1
|
Critical Evaluation of Current Hypotheses for the Pathogenesis of Hypertrophic Cardiomyopathy. Int J Mol Sci 2022; 23:ijms23042195. [PMID: 35216312 PMCID: PMC8880276 DOI: 10.3390/ijms23042195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Hereditary hypertrophic cardiomyopathy (HCM), due to mutations in sarcomere proteins, occurs in more than 1/500 individuals and is the leading cause of sudden cardiac death in young people. The clinical course exhibits appreciable variability. However, typically, heart morphology and function are normal at birth, with pathological remodeling developing over years to decades, leading to a phenotype characterized by asymmetric ventricular hypertrophy, scattered fibrosis and myofibrillar/cellular disarray with ultimate mechanical heart failure and/or severe arrhythmias. The identity of the primary mutation-induced changes in sarcomere function and how they trigger debilitating remodeling are poorly understood. Support for the importance of mutation-induced hypercontractility, e.g., increased calcium sensitivity and/or increased power output, has been strengthened in recent years. However, other ideas that mutation-induced hypocontractility or non-uniformities with contractile instabilities, instead, constitute primary triggers cannot yet be discarded. Here, we review evidence for and criticism against the mentioned hypotheses. In this process, we find support for previous ideas that inefficient energy usage and a blunted Frank–Starling mechanism have central roles in pathogenesis, although presumably representing effects secondary to the primary mutation-induced changes. While first trying to reconcile apparently diverging evidence for the different hypotheses in one unified model, we also identify key remaining questions and suggest how experimental systems that are built around isolated primarily expressed proteins could be useful.
Collapse
|
2
|
Ma J, Guan L, Yang L, Mahemuti A, Mu Y. Relationship Between Myocardial Perfusion and Myocardial Function in Dilated Cardiomyopathy by Shown Ultrasonography. Int Heart J 2021; 62:792-800. [PMID: 34276003 DOI: 10.1536/ihj.20-599] [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: 11/18/2022]
Abstract
Myocardial contrast echocardiography (MCE) and two-dimensional speckle tracking echocardiography (2D-STE) were used to detect left ventricular myocardial microcirculation perfusion and myocardial systolic function in dilated cardiomyopathy (DCM) and to explore the relationship between the two.Conventional ultrasound, MCE, and 2D-STE examinations were performed on 30 patients and 30 controls. Left ventricular microcirculation perfusion, left ventricular longitudinal strain (GLS), and circumferential strain (GCS) were analyzed to further compare the correlation between left ventricular perfusion and myocardial strain parameters.Regional myocardial perfusion was reduced in patients with DCM, manifesting as a decrease in the rising slope (A) of the mid-segment of the posterior septum, the peak intensity (PI) of the mid-segment of the anterior septum and the posterior septum, the apical segment of the lateral wall, the area under the curve (AUC) of the posterior septum, the basal segment of the posterior wall, the anterior septum, posterior septum, posterior wall, mid-segment of the lateral wall, and apical segment of the lateral wall and the overall average PI and AUC of the mid-segment, compared with that in the controls (P < 0.05). The left ventricular systolic function and the strain parameters GLS and GCS of DCM patients were lower than those of the controls (P < 0.001). Correlation analysis revealed a positive correlation between the A of the mitral valve and GCS (r = 0.372, P = 0.043), and MV-E/e' had a positive correlation with the AUC of the basal and intermediate segments (r = 0.379, P = 0.039; r = 0.404, P = 0.027).In patients with DCM, regional myocardial microcirculation perfusion is reduced, and myocardial strain is impaired. Myocardial perfusion has a good positive correlation with myocardial mechanics.
