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Malcolmson JW, Hughes RK, Husselbury T, Khan K, Learoyd AE, Lees M, Wicks EC, Smith J, Simms AD, Moon JC, Lopes LR, O'Mahony C, Sekhri N, Elliott PM, Petersen SE, Dhinoja MB, Mohiddin SA. Distal Ventricular Pacing for Drug-Refractory Mid-Cavity Obstructive Hypertrophic Cardiomyopathy: A Randomized, Placebo-Controlled Trial of Personalized Pacing. Circ Arrhythm Electrophysiol 2024; 17:e012570. [PMID: 39012930 DOI: 10.1161/circep.123.012570] [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: 12/15/2023] [Accepted: 05/14/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Patients with refractory, symptomatic left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy have few therapeutic options. Right ventricular pacing is associated with modest hemodynamic and symptomatic improvement, and LV pacing pilot data suggest therapeutic potential. We hypothesized that site-specific pacing would reduce LVMCO gradients and improve symptoms. METHODS Patients with symptomatic-drug-refractory LVMCO were recruited for a randomized, blinded trial of personalized prescription of pacing (PPoP). Multiple LV and apical right ventricular pacing sites were assessed during an invasive hemodynamic study of multisite pacing. Patient-specific pacing-site and atrioventricular delays, defining PPoP, were selected on the basis of LVMCO gradient reduction and acceptable pacing parameters. Patients were randomized to 6 months of active PPoP or backup pacing in a crossover design. The primary outcome examined invasive gradient change with best-site pacing. Secondary outcomes assessed quality of life and exercise following randomization to PPoP. RESULTS A total of 17 patients were recruited; 16 of whom met primary end points. Baseline New York Heart Association was 3±0.6, despite optimal medical therapy. Hemodynamic effects were assessed during pacing at the right ventricular apex and at a mean of 8 LV sites. The gradients in all 16 patients fell with pacing, with maximum gradient reduction achieved via LV pacing in 14 (88%) patients and right ventricular apex in 2. The mean baseline gradient of 80±29 mm Hg fell to 31±21 mm Hg with best-site pacing, a 60% reduction (P<0.0001). One cardiac vein perforation occurred in 1 case, and 15 subjects entered crossover; 2 withdrawals occurred during crossover. Of the 13 completing crossover, 9 (69%) chose active pacing in PPoP configuration as preferred setting. PPoP was associated with improved 6-minute walking test performance (328.5±99.9 versus 285.8±105.5 m; P=0.018); other outcome measures also indicated benefit with PPoP. CONCLUSIONS In a randomized placebo-controlled trial, PPoP reduces obstruction and improves exercise performance in severely symptomatic patients with LVMCO. REGISTRATION URL: https://clinicaltrials.gov/study; Unique Identifier: NCT03450252.
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Affiliation(s)
- James W Malcolmson
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)
| | - Rebecca K Hughes
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)
| | - Tim Husselbury
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
| | - Kamran Khan
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)
| | - Annastazia E Learoyd
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)
| | - Martin Lees
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
| | - Eleanor C Wicks
- Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)
- Inherited Cardiovascular Diseases Unit, John Radcliffe Hospital, London, United Kingdom (E.C.W.)
| | - Jamie Smith
- Raigmore Hospital, NHS Highland, Inverness, United Kingdom (J.S.)
| | - Alexander D Simms
- Yorkshire Heart Centre, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom (A.D.S.)
| | - James C Moon
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)
| | - Luis R Lopes
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)
| | - Constantinos O'Mahony
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)
| | - Neha Sekhri
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
| | - Perry M Elliott
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)
| | - Steffen E Petersen
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)
- Health Data Research UK, London (S.E.P.)
