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Li J, Fang J, Liu Y, Wei X. Apical hypertrophic cardiomyopathy: pathophysiology, diagnosis and management. Clin Res Cardiol 2024; 113:680-693. [PMID: 37982860 PMCID: PMC11026226 DOI: 10.1007/s00392-023-02328-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
Since the first description of apical hypertrophic cardiomyopathy (ApHCM) in 1976, contrasting information from all over the world has emerged regarding the natural history of the disease. However, the recommended guidelines on hypertrophic cardiomyopathy (HCM) pay a cursory reference to ApHCM, without ApHCM-specific recommendations to guide the diagnosis and management. In addition, cardiologists may not be aware of certain aspects that are specific to this disease subtype, and a robust understanding of specific disease features can facilitate recognition and timely diagnosis. Therefore, the review covers the incidence, pathogenesis, and characteristics of ApHCM and imaging methods. Echocardiography and cardiovascular magnetic resonance imaging (CMR) are the most commonly used imaging methods. Moreover, this review presents the management strategies of this heterogeneous clinical entity. In this review, we introduce a novel transapical beating-heart septal myectomy procedure for ApHCM patients with a promising short-time result.
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Affiliation(s)
- Jiangtao Li
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Jing Fang
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
| | - Xiang Wei
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China.
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2
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Apical hypertrophic cardiomyopathy with subendocardial late gadolinium enhancement in an adolescent. Cardiol Young 2021; 31:286-288. [PMID: 33377856 DOI: 10.1017/s1047951120004692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 17-year-old boy with a history of dyspnea attacks and chest pain was referred to our paediatric cardiology department. Electrocardiogram at presentation showed T-wave inversion in the inferior leads. Cardiovascular magnetic resonance imaging revealed the rare diagnosis of apical hypertrophic cardiomyopathy with subendocardial late gadolinium enhancement, missed by echocardiography.
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3
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Hughes RK, Knott KD, Malcolmson J, Augusto JB, Mohiddin SA, Kellman P, Moon JC, Captur G. Apical Hypertrophic Cardiomyopathy: The Variant Less Known. J Am Heart Assoc 2020; 9:e015294. [PMID: 32106746 PMCID: PMC7335568 DOI: 10.1161/jaha.119.015294] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Rebecca K Hughes
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - Kristopher D Knott
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - James Malcolmson
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - João B Augusto
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - Saidi A Mohiddin
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom.,William Harvey Institute Queen Mary University of London London United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute National Institutes of Health DHHS Bethesda MD
| | - James C Moon
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - Gabriella Captur
- Institute of Cardiovascular Science University College London London United Kingdom.,Inherited Heart Muscle Conditions Clinic Department of Cardiology Royal Free London NHS Foundation Trust Hampstead United Kingdom.,University College London MRC Unit of Lifelong Health and Ageing London United Kingdom
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4
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Bizarre ST elevation. Anatol J Cardiol 2018; 20:252-253. [PMID: 30297588 PMCID: PMC6249535 DOI: 10.14744/anatoljcardiol.2018.38202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Bahlmann E, van der Schalk H, Dreher A, Schmidt-Salzmann M, Kivelitz D, Starekova J, Ghanem A, Kuck KH. Plötzlicher Herztod einer Fitnesstrainerin mit hypertropher Kardiomyopathie vom apikalen Typ assoziiert mit Cor triatriatum sinister. Med Klin Intensivmed Notfmed 2018; 113:426-429. [DOI: 10.1007/s00063-017-0335-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/24/2017] [Accepted: 08/25/2017] [Indexed: 11/30/2022]
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6
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Zhai SS, Fan CM, An SY, Hang F, Yang YJ, Yan LR, Guo XY, Li YS. Clinical Outcomes of Myocardial Bridging versus No Myocardial Bridging in Patients with Apical Hypertrophic Cardiomyopathy. Cardiology 2018; 139:161-168. [DOI: 10.1159/000486276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 12/11/2017] [Indexed: 01/26/2023]
