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Hedayati Goudarzi MT, Moradi M, Abrotan S, Saravi M, Shirafkan H, Irilouzadian R, Omran HS. Complications of Implantable Cardioverter Defibrillator and Their Potential Risk Factors in Patients with Hypertrophic Cardiomyopathy. Cardiol Res Pract 2023; 2023:4552100. [PMID: 38204930 PMCID: PMC10781524 DOI: 10.1155/2023/4552100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/13/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) has different complications such as cardiac arrhythmia and sudden cardiac death (SCD). Insertion of an implantable cardioverter defibrillator (ICD) is recommended for HCM patients who are at high risk of SCD and malignant arrhythmias, despite having their own potential complications. Hypothesis. We aimed to investigate the prevalence of different complications of ICD insertion and the impact of the potential influential baseline characteristics in a one-year follow-up period. Methods This was a retrospective study with a total of 71 HCM patients with ICD insertion. We evaluated the prevalence of different complications of ICD implantation and the impact of baseline characteristics on the occurrence of ICD complications using multivariate regression analysis in three 4-month periods. Results In a one-year follow-up, 13 patients (18.3%) experienced at least one of the complications including pneumothorax, lead failure, ICD infection, inappropriate shocks, perforation, and upper limb deep vein thrombosis (DVT) with no mortality. Inappropriate shocks were reported as the most common (11.3%) complication during this period, with a gradual increase in the second (4.2%) and third (5.6%) follow-up sessions. Among all of the baseline characteristics that were investigated in this study, a positive history of hypertension was the only risk factor with significant impact on the occurrence of complications (P = 0.01). Conclusion We demonstrated the occurrence of complications during a one-year follow-up as 18.3% in HCM patients with ICD insertion. A positive history of hypertension was the only baseline characteristic affecting the occurrence of complications, and inappropriate shocks were the most common complication.
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Affiliation(s)
| | - Maryam Moradi
- Department of Cardiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Abrotan
- Cardiology Department, Rohani Hospital, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Saravi
- Department of Cardiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Hoda Shirafkan
- Social Determinants for Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Rana Irilouzadian
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Salehi Omran
- Cardiology Department, Rohani Hospital, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Renjihtlal SLM, Eid MM, Vyas C, Mohamed S, Shanmukhappa S, Renjith K, Mostafa MR, Baibhav B, Pillai N. Demographics and Trends of Hypertrophic Cardiomyopathy-Related Mortality in the US, 1999-2020. Curr Probl Cardiol 2023; 48:101681. [PMID: 36906160 DOI: 10.1016/j.cpcardiol.2023.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND There is limited data on the mortality trends of HCM in the US. OBJECTIVE To study the demographics and trends of mortality in patients with HCM. METHODS A retrospective cohort analysis was done with mortality data of patients with HCM listed as an underlying cause of death in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (CDC-WONDER) from January 1999 to December 2020. The analysis took place in February 2022. First, we measured HCM-related Age-Adjusted Mortality Rate (AAMR) per 100,000 US population stratified by sex, race, ethnicity, and geographic area. We then calculated the Annual Percentage Change (APC) for AAMR for each. RESULTS A total of 24,655 HCM-related deaths occurred between 1999 and 2020. The AAMR for HCM-related deaths declined from 0.5/100,000 patients in 1999 to 0.2 in 2020. The APC changes are as follows: -6.8 (95% CI: -11.8 to -1.5) from 2002-2009, -1.23 (95%CI -13.8 to 13.2) from 2009-2014, -6.71 (95%CI -46.2 to 61.7) from 2014-2017 and remained at 2.07 (95%CI -26.1 to 41.1) from 2017-2020. Men had consistently higher AAMR than women. Overall, AAMR in men was 0.4 (95% CI: 0.4-0.5), and in women was 0.3 (95% CI: 0.3-0.3). A similar trend was noticed in men and women over the years, starting from 1999 (AAMR men: 0.7 and women: 0.4) to 2020 (AAMR men: 0.3 and women: 0.2). AAMRs were highest among black or African American patients 0.6 (95% CI: 0.5-0.6), followed by Non-Hispanic and Hispanic white 0.3 (95% CI 0.3-0.3) and Asian or Pacific Islander 0.2 (95% CI 0.2-0.2). There was substantial variation in each region in the US. States such as California, Ohio, Michigan, Oregon, and Wyoming had the highest AAMR. Large metropolitan cities had higher AAMR than non-metropolitan cities. CONCLUSION During the study period from 1999 to 2020, HCM-related mortality steadily decreased. The highest AAMR was observed among men, black patients, and residents of metropolitan areas. States such as California, Ohio, Michigan, Oregon, and Wyoming had the highest AAMR.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nisha Pillai