| | - Mehul B Dhinoja
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
| | - Saidi A Mohiddin
- Barts Heart Center, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)
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2
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Abraham MR, Abraham TP. Role of Imaging in the Diagnosis, Evaluation, and Management of Hypertrophic Cardiomyopathy. Am J Cardiol 2024; 212S:S14-S32. [PMID: 38368033 DOI: 10.1016/j.amjcard.2023.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is increasingly recognized and may benefit from the recent approval of new, targeted medical therapy. Successful management of HCM is dependent on early and accurate diagnosis. The lack of a definitive diagnostic test, the wide variation in phenotype and the commonness of phenocopy conditions, and the presence of normal or hyperdynamic left ventricular function in most patients makes HCM a condition that is highly dependent on imaging for all aspects of management including, diagnosis, classification, predicting risk of complications, detecting complications, identifying risk for ventricular arrhythmias, evaluating choice of therapy and monitoring therapy, intraprocedural guidance, and screening family members. Although echocardiographic imaging remains the mainstay in the diagnosis and subsequent management of HCM, this disease clearly requires multimethod imaging for various aspects of optimal patient care. Advances in echocardiography hardware and techniques, development and refinement of imaging with computed tomography, magnetic resonance, and nuclear scanning, and the emergence of very focused assessments such as diastology and fibrosis imaging have all advanced the diagnosis and management of HCM. In this review, we discuss the relative utility and evidence support for these imaging approaches to contribute to improve patient outcomes.
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Affiliation(s)
- Maria Roselle Abraham
- UCSF Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Theodore P Abraham
- UCSF Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California.
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3
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Mitchell CC, Frye C, Jankowski M, Symanski J, Lester SJ, Woo A, Gilliland Y, Dragulescu A, Abraham T, Desai M, Martinez MW, Nagueh SF, Phelan D. A Practical Approach to Echocardiographic Imaging in Patients With Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:913-932. [PMID: 37160197 DOI: 10.1016/j.echo.2023.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is frequently unrecognized or misdiagnosed. The recently published consensus recommendations from the American Society of Echocardiography provided recommendations for the utilization of multimodality imaging in the care of patients with HCM. This document provides an additional practical framework for optimal image and measurement acquisition and guidance on how to tailor the echocardiography examination for individuals with HCM. It also provides resources for physicians and sonographers to use to develop HCM imaging protocols.
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Affiliation(s)
- Carol C Mitchell
- School of Medicine and Public Health Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Cody Frye
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Madeline Jankowski
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - John Symanski
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | | | - Anna Woo
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina.
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Lo Russo GV, Pepi M, Mushtaq S, Mantegazza V, Celeste F. Is There a Typical Doppler Pattern in Patients With Apical Hypertrophic Cardiomyopathy With Aneurysm? JACC Case Rep 2023; 14:101836. [PMID: 37152703 PMCID: PMC10157147 DOI: 10.1016/j.jaccas.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/26/2023] [Accepted: 03/01/2023] [Indexed: 05/09/2023]
Abstract
Nineteen consecutive patients with apical hypertrophic cardiomyopathy and apical aneurysm underwent a comprehensive echo-Doppler including continuous wave Doppler at midventricular level. Three different flow patterns, pattern A (more frequent), pattern B, and pattern C, and expression of different intracavitary pressure gradients were defined. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Gerardo Vito Lo Russo
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Address for correspondence: Dr Gerardo Vito Lo Russo, Centro Cardiologico Fondazione Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, Milan 20138, Italy.
| | - Mauro Pepi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Valentina Mantegazza
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Fabrizio Celeste
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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5
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Lee M, Shechter A, Han D, Nguyen LC, Kim MS, Berman DS, Rader F, Siegel RJ. Left ventricular morphologic progression in apical hypertrophic cardiomyopathy. Int J Cardiol 2023; 381:62-69. [PMID: 37028709 DOI: 10.1016/j.ijcard.2023.04.006] [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] [Received: 12/27/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Left ventricular (LV) morphologic progression in apical hypertrophic cardiomyopathy (AHC) has not been well studied. We evaluated serial echocardiographic changes in LV morphology. METHODS Serial echocardiograms in AHC patients were assessed. LV morphology was categorized according to the presence of an apical pouch or aneurysm, and LV hypertrophic severity and extent; relative, pure, and apical-mid type defined as mild (<15 mm thickness) apical hypertrophy, significant (≥15 mm) apical hypertrophy, and both apical and midventricular hypertrophy, respectively. Adverse clinical events and late gadolinium enhancement (LGE) extent on cardiac magnetic resonance were evaluated for each morphologic type. RESULTS In 41 patients, 165 echocardiograms (maximal interval: 4.2 [IQR, 2.3-11.8] years) were evaluated. Morphologic changes were observed in 19 (46%) patients. Eleven (27%) patients displayed the progression of LV hypertrophy toward pure or apical-mid type. Five (12%) and 6 (15%) patients developed new pouches and aneurysms. Patients with progression tended to be younger (50 ± 15.6 vs 59 ± 14.4 years, P = 0.058) and had a longer period of follow-up (12 [5-14] vs 3 [2-4] years, P < 0.001). During a follow-up of 7.6 (IQR 3.0-12.1) years, 21 (51%) experienced clinical events. The relative, pure, and apical-mid types showed different LGE extents (2%, 6%, and 19%, P = 0.004). Patients with severe hypertrophic and apical involvement showed higher clinical event rates. CONCLUSIONS About half of AHC patients had a progression of LV morphology to more hypertrophic involvement and/or an apical pouch or aneurysm formation. Advanced AHC morphologic types were associated with higher event rates and scar burdens.