Abstract
Objective: To determine the prevalence and clinical effects of myocardial bridging (MB) in patients with apical hypertrophic cardiomyopathy (AHCM). Methods: Angiograms from 212 AHCM patients were reviewed to identify MB. The patients were classified into 2 groups: AHCM with and AHCM without MB. We reviewed patient records on cardiovascular (CV) risk factors, symptoms, CV events, and CV mortality. Results: In all, 60 patients with MB and 100 without MB were included. Rates of angina (61.7 vs. 40%; p = 0.008), mimicking non-ST-segment elevation myocardial infarction (15 vs. 3%, p = 0.013), and Canadian Cardiovascular Society class III/IV angina (18.3 vs. 4%; p = 0.003) were higher in patients with MB than in those without. Mean follow-up periods (65.5 ± 50.5 vs. 64.4 ± 43.6 months, p = 0.378) and CV mortality (3.3 vs. 1%; p = 0.652) were similar in the 2 groups. Kaplan-Meier estimates demonstrated that CV event-free survival rates were lower in patients with MB than in those without (71.7 vs. 88%; p = 0.022). MB, late gadolinium enhancement, and female sex were independent risk factors for CV events in a multivariate Cox regression analysis adjusted for other risk factors. Conclusion: More serious symptoms and a higher risk of CV events were observed in AHCM patients with MB than in those without MB. CV mortality was similar in these 2 groups.
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7
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Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy. Ann Nucl Med 2017; 31:399-406. [PMID: 28364376 DOI: 10.1007/s12149-017-1167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Apical wall thickening with an "ace-of-spades" configuration is a unique sign of apical hypertrophic cardiomyopathy (AHCM). We investigated spade-shaped FDG uptake around the left ventricular apex (SSUA) incidentally found in routine oncological FDG PET. METHODS Cases showing SSUA were selected based on retrospective review. The pattern or intensity of SSUA was compared with the results of electrocardiogram (ECG), echocardiography, and stress myocardial perfusion SPECT. The diagnosis of ACHM was based on the presence of giant negative T wave in ECG, thickness of spade-shaped hypertrophy in the apex in echocardiography, and increased tracer uptake in the apex in rest SPECT. RESULTS Among the 34 patients in 36 PET scans showing SSUA, SSUA was weak in 17 and intense in 17. There were isolated SSUA (n = 29) and SSUA with diffuse or other focal left ventricular uptake (n = 5). Three patients with the latter uptake pattern turned out to have coexistence of AHCM and asymmetric septal hypertrophy. Of the 16 SSUA-positive patients who underwent echocardiography, 13 (81%) were diagnosed as AHCM and the remaining 3 were regarded as borderline AHCM (apical wall thickness, 14-15 mm). There were 16 patients with SSUA who also underwent PET scans after the study period among which 11 (69%) had persistent SSUA in the follow-up PET. In the remaining 5, follow-up PET scans showed diffuse left ventricular uptake and SSUA was barely visible. The intensity of SSUA was significantly or marginally associated with giant negative T wave (p < 0.01), apical asynergy (p = 0.08), and impaired coronary flow reserve (p < 0.05). There were no other factors correlated with the pattern or intensity of SSUA. CONCLUSION SSUA incidentally found in oncological FDG PET appeared to be associated with AHCM, especially in ischemic conditions. The moderate repeatability of SSUA was probably due to obscurity by physiological uptake.
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Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet 2017; 389:1253-1267. [PMID: 27912983 DOI: 10.1016/s0140-6736(16)31321-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/22/2016] [Accepted: 08/02/2016] [Indexed: 12/23/2022]
Abstract
Hypertrophic obstructive cardiomyopathy is an inherited myocardial disease defined by cardiac hypertrophy (wall thickness ≥15 mm) that is not explained by abnormal loading conditions, and left ventricular obstruction greater than or equal to 30 mm Hg. Typical symptoms include dyspnoea, chest pain, palpitations, and syncope. The diagnosis is usually suspected on clinical examination and confirmed by imaging. Some patients are at increased risk of sudden cardiac death, heart failure, and atrial fibrillation. Patients with an increased risk of sudden cardiac death undergo cardioverter-defibrillator implantation; in patients with severe symptoms related to ventricular obstruction, septal reduction therapy (myectomy or alcohol septal ablation) is recommended. Life-long anticoagulation is indicated after the first episode of atrial fibrillation.