Collapse
Affiliation(s)
- Juan Ma
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University
| | - Lina Guan
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University
| | - Lingjie Yang
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University
| | - Ailiman Mahemuti
- Department of Cardiovascular, First Affiliated Hospital of Xinjiang Medical University
| | - Yuming Mu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University
| |
Collapse
|
3
|
Lv Q, Li M, Li H, Wu C, Dong N, Li Y, Zhang L, Xie M. Assessment of biventricular function by three-dimensional speckle-tracking echocardiography in clinically well pediatric heart transplantation patients. Echocardiography 2020; 37:2107-2115. [PMID: 33078446 DOI: 10.1111/echo.14893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The biventricular function plays an important role in the prognosis of pediatric heart transplantation (HTx) patients. Therefore, in this study, we aimed to evaluate the biventricular function of pediatric HTx patients by three-dimensional (3D) speckle-tracking echocardiography (3D-STE). METHODS We enrolled 30 clinically well pediatric HTx patients and 30 healthy controls with a similar distribution of sex and age to the HTx. All participants underwent comprehensive two-dimensional (2D) and 3D echocardiography. Left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS), left and right ventricular ejection fraction (LVEF and RVEF, respectively), and right ventricular free wall longitudinal strain (RV FWLS) were acquired by 3D-STE. Moreover, the correlations between strains and clinical data were explored. RESULTS Compared with controls, LV GLS was decreased in pediatric HTx patients (P < .05), while LV GCS and LVEF showed no difference. LV GLS showed a weak correlation with cold ischemic time in HTx group (r = 0.396, P < .05). Meanwhile, RVEF and RV FWLS were significantly lower in the HTx group (P < .05). In the HTx group, RV FWLS showed a weak correlation with the preoperative mean pulmonary artery pressure (r = 0.420, P < .05) and postoperative pulmonary artery systolic pressure (r = 0.465, P < .05). CONCLUSION The 3D-biventricular mechanical functions were decreased in clinically well pediatric HTx patients. The provided characteristics and appropriate normal values of biventricular mechanical functions can be the basis in subsequent studies in the pediatric HTx patients.
Collapse
Affiliation(s)
- Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Meng Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - He Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| |
Collapse
|
4
|
Echocardiographic tissue imaging evaluation of myocardial characteristics and function in cardiomyopathies. Heart Fail Rev 2020; 26:813-828. [PMID: 31950337 DOI: 10.1007/s10741-020-09918-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Current echocardiography techniques have allowed more precise assessment of cardiac structure and function of the several types of cardiomyopathies. Parameters derived from echocardiographic tissue imaging (ETI)-tissue Doppler, strain, strain rate, and others-are extensively used to provide a framework in the evaluation and management of cardiomyopathies. Generally, myocardial function assessed by ETI is depressed in all types of cardiomyopathies, non-ischemic dilated cardiomyopathy (DCM) in particular. In hypertrophic cardiomyopathy (HCM), ETI is useful to identify subclinical disease in family members of HCM, to differentiate HCM from other conditions causing cardiac hypertrophy and to predict cardiac events. ETI also for HCM allows addressing the mechanism behind left ventricular outflow tract obstruction and its improvement after therapeutic options. ETI provides cardiac amyloidosis with unique and specific findings such as "apical sparing." Nevertheless, ETI does not seem to provide as much information amenable to histological findings as recently emerging techniques of cardiac magnetic resonance imaging. This review introduces usefulness of ETI and some other ultrasound techniques for detecting clinical and subclinical characteristics of cardiomyopathies, focusing on DCM, HCM, and cardiac amyloidosis.
Collapse
|
5
|
Pagourelias ED, Mirea O, Vovas G, Duchenne J, Michalski B, Van Cleemput J, Bogaert J, Vassilikos VP, Voigt JU. Relation of regional myocardial structure and function in hypertrophic cardiomyopathy and amyloidois: a combined two-dimensional speckle tracking and cardiovascular magnetic resonance analysis. Eur Heart J Cardiovasc Imaging 2018; 20:426-437. [DOI: 10.1093/ehjci/jey107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/12/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, University County Hospital of Craiova, 1 Tabaci Str, Craiova, Romania
| | - Georgios Vovas
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Blazej Michalski
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Vasilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| |
Collapse
|
6
|
Abstract
Modern advanced imaging techniques have allowed increasingly more rigorous assessment of the cardiac structure and function of several types of cardiomyopathies. In contemporary cardiology practice, echocardiography and cardiac magnetic resonance imaging are widely used to provide a basic framework in the evaluation and management of cardiomyopathies. Echocardiography is the quintessential imaging technique owing to its unique ability to provide real-time images of the beating heart with good temporal resolution, combined with its noninvasive nature, cost-effectiveness, availability, and portability. Cardiac magnetic resonance imaging provides data that are both complementary and uniquely distinct, thus allowing for insights into the disease process that until recently were not possible. The new catchphrase in the evaluation of cardiomyopathies is multimodality imaging, which is purported to be the efficient integration of various methods of cardiovascular imaging to improve the ability to diagnose, guide therapy, or predict outcomes. It usually involves an integrated approach to the use of echocardiography and cardiac magnetic resonance imaging for the assessment of cardiomyopathies, and, on occasion, single-photon emission computed tomography and such specialized techniques as pyrophosphate scanning.