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Affiliation(s)
- Mirae Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alon Shechter
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Israel; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Long-Co Nguyen
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Min Sun Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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6
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Sherrid MV, Bernard S, Tripathi N, Patel Y, Modi V, Axel L, Talebi S, Ghoshhajra BB, Sanborn DY, Saric M, Adlestein E, Alvarez IC, Xia Y, Swistel DG, Massera D, Fifer MA, Kim B. Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2023; 16:591-605. [PMID: 36681586 DOI: 10.1016/j.jcmg.2022.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Apical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. OBJECTIVES The authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. METHODS The authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). RESULTS There were 108 patients with a mean age of 57.4 ± 13.5 years; 40 (37%) were women. One hundred three aneurysm patients (95%) had mid-LV obstruction with mid-LV complete systolic emptying. Of the patients with obstruction, 84% had a midsystolic Doppler signal void, a marker of complete flow cessation, but only 19% had Doppler systolic gradients ≥30 mm Hg. Five patients (5%) had relative hypokinesia in mid-LV without obstruction. Aneurysm size is not bimodal but appears distributed by power law, with large aneurysms decidedly less common. Comparing mid-LV obstruction aneurysm patients with all control groups, the short-axis (SAX) systolic areas were smaller (P < 0.007), the percent SAX area change was greater (P < 0.005), the papillary muscle (PM) areas were larger (P < 0.003), and the diastolic PM areas/SAX diastolic areas were greater (P < 0.005). Patients with aneurysms had 22% greater SAX PM areas compared with those with elevated LV velocities but no aneurysms (median: 3.00 cm2 [IQR: 2.38-3.70 cm2] vs 2.45 [IQR: 1.81-2.95 cm2]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. CONCLUSIONS The great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted.
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Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA.
| | - Samuel Bernard
- Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Nidhi Tripathi
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Yash Patel
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Vivek Modi
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Leon Axel
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Soheila Talebi
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danita Y Sanborn
- Echocardiography Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Muhamed Saric
- Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Elizabeth Adlestein
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Isabel Castro Alvarez
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Yuhe Xia
- Division of Biostatistics, New York University Langone Health, New York, New York, USA
| | - Daniel G Swistel
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Michael A Fifer
- Hypertrophic Cardiomyopathy Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bette Kim
- Echocardiography Laboratory and Cardiomyopathy Program, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
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Wengrofsky P, Akivis Y, Bukharovich I. Cardiac Multimodality Imaging in Hypertrophic Cardiomyopathy: What to Look for and When to Image. Curr Cardiol Rev 2023; 19:1-18. [PMID: 36927425 PMCID: PMC10518881 DOI: 10.2174/1573403x19666230316103117] [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: 12/02/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM), now recognized as a common cardiomyopathy of complex genomics and pathophysiology, is defined by the presence of left ventricular hypertrophy of various morphologies and severity, significant hemodynamic consequences, and diverse phenotypic, both structural and clinical, profiles. Advancements in cardiac multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, with and without angiography have greatly improved the diagnosis of HCM, and enable precise measurements of cardiac mass, volume, wall thickness, function, and physiology. Multimodality imaging provides comprehensive and complementary information and hasemerged as the bedrock for the diagnosis, clinical assessment, serial monitoring, and sudden cardiac death risk stratification of patients with HCM. This review highlights the role of cardiac multimodality imaging in the modern diagnosis and management of HCM.