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Affiliation(s)
- Josef Veselka
- Department of Cardiology, 2nd Medical School, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Nandan S Anavekar
- Departments of Cardiology and Radiology, Mayo Clinic, Rochester, MN, USA
| | - Philippe Charron
- Université Paris Sud, UVSQ, INSERM U1018, CESP, Boulogne-Billancourt, France; APHP, ICAN, Hôpital de la Pitié Salpêtrière, Paris, France
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9
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Guo X, Fan C, Tian L, Liu Y, Wang H, Zhao S, Duan F, Zhang X, Zhao X, Wang F, Zhu H, Lin A, Wu X, Li Y. The clinical features, outcomes and genetic characteristics of hypertrophic cardiomyopathy patients with severe right ventricular hypertrophy. PLoS One 2017; 12:e0174118. [PMID: 28323875 PMCID: PMC5360271 DOI: 10.1371/journal.pone.0174118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 03/03/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction Severe right ventricular hypertrophy (SRVH) is a rare phenotype in hypertrophic cardiomyopathy (HCM) for which limited information is available. This study was undertaken to investigate the clinical, prognostic and genetic characteristics of HCM patients with SRVH. Methods HCM with SRVH was defined as HCM with a maximum right ventricular wall thickness ≥10 mm. Whole-genome sequencing (WGS) was performed in HCM patients with SRVH. Multivariate Cox proportional hazards regression models were used to identify risk factors for cardiac death and events in HCM with SRVH. Patients with apical hypertrophic cardiomyopathy (ApHCM) were selected as a comparison group. The clinical features and outcomes of 34 HCM patients with SRVH and 273 ApHCM patients were compared. Results Compared with the ApHCM group, the HCM with SRVH group included younger patients and a higher proportion of female patients and also displayed higher cardiovascular morbidity and mortality. The multivariate Cox proportional hazards regression models identified 2 independent predictors of cardiovascular death in HCM patients with SRVH, a New York Heart Association class ≥III (hazard ratio [HR] = 8.7, 95% confidence interval (CI): 1.43-52.87, p = 0.019) and an age at the time of HCM diagnosis ≤18 (HR = 5.5, 95% CI: 1.24-28.36, p = 0.026). Among the 11 HCM patients with SRVH who underwent WGS, 10 (90.9%) were identified as carriers of at least one specific sarcomere gene mutation. MYH7 and TTN mutations were the most common sarcomere mutations noted in this study. Two or more HCM-related gene mutations were observed in 9 (82%) patients, and mutations in either other cardiomyopathy-related genes or ion-channel disease-related genes were found in 8 (73%) patients. Conclusions HCM patients with SRVH were characterized by poor clinical outcomes and the presentation of multiple gene mutations.