Collapse
Affiliation(s)
- M Fuad Jan
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI
| | - A Jamil Tajik
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI.
| |
Collapse
|
7
|
Ntelios D, Tzimagiorgis G, Efthimiadis GK, Karvounis H. Mechanical aberrations in hypetrophic cardiomyopathy: emerging concepts. Front Physiol 2015; 6:232. [PMID: 26347658 PMCID: PMC4541419 DOI: 10.3389/fphys.2015.00232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/03/2015] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic cardiomyopathy is the most common monogenic disorder in cardiology. Despite important advances in understanding disease pathogenesis, it is not clear how flaws in individual sarcomere components are responsible for the observed phenotype. The aim of this article is to provide a brief interpretative analysis of some currently proposed pathophysiological mechanisms of hypertrophic cardiomyopathy, with a special emphasis on alterations in the cardiac mechanical properties.
Collapse
Affiliation(s)
- Dimitrios Ntelios
- Laboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Department of Cardiology, AHEPA University Hospital Thessaloniki, Greece
| | - Georgios Tzimagiorgis
- Laboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | | | | |
Collapse
|
8
|
Duchateau J, Cornolle C, Peyrou J, Ritter P, Pillois X, Réant P, Reynaud A, Landelle M, Lafitte S. Abnormal left ventricular contraction sequence in hypertrophic cardiomyopathy patients: first description of hypersynchrony and invert synchrony. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1632-1639. [PMID: 25747939 DOI: 10.1016/j.ultrasmedbio.2015.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to compare left ventricular contraction sequence in patients with hypertrophic cardiomyopathy (HCM) and healthy controls. Normal left ventricular contraction sequence in healthy controls exhibits an apex-to-base delay (ABD) contributing to efficient cardiac mechanics (physiologic asynchrony). Echocardiographic data from 20 controls and 40 HCM patients were prospectively analyzed. Endocardial longitudinal and circumferential strains and ABD were measured using custom-built software. HCM patients had increased circumferential (-36.4 ± 6.0 vs. -32.9 ± 5.0, p < 0.01) and decreased longitudinal (-19.3 ± 6.4 vs. -23.4 ± 5.7, p < 0.01) strains. In controls, physiologic ABD was observed (35.7 ± 18.1 ms). This delay was reduced in HCM patients (5.5 ± 22.7 ms, p < 0.01 vs. controls). There was no interaction between ABD and common clinical or echocardiographic parameters in the HCM population. Left ventricular contraction sequence can be modified in HCM patients, with the loss of the physiologic ABD. This phenomenon is independent from commonly measured parameters.
Collapse
Affiliation(s)
- Josselin Duchateau
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Claire Cornolle
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Jérome Peyrou
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Philippe Ritter
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Xavier Pillois
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Patricia Réant
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Amélie Reynaud
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Mathieu Landelle
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Stéphane Lafitte
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France.
| |
Collapse
|
9
|
Urbano-Moral JA, Rowin EJ, Maron MS, Crean A, Pandian NG. Investigation of Global and Regional Myocardial Mechanics With 3-Dimensional Speckle Tracking Echocardiography and Relations to Hypertrophy and Fibrosis in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2014; 7:11-9. [DOI: 10.1161/circimaging.113.000842] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jose Angel Urbano-Moral
- From the Hypertrophic Cardiomyopathy Center and Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston, MA (J.A.U.-M., E.J.R., M.S.M., N.G.P.); and Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada (A.C.)
| | - Ethan J. Rowin
- From the Hypertrophic Cardiomyopathy Center and Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston, MA (J.A.U.-M., E.J.R., M.S.M., N.G.P.); and Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada (A.C.)
| | - Martin S. Maron
- From the Hypertrophic Cardiomyopathy Center and Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston, MA (J.A.U.-M., E.J.R., M.S.M., N.G.P.); and Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada (A.C.)
| | - Andrew Crean
- From the Hypertrophic Cardiomyopathy Center and Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston, MA (J.A.U.-M., E.J.R., M.S.M., N.G.P.); and Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada (A.C.)
| | - Natesa G. Pandian
- From the Hypertrophic Cardiomyopathy Center and Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston, MA (J.A.U.-M., E.J.R., M.S.M., N.G.P.); and Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada (A.C.)
| |
Collapse
|
10
|
Myocardial Mechanics in Noncontiguous HCM. JACC Cardiovasc Imaging 2013; 6:1216-8. [DOI: 10.1016/j.jcmg.2013.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/29/2013] [Accepted: 04/04/2013] [Indexed: 11/23/2022]
|