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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3
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Zampieri M, Salvi S, Fumagalli C, Argirò A, Zocchi C, Del Franco A, Iannaccone G, Giovani S, Ferrantini C, Palinkas ED, Cappelli F, Olivotto I. Clinical scenarios of hypertrophic cardiomyopathy-related mortality: Relevance of age and stage of disease at presentation. Int J Cardiol 2023; 374:65-72. [PMID: 36621577 DOI: 10.1016/j.ijcard.2022.12.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
The evolving epidemiology of hypertrophic cardiomyopathy (HCM) has progressively changed our perception of HCM-related mortality. However, recent studies detailing individual causes of death based on age and clinical setting are lacking. Thus, the present study aimed to describe the modes of death in a consecutive cohort of HCM patients based on presenting clinical features and stage of disease. METHODS By retrospective analysis of a large HCM cohort, we identified 161 patients with >1 year follow-up who died between 2000 and 2020 and thoroughly investigated their modes of death. HCM stage at presentation was defined as "classic", "adverse remodeling" or "overt dysfunction". RESULTS Of the 161 patients, 103 (64%) died of HCM-related causes, whereas 58 (36%) died of non-HCM-related causes. Patients who died of HCM-related causes were younger than those who died of non-HCM related causes. The most common cause of death was heart failure (HF). Sudden cardiac death (SCD) ranked third, after non cardiovascular death, and mostly occurred in young individuals. The proportion of HF related death and SCD per stage of disease was 14% and 27% in "classic", 38% and 21% in "adverse remodeling" and 74% and 10% in "overt dysfunction". CONCLUSIONS Most HCM patients die due to complications of their own disease, mainly in the context of HF. While SCD tends to be juvenile, HF related deaths often occur in age groups no longer amenable to cardiac transplant. Modes of death vary with the stage of disease, with SCD becoming less prevalent in more advanced phases, when competitive risk of HF becomes overwhelming.
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Affiliation(s)
- Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Samuele Salvi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
| | - Chiara Zocchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Annamaria Del Franco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Giulia Iannaccone
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Sara Giovani
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Florencce, Italy
| | - Eszter Dalma Palinkas
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Doctoral School of Clinical Medicine, University of Szeged, Hungary
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florencce, Italy
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Lu JF, Fan ZX, Li Y, Wang ZY, Ma L, Yuan BY, Yang TT, Liu PJ, Liu GZ. Risk factors, clinical features, and outcomes of patients with hypertrophic cardiomyopathy complicated by ischemic stroke: A single-center retrospective study. Front Cardiovasc Med 2022; 9:1054199. [PMID: 36568560 PMCID: PMC9772473 DOI: 10.3389/fcvm.2022.1054199] [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: 09/29/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objective This study aimed to explore risk factors, clinical features, and prognosis of patients with hypertrophic cardiomyopathy (HCM) complicated by ischemic stroke (IS). Methods We conducted a retrospective analysis of all HCM patient data and a 1-year follow-up study. Results Totally, 506 patients with HCM, including 71 with IS, were enrolled. Older age (≥63 years) was associated with an increased risk of IS in HCM patients (OR = 1.045, 95% CI: 1.018-1.072, p = 0.001). Among 37 patients complicated by IS, 22 (59.5%, 22/37) manifested as cardioembolism (CE) subtype, and 13 (35.1%, 3/37) small artery occlusion (SAO) subtype, according to TOAST classification. In the acute phase, the IS patients presented with NIHSS 4 (interquartile range: 1, 10). Multi-infarction was more common than single infarction (72.7 vs. 27.3%), while cortical + subcortical infarction (CE group: 50%) or subcortical infarction (SAO group: 53.8%) constituted most IS cases. Additionally, the blood supply areas of anterior circulation (CE group: 45.5%; SAO group: 92.3%) or anterior + posterior circulation (CE group: 50%) were mainly involved. The 1-year survival rate of HCM patients with concomitant IS was 81.8%, and IS was associated with 1-year all-cause death in HCM patients (HR = 5.689, 95% CI: 1.784-18.144, p = 0.003). Conclusion Older age is a risk factor for IS occurrence in HCM patients. Patients with HCM complicated by IS had mild or moderate neurologic deficits at disease onset. CE and SAO subtypes predominate in patients with concomitant IS, especially the former. Multiple cortical and subcortical infarctions are their neuroimaging characteristics, mainly involving the anterior circulation or anterior + posterior circulation. Is is a risk factor for all-cause death in HCM patients within 1 year.
