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Izumi Y, Takanashi S, Kitamura M, Takamisawa I, Saito M, Otaki Y, Iwakura T, Takayama M. Morphological anomalies in obstructive hypertrophic cardiomyopathy: Insights from four-dimensional computed tomography and surgical correlation. J Cardiol 2024:S0914-5087(24)00130-8. [PMID: 39002717 DOI: 10.1016/j.jjcc.2024.07.002] [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: 05/16/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disorder in which left ventricular outflow tract obstruction critically affects symptoms and prognosis. Traditionally, left ventricular outflow tract obstruction was primarily attributed to septal hypertrophy with systolic anterior motion of the mitral valve. However, recent evidence highlights significant contributions from the mitral valve and papillary muscle anomalies, as well as an apical-basal muscle bundle observed in HCM patients. Accurate morphological assessment is essential when considering septal reduction therapy. While transesophageal echocardiography and cardiac magnetic resonance are recommended for assessing the anomalous structures, four-dimensional computed tomography offers superior spatial resolution and multiplanar reconstruction capabilities. These features enable the evaluation of details of the morphological anomalies, such as the apical-basal muscle band, papillary muscle anomalies, subaortic stenosis, and right ventricular outflow tract obstruction. Based on the detailed assessment of these morphological features, four-dimensional computed tomography has been utilized for planning of surgical correction in a comprehensive HCM center. This approach facilitates the intervention strategies and may improve outcomes in septal reduction therapy for obstructive HCM.
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Affiliation(s)
- Yuki Izumi
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
| | - Shuichiro Takanashi
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsunobu Kitamura
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mika Saito
- Department of Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yuka Otaki
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomohiro Iwakura
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Morimasa Takayama
- Hypertrophic Cardiomyopathy Center, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Xu W, Zhu F, Zhang Y, Li P, Sheng Y. An overview of the treatments for hypertrophic cardiomyopathy. Front Cardiovasc Med 2024; 11:1387596. [PMID: 38887447 PMCID: PMC11180737 DOI: 10.3389/fcvm.2024.1387596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a very prevalent inherited disease with a wide global distribution and a prevalence rate of approximately 0.2% in the general population. Left ventricular hypertrophy (LVH) caused by sarcomere mutation is the primary reason of HCM. The histopathology feature is that cardiomyocyte hypertrophy, myocyte disorder and myocardial fibrosis lead to diminished diastolic function, left ventricular outflow tract obstruction (LVOTO) and arrhythmia, all of which result in serious cardiac complications. Previously, HCM was considered a malignant disease that was almost untreatable. With the improvement of medical standards and increasing awareness of HCM, it has become a highly treatable disease in contemporary times, with a significant decrease in mortality rates. However, there are still significant unmet requirements in the therapy of HCM. This paper draws on more than 100 references from the past four decades and summarizes current advances in the treatment of HCM. The article will review the pathogenesis and types, recent development in pharmacotherapy, invasive treatments and gene therapies, as well as dilemma and future development of HCM.
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Affiliation(s)
- Wenna Xu
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Fuyu Zhu
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yue Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peng Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yanhui Sheng
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
- Department of Cardiology, Jiangsu Province Hospital, Nanjing, Jiangsu, China
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Nakano S, Yamamoto H, Takahashi N, Takaya T. Bailout MitraClip therapy for deteriorated systolic anterior motion-related severe mitral regurgitation post-alcohol septal ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad599. [PMID: 38089119 PMCID: PMC10711538 DOI: 10.1093/ehjcr/ytad599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/18/2023] [Accepted: 11/24/2023] [Indexed: 03/07/2024]
Abstract
Background Percutaneous alcohol septal ablation (ASA) is a non-surgical treatment for symptomatic hypertrophic obstructive cardiomyopathy. It has a potential risk for systolic anterior motion (SAM)-related mitral regurgitation (MR) deterioration, leading to acute congestive heart failure. In such clinical scenarios, additional surgical interventions for SAM-MR are risky. Case summary A 70-year-old man experienced acutely deteriorated heart failure caused by SAM-related MR following ASA, for which venous-arterial extracorporeal membrane oxygenation (ECMO) and a percutaneous left ventricular assist device (Impella CP, Abiomed, MA, USA) were required. Transoesophageal echocardiography showed that an interventricular septal oedematous protrusion led to a large coaptation gap of mitral leaflets with a pseudo-prolapse of the posterior mitral leaflet (PML). Because of his prohibitive surgical risks, we opted for transcatheter edge-to-edge mitral valve repair with MitraClip therapy. After removing the Impella device, an XT clip (Abbott Vascular, CA, USA) was located to cover the pseudo-prolapsed PML, resulting in optimal MR reduction with an acceptable mean transmitral valve-pressure gradient. Thereafter, his heart failure was well controlled, and venous-arterial ECMO was successfully removed on post-MitraClip Day 2. Discussion This case demonstrated that MitraClip therapy rescued the patient from a rare complication of severe acute heart failure with haemodynamic collapse caused by massive SAM-related MR following ASA. MitraClip therapy can be a feasible, less-invasive interventional therapy for SAM-related MR in cases with acceptable severity of iatrogenic mitral stenosis post-MitraClip implantation.