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Affiliation(s)
- Perry Wengrofsky
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Yonatan Akivis
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Inna Bukharovich
- Division of Cardiology, Department of Medicine, NYC Health and & Hospitals, Kings County, Brooklyn, NY 11203, USA
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8
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Strachinaru M, Huurman R, Bowen DJ, Schinkel AFL, Hirsch A, Michels M. Relation Between Early Diastolic Mid-Ventricular Flow and Elastic Forces Indicating Aneurysm Formation in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2022; 35:846-856.e2. [PMID: 35489541 DOI: 10.1016/j.echo.2022.04.010] [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: 11/15/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The early diastolic paradoxical mid-ventricular flow (EDF) is suggestive of apical aneurysm (AA) formation in hypertrophic cardiomyopathy (HCM). We aimed to determine whether EDF may be a useful screening tool in patients, following the time progression of HCM to the aneurysmal stage. METHODS 121 HCM patients with dominant hypertrophy in the mid and apical segments, based on echocardiography and/or cardiovascular magnetic resonance (CMR), were selected from our HCM database comprising 1332 patients. They were further stratified according to the presence of AA. All imaging studies in a period of 16 years (2005-2021) were considered for time progression. Mid-ventricular Doppler (PW, CW, color and color M-mode) were analyzed. RESULTS 35 patients (29% of the study group and 2.6% of all HCM patients) had AA. EDF had a sensitivity of 92% and specificity of 98.6% for the detection of AA in the study group. In 108 patients follow-up echocardiography was performed (median 5 [3-9] studies). Sixteen patients (15%), with 10 [7-12] years follow-up, displayed progressive time changes in LV apical morphology and/or mid-LV flow. Ten patients (9%) progressed to an AA, during 7 [4-11] years follow-up. Patients progressing to AA were younger (p=0.009), with more severe LV hypertrophy (p=0.01) and more often a significant mid-LV systolic gradient (≥ 30mmHg, p<0.001). A wall thickness over 20mm had 70% sensitivity and 69% specificity in detecting evolution towards AA. With significant systolic gradient, sensitivity was 80% and specificity 62%. Furthermore, patients with AA had higher incidence of ventricular tachycardia (Log-rank p=0.03). CONCLUSION EDF reliably detects AA presence and should prompt for extra imaging studies. In HCM with mid and apical dominant involvement there is a progressive trend towards aneurysm formation, especially in patients with wall thickness over 20mm and significant mid-LV systolic gradient (≥30mmHg), which can be monitored through serial Doppler studies.
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Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Roy Huurman
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Daniel J Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology and Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Arabadjian ME, Reuter MC, Stepanovic A, Sherrid MV, Massera D. COVID-19 in Adults With Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2021; 8:745790. [PMID: 34859067 PMCID: PMC8630625 DOI: 10.3389/fcvm.2021.745790] [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: 07/22/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Individuals with cardiovascular disease are considered high risk for severe COVID-19. However, the clinical impact of COVID-19 in patients with hypertrophic cardiomyopathy (HCM) is unknown. The purpose of this study was to describe the clinical course and outcomes of COVID-19 in patients with HCM. Methods: This retrospective observational study included adults with HCM and positive PCR/antibody test for SARS-CoV-2 at a large urban hospital system in the New York from January, 2020 to January, 2021. Results: Seventy individuals were included, with a mean (SD) age of 60.1 (15.1) years, 39 (55.7%) of whom were male, and 42 (60%) white. Forty-five (65.3%) patients had obstructive HCM. Hypertension and obesity (BMI ≥ 30) were present in 45 (64.3%) and 37 (52.9%) patients, and the prevalence of atrial fibrillation, obstructive sleep apnea and diabetes was high. Common symptoms of COVID-19 were fever, cough, shortness of breath and fatigue, affecting 33 (47.1%), 33 (47.1%), 28 (40.0%), and 28 (40.0%) patients, respectively. Fourteen (20%) patients were hospitalized. The majority (45 [64.3%] patients) recovered without intervention. Two patients had non-fatal pulmonary embolisms, 1 had atrial fibrillation requiring electrical cardioversion and 1 had acute decompensated heart failure. Three (4.3%) patients required mechanical ventilation, two of whom died (case fatality rate 2.9%). A total of 15 (21.4%) patients were asymptomatic. Conclusions: Our data suggest that in this diverse and high-risk group of patients with HCM, established risk factors for severe COVID-19, such as obesity, may be more important drivers of morbidity and mortality than the presence of HCM alone.