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Novo Matos J, Payne JR, Seo J, Luis Fuentes V. Natural history of hypertrophic cardiomyopathy in cats from rehoming centers: The CatScan II study. J Vet Intern Med 2022; 36:1900-1912. [PMID: 36315028 PMCID: PMC9708425 DOI: 10.1111/jvim.16576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The natural history of hypertrophic cardiomyopathy (HCM) in cats has been mainly studied in cats referred for suspected heart disease, which can skew the results towards cats with clinical signs. Few data are available on factors associated with development of HCM in cats. HYPOTHESES (1) Clinical variables can predict which cats will develop HCM; (2) HCM in cats not referred for suspected heart disease is associated with a low rate of cardiovascular events. ANIMALS One hundred seven cats from rehoming centers without a history of clinical signs of cardiac or systemic disease at the time of adoption. METHODS Prospective longitudinal study. After rehoming, shelter cats were reexamined for serial echocardiograms. Cox regression analysis was used to identify predictors of development of HCM in cats that were normal at baseline. Adverse cardiovascular events including heart failure, thromboembolism, or sudden death were recorded. RESULTS Cats were monitored for a median of 5.6 [1.2-9.2] years. At baseline, 68/107 cats were normal, 18/107 were equivocal and 21/107 had HCM. Nineteen cats developed HCM during the study period. The factors at baseline associated with increased hazard of developing HCM were lower left atrial fractional shortening, higher left ventricular fractional shortening, and higher body weight. Cardiovascular events were observed in 21% of cats with HCM. CONCLUSIONS AND CLINICAL IMPORTANCE Cardiovascular events were common in cats with HCM from a rehoming center study sample. Lower left atrial systolic function appears to precede overt HCM.
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Affiliation(s)
- Jose Novo Matos
- Clinical Science and ServicesRoyal Veterinary CollegeHertfordshireUK
| | - Jessie Rose Payne
- Langford Vets Small Animal Referral HospitalUniversity of BristolBristolUK
| | - Joonbum Seo
- Animal Referral CentreAucklandNew Zealand,School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
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6
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Kitaoka H, Tsutsui H, Kubo T, Ide T, Chikamori T, Fukuda K, Fujino N, Higo T, Isobe M, Kamiya C, Kato S, Kihara Y, Kinugawa K, Kinugawa S, Kogaki S, Komuro I, Hagiwara N, Ono M, Maekawa Y, Makita S, Matsui Y, Matsushima S, Sakata Y, Sawa Y, Shimizu W, Teraoka K, Tsuchihashi-Makaya M, Ishibashi-Ueda H, Watanabe M, Yoshimura M, Fukusima A, Hida S, Hikoso S, Imamura T, Ishida H, Kawai M, Kitagawa T, Kohno T, Kurisu S, Nagata Y, Nakamura M, Morita H, Takano H, Shiga T, Takei Y, Yuasa S, Yamamoto T, Watanabe T, Akasaka T, Doi Y, Kimura T, Kitakaze M, Kosuge M, Takayama M, Tomoike H. JCS/JHFS 2018 Guideline on the Diagnosis and Treatment of Cardiomyopathies. Circ J 2021; 85:1590-1689. [PMID: 34305070 DOI: 10.1253/circj.cj-20-0910] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Noboru Fujino
- Department of Cardiovascular and Internal Medicine, Kanazawa University, Graduate School of Medical Science
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Chizuko Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | | | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama International Medical Center, Saitama Medical University
| | - Yoshiro Matsui
- Department of Cardiac Surgery, Hanaoka Seishu Memorial Hospital
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Satoshi Hida
- Department of Cardiovascular Medicine, Tokyo Medical University
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoji Nagata
- Division of Cardiology, Fukui CardioVascular Center
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Chumakova OS. [Hypertrophic cardiomyopathy in elderly: causes, diagnostic and treatment approaches]. TERAPEVT ARKH 2020; 92:63-69. [PMID: 33346433 DOI: 10.26442/00403660.2020.09.000558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
Hypertrophic cardiomyopathy is the most common inherited heart disorder with high clinical heterogeneity. Every fifth patient is older than 60 years at first diagnosis. This review discusses the possible causes for the late onset of hypertrophic cardiomyopathy, the diagnostic and treatment approaches in the elderly.
