95% confidence interval 1.07 to 31.6; p = 0.04) and a restrictive left ventricular filling pattern (hazard ratio 5.19, 95% confidence interval 1.3 to 21.9; p = 0.02). The NT-proBNP cutoff value of 810 pg/ml had the best sensitivity for the primary end point (88%), but the specificity was low (61%). The incidence of the SE in the lower, middle, and upper NT-proBNP tertiles was 4.6%, 12.0%, and 11.2% annually, respectively (overall p = 0.001). An NT-proBNP level of <310 pg/ml was associated with a 75% reduction in the rate of SE compared with a level of ≥310 pg/ml (hazard ratio 0.25, 95% confidence interval 0.11 to 0.57; p = 0.001), independent of age, left ventricular outflow tract obstruction, or atrial fibrillation. In conclusion, in stable outpatients with hypertrophic cardiomyopathy, plasma NT-proBNP proved a powerful independent predictor of death and heart failure-related events. Although the positive predictive accuracy of an elevated NT-proBNP level was modest, low values reflected true clinical stability, suggesting the possibility of avoiding or postponing aggressive treatment options.
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Obesity and its association to phenotype and clinical course in hypertrophic cardiomyopathy. J Am Coll Cardiol 2013; 62:449-57. [PMID: 23643593 DOI: 10.1016/j.jacc.2013.03.062] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 03/03/2013] [Accepted: 03/05/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort. BACKGROUND It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with HCM. METHODS In 275 adult HCM patients (age 48 ± 14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression. RESULTS At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25 to 30 kg/m(2) and >30 kg/m(2), respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m(2)), compared with normal weight patients (BMI <25 kg/m(2); hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 0.73 to 3.74, p = 0.22 and 3.1; 95% CI: 1.42 to 6.86, p = 0.004, respectively). Other features associated with LV mass >120 g/m(2) were LV outflow obstruction (HR: 4.9; 95% CI: 2.4 to 9.8; p < 0.001), systemic hypertension (HR: 2.2; 95% CI: 1.1 to 4.5; p = 0.026), and male sex (HR: 2.1; 95% CI: 0.9 to 4.7; p = 0.083). During a median follow-up of 3.7 years (interquartile range: 2.5 to 5.3), obese patients showed an HR of 3.6 (95% CI: 1.2 to 10.7, p = 0.02) for developing New York Heart Association (NYHA) functional class III to IV symptoms compared to nonobese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA functional class III at the end of follow-up was 13% among obese patients, compared with 6% among those of normal weight (p = 0.03). CONCLUSIONS In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms.
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Coppini R, Ferrantini C, Yao L, Fan P, Del Lungo M, Stillitano F, Sartiani L, Tosi B, Suffredini S, Tesi C, Yacoub M, Olivotto I, Belardinelli L, Poggesi C, Cerbai E, Mugelli A. Late sodium current inhibition reverses electromechanical dysfunction in human hypertrophic cardiomyopathy. Circulation 2012; 127:575-84. [PMID: 23271797 DOI: 10.1161/circulationaha.112.134932] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM), the most common mendelian heart disorder, remains an orphan of disease-specific pharmacological treatment because of the limited understanding of cellular mechanisms underlying arrhythmogenicity and diastolic dysfunction. METHODS AND RESULTS We assessed the electromechanical profile of cardiomyocytes from 26 HCM patients undergoing myectomy compared with those from nonfailing nonhypertrophic surgical patients by performing patch-clamp and intracellular Ca(2+) (Ca(2+)(i)) studies. Compared with controls, HCM cardiomyocytes showed prolonged action potential related to increased late Na(+) (I(NaL)) and Ca(2+) (I(CaL)) currents and decreased repolarizing K(+) currents, increased occurrence of cellular arrhythmias, prolonged Ca(2+)(i) transients, and higher diastolic Ca(2+)(i). Such changes were related to enhanced Ca(2+)/calmodulin kinase II (CaMKII) activity and increased phosphorylation of its targets. Ranolazine at therapeutic concentrations partially reversed the HCM-related cellular abnormalities via I(NaL) inhibition, with negligible effects in controls. By shortening the action potential duration in HCM cardiomyocytes, ranolazine reduced the occurrence of early and delayed afterdepolarizations. Finally, as a result of the faster kinetics of Ca(2+)(i) transients and the lower diastolic Ca(2+)(i), ranolazine accelerated the contraction-relaxation cycle of HCM trabeculae, ameliorating diastolic function. CONCLUSIONS We highlighted a specific set of functional changes in human HCM myocardium that stem from a complex remodeling process involving alterations of CaMKII-dependent signaling, rather than being a direct consequence of the causal sarcomeric mutations. Among the several ion channel and Ca(2+)(i) handling proteins changes identified, an enhanced I(NaL) seems to be a major contributor to the electrophysiological and Ca(2+)(i) dynamic abnormalities of ventricular myocytes and trabeculae from patients with HCM, suggesting potential therapeutic implications of I(NaL) inhibition.
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Affiliation(s)
- Raffaele Coppini
- Department of Preclinical and Clinical Pharmacology, University of Florence, V. le G. Pieraccini 6, 50139 Florence, Italy.
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49
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Kalozoumi G, Tzimas C, Sanoudou D. The expanding role of epigenetics. Glob Cardiol Sci Pract 2012; 2012:7. [PMID: 25610838 PMCID: PMC4239821 DOI: 10.5339/gcsp.2012.7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/20/2012] [Indexed: 12/13/2022] Open
Affiliation(s)
- Georgia Kalozoumi
- Department of Pharmacology, Medical School, University of Athens, Greece
| | - Christos Tzimas
- Molecular Biology Division, Biomedical Research Foundation of the Academy of Athens, Greece
| | - Despina Sanoudou
- Department of Pharmacology, Medical School, University of Athens, Greece ; Molecular Biology Division, Biomedical Research Foundation of the Academy of Athens, Greece
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50
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El-Hamamsy I, Lekadir K, Olivotto I, El Guindy A, Merrifield R, Rega L, Yang G, Cecchi F, Yacoub MH. Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy. Glob Cardiol Sci Pract 2012; 2012:9. [PMID: 25610840 PMCID: PMC4239823 DOI: 10.5339/gcsp.2012.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 01/20/2023] Open
Abstract
Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4–37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29g/m2 versus 154±36g/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function.
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Affiliation(s)
- Ismail El-Hamamsy
- Department of Cardiac Surgery, Montreal Heart Institute, Universite de Montreal, Montreal, Canada ; Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK
| | | | - Iacopo Olivotto
- Department of Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Ahmed El Guindy
- Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK
| | | | - Luigi Rega
- Department of Radiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Franco Cecchi
- Department of Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Magdi H Yacoub
- Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK
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