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Affiliation(s)
- Milla E Arabadjian
- New York University Rory Meyers College of Nursing, New York, NY, United States
| | - Maria C Reuter
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Alexandra Stepanovic
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
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Leistman SC, Melaragno JI, Dokus MK, Martens JA, Salter MA, Hutchinson DJ, Hernandez-Alejandro R, Al-Judaibi B, Nickels MW. The Rochester Relapse Risk Scale: Developing a Standardized Approach to Predicting Substance Relapse in Liver Transplant Candidates. EXP CLIN TRANSPLANT 2021; 19:919-927. [PMID: 34545777 DOI: 10.6002/ect.2021.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Substance abuse is a risk factor for nonadherence and graft failure after orthotopic liver transplant. This study aimed to evaluate the ability of an internally developed tool, the Rochester Relapse Risk Scale, to predict substance relapse in liver transplant candidates. MATERIALS AND METHODS This single-center, retrospective, observational study included adult patients evaluated for orthotopic liver transplant using the Rochester Relapse Risk Scale. Primary outcome was rate of substance relapse, as measured by the risk scale, which stratified patients into relapse risk levels based on the number of factors present. RESULTS In total, 303 patients (71.6% men, 90.4% White, median age of 55 years [interquartile range, 49-60 y]) were included. Median follow-up time was 212 days (interquartile range, 73-661 d). Seventy-four patients (24.4%) relapsed at 127 days (interquartile range, 55-461 d) after evaluation, with 60.8% who relapsed within 6 months. Relapse rates correlated with assigned risk level, with 8.3% relapsing at low, 19.0% at low-moderate, 25.3% at moderate, 33.8% at moderate-high, and 40.0% at high risk. High-risk cohorts had significantly shorter median time to relapse versus low-risk cohorts (104 vs 154 days; P = .001). CONCLUSIONS Assignment of relapse risk level according to the Rochester Relapse Risk Scale aligned with rates of relapse. Additional studies are needed to refine the tool, assess inter-rater reliability, and confirm findings in prospective, multicenter studies.
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Affiliation(s)
- Samantha C Leistman
- From the Department of Pharmacy, University of Rochester Medical Center, Rochester, USA
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11
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Yang K, Song YY, Chen XY, Wang JX, Li L, Yin G, Zheng YC, Wei MD, Lu MJ, Zhao SH. Apical hypertrophic cardiomyopathy with left ventricular apical aneurysm: prevalence, cardiac magnetic resonance characteristics, and prognosis. Eur Heart J Cardiovasc Imaging 2020; 21:1341-1350. [PMID: 32888301 DOI: 10.1093/ehjci/jeaa246] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 08/08/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
Hypertrophic cardiomyopathy (HCM) with left ventricular apical aneurysm (LVAA) is associated with an increased risk of adverse cardiovascular events. However, the clinical significance of LVAA in apical HCM (ApHCM) has not been reported. This study aimed to investigate the prevalence, cardiac magnetic resonance (CMR) characteristics, and prognosis of LVAA in ApHCM patients.
Methods and results
A total of 1332 consecutive ApHCM patients confirmed by CMR in our hospital were retrospectively analysed. LVAAs were identified in 31 patients of all ApHCM patients (2.3%, 31/1332). Besides, 31 age- and gender-matched ApHCM patients without LVAA were used for comparison. Of the 31 aneurysm patients (mean age, 53.8 ± 15.1 years old), 28 (90.3%) had clinical symptoms, and 3 (9.7%) had a family history of HCM. The rate of missed diagnosis of echocardiography for detecting LVAA was 64.5% (20/31), most (90%, 18/20) of unidentified LVAAs by echocardiography were small aneurysms (<20 mm). Compared with ApHCM patients without LVAA, the proportion of systolic mid-cavity obstruction and late gadolinium enhancement (LGE) presence, and the LGE extent in ApHCM patients with LVAA were significantly higher (all P<0.05). The Kaplan–Meier curves showed that the event-free survival rate in ApHCM patients with LVAA was significantly lower than that in ApHCM patients without LVAA (log rank, P = 0.010).