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Affiliation(s)
- O S Chumakova
- Central State Medical Academy of the President of the Russian Federation
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8
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Mandeş L, Roşca M, Ciupercă D, Popescu BA. The role of echocardiography for diagnosis and prognostic stratification in hypertrophic cardiomyopathy. J Echocardiogr 2020; 18:137-148. [PMID: 32301048 PMCID: PMC7473965 DOI: 10.1007/s12574-020-00467-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/01/2020] [Accepted: 03/10/2020] [Indexed: 12/15/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequent cardiac disease with genetic substrate, affecting about 0.2-0.5% of the population. While most of the patients with HCM have a relatively good prognosis, some are at increased risk of adverse events. Identifying such patients at risk is important for optimal treatment and follow-up. While clinical and electrocardiographic information plays an important role, echocardiography remains the cornerstone in assessing patients with HCM. In this review, we discuss the role of echocardiography in diagnosing HCM, the key features that differentiate HCM from other diseases and the use of echocardiography for risk stratification in this setting (risk of sudden cardiac death, heart failure, atrial fibrillation and stroke). The use of modern echocardiographic techniques (deformation imaging, 3D echocardiography) refines the diagnosis and prognostic assessment of patients with HCM. The echocardiographic data need to be integrated with clinical data and other information, including cardiac magnetic resonance, especially in challenging cases or when there is incomplete information, for the optimal management of these patients.
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Affiliation(s)
- Leonard Mandeş
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Şos. Fundeni 258, Sector 2, 022328, Bucharest, Romania
| | - Monica Roşca
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Şos. Fundeni 258, Sector 2, 022328, Bucharest, Romania
| | - Daniela Ciupercă
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Şos. Fundeni 258, Sector 2, 022328, Bucharest, Romania.