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Affiliation(s)
- Shinsuke Nakano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
| | - Nobuyuki Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
- Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Ishihara K, Kubota Y, Matsuda J, Imori Y, Tokita Y, Asai K, Takano H. Predictive Factors for Decreasing Left Ventricular Ejection Fraction and Progression to the Dilated Phase of Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:5137. [PMID: 37568539 PMCID: PMC10420074 DOI: 10.3390/jcm12155137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with hypertrophic cardiomyopathy (HCM) may progress to the dilated phase (DHCM). This study aimed to identify the predictive factors for DHCM progression, including left ventricular (LV) ejection fraction (LVEF < 50%) or decreased LV contraction (LVEF < 60%). The study included 291 patients enrolled in our hospital's HCM registry who were grouped based on their poststudy LVEF (LVEF of ≥60%, 50-59%, and <50%). Predictive factors of an LVEF of <50% or <60% were determined. Further, the effects of percutaneous transluminal septal myocardial ablation (PTSMA) on long-term systolic LV function and DHCM development were investigated. LVEF was ≥60%, 50-59%, and <50% in 239, 33, and 19 patients, respectively, during the follow-up period (mean: 64.9 months). Multivariate analyses indicated baseline atrial fibrillation (AF), nonsustained ventricular tachycardia (NSVT), and left ventricular diameter at end-systole (LVDs) as significant predictors of DHCM. Using a scoring method based on AF, NSVT, and LVDs, patients with 2 and 3 points had a significantly higher risk of developing DHCM. PTSMA in 78 HCM patients demonstrated no significant effect on long-term LVEF changes or DHCM development. We concluded that AF, NSVT, and LVDs are significant predictors of DHCM development. However, a validation study with a larger population is required.
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Affiliation(s)
| | | | | | | | | | | | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-0022, Japan; (K.I.); (Y.K.); (J.M.); (Y.I.); (Y.T.); (K.A.)
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Zheng X, Yang B, Hui H, Lu B, Feng Y. Alcohol Septal Ablation or Septal Myectomy? An Updated Systematic Review and Meta-Analysis of Septal Reduction Therapy for Hypertrophic Obstructive Cardiomyopathy. Front Cardiovasc Med 2022; 9:900469. [PMID: 35694661 PMCID: PMC9178179 DOI: 10.3389/fcvm.2022.900469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the safety and effectiveness of alcohol septal ablation (ASA) and septal myectomy (SM) for the treatment of hypertrophic obstructive cardiomyopathy.MethodsWe searched the PubMed, MEDLINE, EMBASE, and CBM databases for observational research articles related to ASA and SM published from the establishment of the databases to November 2021. All ultimate selected articles were highly related to our target. The Newcastle-Ottawa Scale was used to evaluate the literature quality. A fixed or random effect model was performed in the meta-analysis depending on the heterogeneity of the included studies. The Mantel-Haenszelt test with relative risk ratio (RR) and 95% confidence interval (CI) was used to measure the effect indicator of binary data, while the inverse variance method with weighted mean difference (WMD) and 95% CI was used to measure the effect indicator of continuous data.ResultsA totally of 3,647 cases (1,555 cases treated with ASA and 2,092 cases treated with SM) were included. The results of the systematic review indicated no statistically significant difference in postoperative all-cause mortality (RR = 0.82; 95% CI: 0.65–1.04; P = 0.10) between patients treated with ASA and SM, but both the reduction in the postoperative left ventricular outflow tract pressure gradient (WMD = 9.35 mmHg, 95% CI: 5.38–13.31, P < 0.00001) and the post-operative improvement on cardiac function, assessed by the grade of New York Heart Association (NYHA), compared to pre-operative measurements (WMD = 0.13; 95% CI: 0.00–0.26; P < 0.04) in the ASA group were slightly inferior to those in the SM group. In addition, both the risk of pacemaker implantation (RR = 2.83, 95% CI: 2.06–3.88; P < 0.00001) and the risk of reoperation (RR = 11.23, 95% CI: 6.21–20.31; P < 0.00001) are recorded at a higher level after ASA procedure.ConclusionBoth ASA and SM have a high degree of safety, but the reduction in the postoperative left ventricular outflow tract pressure gradient and the improvement on cardiac function are slightly inferior to SM. In addition, both the risk of pacemaker implantation and the risk of reoperation are recorded at a higher level after ASA procedure. The operative plan should be chosen through multidisciplinary discussions in combination with the wishes of the patients and the actual clinical situation.
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Affiliation(s)
- Xifeng Zheng
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bin Yang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haosheng Hui
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bing Lu
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yinhui Feng
- Department of Nuclear Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Yinhui Feng
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