Conclusion
ApHCM with LVAA is a very rare condition, which is often missed by echocardiography and could be reliably detected with CMR and is associated with a higher risk of adverse cardiovascular events compared with ApHCM without LVAA.
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Affiliation(s)
- Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Yan-Yan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Xiu-Yu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Jia-Xin Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Lu Li
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Gang Yin
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Yu-Cong Zheng
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Meng-Die Wei
- Department of Radiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road No.33, Shijingshan District, Beijing 100144, China
| | - Min-Jie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Shi-Hua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
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Sherrid MV, Massera D. Risk Stratification and Hypertrophic Cardiomyopathy Subtypes. J Am Coll Cardiol 2020; 74:2346-2349. [PMID: 31699274 DOI: 10.1016/j.jacc.2019.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
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Sherrid MV, Riedy K, Rosenzweig B, Ahluwalia M, Arabadjian M, Saric M, Balaram S, Swistel DG, Reynolds HR, Kim B. Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning. Echocardiography 2018; 36:47-60. [PMID: 30548699 DOI: 10.1111/echo.14212] [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: 08/08/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Acute left ventricular (LV) apical ballooning with normal coronary angiography occurs rarely in obstructive hypertrophic cardiomyopathy (OHCM); it may be associated with severe hemodynamic instability. METHODS, RESULTS We searched for acute LV ballooning with apical hypokinesia/akinesia in databases of two HCM treatment programs. Diagnosis of OHCM was made by conventional criteria of LV hypertrophy in the absence of a clinical cause for hypertrophy and mitral-septal contact. Among 1519 patients, we observed acute LV ballooning in 13 (0.9%), associated with dynamic left ventricular outflow tract (LVOT) obstruction and high gradients, 92 ± 37 mm Hg, 10 female (77%), age 64 ± 7 years, LVEF 31.6 ± 10%. Septal hypertrophy was mild compared to that of the rest of our HCM cohort, 15 vs 20 mm (P < 0.00001). An elongated anterior mitral leaflet or anteriorly displaced papillary muscles occurred in 77%. Course was complicated by cardiogenic shock and heart failure in 5, and refractory heart failure in 1. High-dose beta-blockade was the mainstay of therapy. Three patients required urgent surgical relief of LVOT obstruction, 2 for refractory cardiogenic shock, and one for refractory heart failure. In the three patients, surgery immediately normalized refractory severe LV dysfunction, and immediately reversed cardiogenic shock and heart failure. All have normal LV systolic function at 45-month follow-up, and all have survived. CONCLUSIONS Acute LV apical ballooning, associated with high dynamic LVOT gradients, may punctuate the course of obstructive HCM. The syndrome is important to recognize on echocardiography because it may be associated with profound reversible LV decompensation.