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Affiliation(s)
- Xiying Guo
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaomei Fan
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (CMF); (LT)
| | - Lei Tian
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (CMF); (LT)
| | - Yanling Liu
- Department of Ultrasound, Fuwai Hospital, Beijing, China
| | - Hongyue Wang
- Department of Pathology, Fuwai Hospital, Beijing, China
| | - Shihua Zhao
- Department of Radiology, Fuwai Hospital, Beijing, China
| | - Fujian Duan
- Department of Ultrasound, Fuwai Hospital, Beijing, China
| | - Xiuling Zhang
- Department of Cardiology, Anqiu Chinese Medicine Hospital, Anqiu, China
| | - Xing Zhao
- Department of Cardiology, Heze Zone Central Hospital, Heze, China
| | - Fengqi Wang
- Department of Cardiology, Zhecheng People’s Hospital, Zhecheng, China
| | - Hongguang Zhu
- Department of Cardiology, The Harbor Hospital of Yantai, Yantai, China
| | - Aiqing Lin
- Department of Cardiology, Muping District Chinese Medicine Hospital of Yantai, Yantai, China
| | - Xia Wu
- Department of Cardiology, Laiwu Central Hospital, Laiwu, China
| | - Yishi Li
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Abdelsalam MA, Geske JB. 77-year-old female with syncope. BRITISH HEART JOURNAL 2017; 103:315. [DOI: 10.1136/heartjnl-2016-310250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Baxi AJ, Restrepo CS, Vargas D, Marmol-Velez A, Ocazionez D, Murillo H. Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and Management. Radiographics 2017; 36:335-54. [PMID: 26963450 DOI: 10.1148/rg.2016150137] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a heterogeneous group of diseases related to sarcomere gene mutations exhibiting heterogeneous phenotypes with an autosomal dominant mendelian pattern of inheritance. The disorder is characterized by diverse phenotypic expressions and variable natural progression, which may range from dyspnea and/or syncope to sudden cardiac death. It is found across all racial groups and is associated with left ventricular hypertrophy in the absence of another systemic or cardiac disease. The management of HCM is based on a thorough understanding of the underlying morphology, pathophysiology, and clinical course. Imaging findings of HCM mirror the variable expressivity and penetrance heterogeneity, with the added advantage of diagnosis even in cases where a specific mutation may not yet be found. The diagnostic information obtained from imaging varies depending on the specific stage of HCM-phenotype manifestation, including the prehypertrophic, hypertrophic, and later stages of adverse remodeling into the burned-out phase of overt heart failure. However, subtle or obvious, these imaging findings become critical components in diagnosis, management, and follow-up of HCM patients. Although diagnosis of HCM traditionally relies on clinical assessment and transthoracic echocardiography, recent studies have demonstrated increased utility of multidetector computed tomography (CT) and particularly cardiac magnetic resonance (MR) imaging in diagnosis, phenotype differentiation, therapeutic planning, and prognostication. In this article, we provide an overview of the genetics, pathophysiology, and clinical manifestations of HCM, with the spectrum of imaging findings at MR imaging and CT and their contribution in diagnosis, risk stratification, and therapy.
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Affiliation(s)
- Ameya Jagdish Baxi
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Carlos S Restrepo
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Daniel Vargas
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Alejandro Marmol-Velez
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Daniel Ocazionez
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Horacio Murillo
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
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Niwa R, Hasumi E, Fujiu K, Uehara M, Nitta D, Hatano M, Akazawa H, Watanabe M, Komuro I. A Case of Multiple Coronary Artery-Left Ventricular Micro Fistulae Complicated With Hepatic Arteriovenous Fistulae. Int Heart J 2016; 57:123-6. [DOI: 10.1536/ihj.15-263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ryoko Niwa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Kastuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Vucicevic D, Lester SJ, Appleton CP, Panse PM, Schleifer JW, Wilansky S. The Incremental Value of Magnetic Resonance Imaging for Identification of Apical Pouch in Patients with Apical Variant of Hypertrophic Cardiomyopathy. Echocardiography 2015; 33:572-8. [DOI: 10.1111/echo.13118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Darko Vucicevic
- Division of Cardiovascular Diseases; Mayo Clinic; Scottsdale Arizona
| | - Steven J. Lester
- Division of Cardiovascular Diseases; Mayo Clinic; Scottsdale Arizona
| | | | | | | | - Susan Wilansky
- Division of Cardiovascular Diseases; Mayo Clinic; Scottsdale Arizona
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14
