2
|
Limongelli G, Monda E, Tramonte S, Gragnano F, Masarone D, Frisso G, Esposito A, Gravino R, Ammendola E, Salerno G, Rubino M, Caiazza M, Russo M, Calabrò P, Elliott PM, Pacileo G. Prevalence and clinical significance of red flags in patients with hypertrophic cardiomyopathy. Int J Cardiol 2019; 299:186-191. [PMID: 31303393 DOI: 10.1016/j.ijcard.2019.06.073] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We sought to determine prevalence and predictive accuracy of clinical markers (red flags, RF), known to be associated with specific systemic disease in a consecutive cohort of patients with hypertrophic cardiomyopathy (HCM). METHODS We studied 129 consecutive patients (23.7 ± 20.9 years, range 0-74 years; male/female 68%/32%). Pre-specified RF were categorized into five domains: family history; signs/symptoms; electrocardiography; imaging; and laboratory. Sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and predictive accuracy of RF were analyzed in the genotyped population. RESULTS In the overall cohort of 129 patients, 169 RF were identified in 62 patients (48%). Prevalence of RF was higher in infants (78%) and in adults >55 years old (58%). Following targeted genetic and clinical evaluation, 94 patients (74%) had a definite diagnosis (sarcomeric HCM or specific causes of HCM). We observed 14 RF in 13 patients (21%) with sarcomeric gene disease, 129 RF in 34 patients (97%) with other specific causes of HCM, and 26 RF in 15 patients (45%) with idiopathic HCM (p < 0.0001). Non-sarcomeric causes of HCM were the most prevalent in ages <1yo and > 55yo. Se, Sp, PPV, NPV and PA of RF were 97%, 70%, 55%, 98% and 77%, respectively. Single and clinical combination of RF (clusters) had an high specificity, NPV and predictive accuracy for the specific etiologies (syndromes/metabolic/infiltrative disorders associated with HCM). CONCLUSIONS An extensive diagnostic work up, focused on analysis of specific diagnostic RF in patients with unexplained LVH facilitates a clinical diagnosis in 74% of patients with HCM.
Collapse
Affiliation(s)
- Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli, Italy; Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy; European Reference Network - GUARD HEART, UK; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK.
| | - Emanuele Monda
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli, Italy; Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Stefania Tramonte
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Felice Gragnano
- UOC Cardiologia Vanvitelli - Osp. Snat'Anna e San Sebastiano - Caserta, Italy
| | - Daniele Masarone
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli 'Federico II', Italy; CEINGE-Biotecnologie Avanzate s.c.a r.l, Italy
| | - Augusto Esposito
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Rita Gravino
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Ernesto Ammendola
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Gemma Salerno
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Marta Rubino
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Martina Caiazza
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Mariagiovanna Russo
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Paolo Calabrò
- UOC Cardiologia Vanvitelli - Osp. Snat'Anna e San Sebastiano - Caserta, Italy
| | - Perry Mark Elliott
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK
| | - Giuseppe Pacileo
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| |
Collapse
|