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Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Katherine Riedy
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Barry Rosenzweig
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Monica Ahluwalia
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Milla Arabadjian
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Muhamed Saric
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Sandhya Balaram
- Mount Sinai St. Luke's, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Daniel G Swistel
- Hypertrophic Cardiomyopathy Program, Division of Cardiac Surgery, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Harmony R Reynolds
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York
| | - Bette Kim
- Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, New York
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Elsheshtawy MO, Mahmoud AN, Abdelghany M, Suen IH, Sadiq A, Shani J. Left ventricular aneurysms in hypertrophic cardiomyopathy with midventricular obstruction: A systematic review of literature. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:854-865. [PMID: 29786883 DOI: 10.1111/pace.13380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/11/2018] [Accepted: 05/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) with or without left ventricular apical aneurysm (LVA) had been studied in the past. Midventricular obstruction associated with HCM and LVA is a unique entity that has not been distinguished previously as a separate phenotypic disease in HCM patients. METHODS A systematic review of Pubmed and Google Scholar was conducted from inception until September 2017 for all observational studies conducted on HCM with midventricular obstruction and LVA. RESULTS A total of 94 patients from 39 studies were included in our analysis. The mean age of the patients was 58.05 ± 11.76 years with 59.6% being males. The most common electrocardiographic finding was T wave inversion occurring in 13.8% of the cases followed by ST elevation (9.5%). Maximal left ventricle (LV) wall thickness was reported 18.89 ± 5.19 mm on transthoracic echocardiography and paradoxical jet flow was detected in 29.8% of patients. Beta-blockers (58.5%) were the most common drug therapy at baseline and amiodarone (10.6%) was the most common antiarrhythmic used for ventricular tachycardia (VT). The most common complication, VT, occurred in 39.3% of cases and the incidence of all-cause mortality was 13.8 % over 16 ± 20.1 months follow-up. Implantable cardioverter defibrillator (ICD) was used in 37.2% of patients; 25.7% of patients with ICD received appropriate shock therapy. CONCLUSION HCM with LVA and midventricular obstruction is a unique entity that appears to be associated with high incidence of morbidity and mortality. Thus, early diagnosis and therapeutic intervention is recommended for management of this condition.
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Affiliation(s)
- Moustafa O Elsheshtawy
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA.,Division of Cardiovascular Medicine, Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Mahmoud Abdelghany
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Ida H Suen
- Division of Cardiovascular Medicine, Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Adnan Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jacob Shani
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Intraoperative Two- and Three-Dimensional Transesophageal Echocardiography in Combined Myectomy-Mitral Operations for Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2018; 31:275-288. [DOI: 10.1016/j.echo.2017.11.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Indexed: 11/18/2022]
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16
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Maron BJ, Maron MS. The Remarkable 50 Years of Imaging in HCM and How it Has Changed Diagnosis and Management: From M-Mode Echocardiography to CMR. JACC Cardiovasc Imaging 2017; 9:858-872. [PMID: 27388665 DOI: 10.1016/j.jcmg.2016.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/02/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
The almost 50-year odyssey of cardiac imaging in hypertrophic cardiomyopathy (HCM), revisited and described here, has been remarkable, particularly when viewed in the timeline of advances that occurred during a single generation of investigators. At each step along the way, from M-mode to 2-dimensional echocardiography to Doppler imaging, and finally over the last 10 years with the emergence of high-resolution tomographic cardiac magnetic resonance (CMR), evolution of the images generated by each new technology constituted a paradigm change over what was previously available. Together, these advances have transformed the noninvasive diagnosis and management of HCM in a number of important clinical respects. These changes include a more complete definition of the phenotype, resulting in more reliable clinical identification of patients and family members, defining mechanisms (and magnitude) of left ventricular outflow obstruction, and novel myocardial tissue characterization (including in vivo detection of fibrosis/scarring); notably, these advances afford more precise recognition of at-risk patients who are potential candidates for life-saving primary prevention defibrillator therapy. This evolution in imaging as applied to HCM has indelibly changed cardiovascular practice for this morphologically and clinically complex genetic disease.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Division of Cardiology, Boston, Massachusetts.
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Division of Cardiology, Boston, Massachusetts
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Pacelli F, Rapacciuolo A, Giamundo A, Canciello G, Franzone A, Imbriaco M, Trimarco B, Losi MA. Left ventricular diastolic gradient in hypertrophic cardiomyopathy. IJC HEART & VASCULATURE 2017; 14:20-22. [PMID: 28616558 PMCID: PMC5454169 DOI: 10.1016/j.ijcha.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Maria-Angela Losi
- Corresponding author at: Dpt of Advanced Biomedical Sciences, University Federico II of Naples, I-80131 Naples, Italy.Dpt of Advanced Biomedical SciencesUniversity Federico II of NaplesNaplesI-80131Italy
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Silbiger JJ. Abnormalities of the Mitral Apparatus in Hypertrophic Cardiomyopathy: Echocardiographic, Pathophysiologic, and Surgical Insights. J Am Soc Echocardiogr 2016; 29:622-39. [DOI: 10.1016/j.echo.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/30/2022]
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