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Successful prediction of MACE by myocardial fibrosis on CT in hypertrophic cardiomyopathy patients without obstructed coronary arteries. Int J Cardiol 2015; 199:34-7. [DOI: 10.1016/j.ijcard.2015.06.139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/27/2015] [Indexed: 11/17/2022]
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15
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Ozawa K, Funabashi N, Takaoka H, Kamata T, Kanaeda A, Saito M, Nomura F, Kobayashi Y. Characteristic myocardial strain identified in hypertrophic cardiomyopathy subjects with preserved left ventricular ejection fraction using a novel multi-layer transthoracic echocardiography technique. Int J Cardiol 2015; 184:237-243. [PMID: 25723651 DOI: 10.1016/j.ijcard.2015.01.070] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/22/2014] [Accepted: 01/26/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE In order to evaluate compensatory mechanisms in hypertrophic-cardiomyopathy (HCM) subjects with preserved left-ventricular (LV) ejection-fraction (EF), we measured myocardial percentage endocardial strain dependency, as represented by 2D LV global longitudinal (GLS) and circumferential-strain (GCS), using a novel, multi-layer, speckle-tracking transthoracic-echocardiography (TTE) technique. METHODS A total of 60 subjects (40 HCM with preserved LV EF (30 male; 62 ± 15 years, all LV EF>50%)) and 20 controls (10 male; 59 ± 10 years) underwent TTE (Vivid-E9). Quantitative strain-measurements of: endocardial, all and epicardial layers were performed at each-site. We defined percentage endocardial strain dependency as the ratio of endocardial strain to epicardial strain. RESULTS Absolute GLS values at all views in all, endocardial and epicardial myocardial layers were significantly smaller in HCM subjects than in controls (all P<0.001). There were no significant differences between both-groups in absolute GCS values in the endocardial layers, at the mitral valve and papillary muscle levels. Percentage endocardial GCS dependency at all levels were greater in HCM subjects than in controls (all P<0.01). In HCM subjects, percentage endocardial GCS dependency at the mitral valve and papillary muscle levels revealed significant, moderate, negative correlations with LV end-diastolic and systolic dimensions (correlation coefficients -0.505, -0.451 (mitral valve level) and -0.533, -0.591 (papillary muscle level), respectively). CONCLUSIONS In HCM subjects with preserved LV EF, 2D LV GLS was lower than in controls, but endocardial GCS was maintained in compensation for reduction in endocardial GLS; thus percentage endocardial GCS dependency may increase, and the larger the LV size, the smaller this compensatory effect.
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Affiliation(s)
- Koya Ozawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
| | - Nobusada Funabashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
| | - Tomoko Kamata
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
| | - Akiyo Kanaeda
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
| | - Mariko Saito
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
| | - Fumio Nomura
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
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16
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An Atypical Case of Apical Hypertrophic Cardiomyopathy: Absence of Giant T Waves in spite of Extreme Apical Wall Hypertrophy. Case Rep Cardiol 2015; 2015:980971. [PMID: 26779351 PMCID: PMC4686669 DOI: 10.1155/2015/980971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022] Open
Abstract
Apical hypertrophic cardiomyopathy is an uncommon variant of hypertrophic cardiomyopathy, with hypertrophy mainly affecting the apex of the left ventricle. We hereby describe a case of an octogenarian female patient who was randomly diagnosed with AHCM due to other comorbidities.
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Hoey ET, Elassaly M, Ganeshan A, Watkin RW, Simpson H. The role of magnetic resonance imaging in hypertrophic cardiomyopathy. Quant Imaging Med Surg 2014; 4:397-406. [PMID: 25392824 PMCID: PMC4213427 DOI: 10.3978/j.issn.2223-4292.2014.09.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 12/21/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inheritable cardiac disorder, with an estimated prevalence of 1:500 in the general population. Most cases of HCM are phenotypically expressed in adolescence or early adulthood but age-related penetrance with certain phenotypes is increasingly recognized. Clinical manifestations of HCM are usually the result of systolic and/or diastolic dysfunction, left ventricular outflow tract (LVOT) obstruction, arrhythmias and sudden cardiac death (SCD). In recent years magnetic resonance imaging (MRI) has become established as an important tool for the evaluation of suspected HCM as it can reliably establish the diagnosis, help distinguish HCM from other causes of left ventricular hypertrophy (LVH) and identify those patients at greatest risk of SCD. This article reviews the current status of MRI in the evaluation of the HCM patient including imaging protocols, disease characterization and the emerging role of MRI for risk stratification and proband screening.
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