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Ando K, Nagao M, Watanabe E, Sakai A, Suzuki A, Nakao R, Ishizaki U, Sakai S, Hagiwara N. Association between myocardial hypoxia and fibrosis in hypertrophic cardiomyopathy: analysis by T2* BOLD and T1 mapping MRI. Eur Radiol 2020; 30:4327-4336. [PMID: 32211964 DOI: 10.1007/s00330-020-06779-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We assessed whether an association exists between myocardial oxygenation and myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM), using blood-oxygen-level-dependent (BOLD) T2* cardiac magnetic resonance imaging (T2*-CMR) and T1 mapping. METHODS T1 mapping and T2*-CMR data were collected from 55 HCM patients using a 3-T MR and were prospectively analyzed. T2*-CMR was conducted using the black blood, breath-hold, multi-echo, and gradient echo sequence. Over 10 min, inhalation of oxygen at the flow rate of 10 L/min, T2* for mid-septum was measured following room-air and oxygen inhalation, and ΔT2* ratio (T2*oxy-T2*air/T2*air, %) was calculated. During pre- and post-gadolinium enhancement, native T1 (ms) and extracellular volume fractions (ECV, %) were calculated at sites same as the T2* measurement. Hypoxia was defined as the segment with an absolute value of the ΔT2* ratio ≥ 10%. RESULTS ΔT2* ratio was significantly higher for segments with native T1 ≥ 1290 ms than those with native T1 < 1290 ms (21 ± 32% vs. 8 ± 6%, p = 0.005). ΔT2* ratio was also significantly higher for segments with ECV ≥ 28% than those with ECV < 28% (21 ± 32% vs. 8 ± 8%, p = 0.0003). ROC curve analysis revealed that ΔT2* ratio could detect segments with native T1 ≥ 1290 ms and ECV ≥ 28% and c-statistics of 0.72 and 0.79. According to the multivariate logistic regression analysis results, ECV is an independent factor in hypoxia (odds ratio, 1.47; 95% confidence interval, 1.02-2.13; p < 0.05). CONCLUSIONS Analysis of BOLD T2*-CMR and T1 mapping revealed that ECV is strongly associated with ΔT2* ratio, suggesting that the onset of myocardial fibrosis is related to hypoxia in HCM patients. TRIAL REGISTRATION Our study was approved by the ethics committee of our institute (#4036, registered on 21 July 2016) KEY POINTS: • Analysis of ΔT2* ratio and ECV with BOLD-T2* and T1 mapping revealed a strong association between myocardial fibrosis and hypoxia in HCM patients.
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Affiliation(s)
- Kiyoe Ando
- Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Eri Watanabe
- Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Umiko Ishizaki
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan
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10
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Risk stratification in hypertrophic cardiomyopathy. Herz 2020; 45:50-64. [PMID: 29696341 DOI: 10.1007/s00059-018-4700-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/15/2018] [Accepted: 03/24/2018] [Indexed: 12/20/2022]
Abstract
Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). The greatest challenge in the management of HCM is identifying those at increased risk, since an implantable cardioverter-defibrillator (ICD) is a potentially life-saving therapy. We sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting data on risk stratification, with balanced guidance regarding rational clinical decision-making. Additionally, we sought to determine the status of the current implementation of guidelines compiled by HCM experts worldwide. The HCM Risk-SCD model helps improve the risk stratification of HCM patients for primary prevention of SCD by calculating an individual risk estimate that contributes to the clinical decision-making process. Improved risk stratification is important for decision-making before ICD implantation for the primary prevention of SCD.
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11
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Songsirisuk N, Kittipibul V, Methachittiphan N, Charoenattasil V, Zungsontiporn N, Spanuchart I, Buppajarntham S, Mankongpaisarnrung C, Satitthummanid S, Srimahachota S, Chattranukulchai P, Boonyaratavej Songmuang S, Puwanant S. Modes of death and clinical outcomes in adult patients with hypertrophic cardiomyopathy in Thailand. BMC Cardiovasc Disord 2019; 19:1. [PMID: 30606129 PMCID: PMC6318850 DOI: 10.1186/s12872-018-0984-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/19/2018] [Indexed: 01/23/2023] Open
Abstract
Background There are limited data about modes of death and major adverse cardiovascular events (MACEs) in patients with hypertrophic cardiomyopathy (HCM) in South East Asian population. The aim of the study was to examine modes of death and clinical outcomes in Thai patients with HCM. Methods Between January 1, 2009 and December 31, 2013, 166 consecutive patients with HCM diagnosed in our institution were evaluated. Five patients were excluded because of non-Thai ethnic groups (n = 3) and diagnosis of myocardial infarction at initial presentation documented by coronary angiography (n = 2). The final study population consisted of 161 patients with HCM. HCM-related deaths included: (1) sudden cardiac death (SCD) – death due to sudden cardiac arrest or unexpected sudden death; (2) heart failure – death due to refractory heart failure; or (3) stroke - death due to embolic stroke associated with atrial fibrillation. MACEs included: (1) SCD, sudden unexpected aborted cardiac arrest, fatal, or nonfatal ventricular arrhythmia (ventricular fibrillation or sustained ventricular tachycardia); (2) heart failure (fatal or non-fatal), or heart transplantation; or (3) stroke - fatal or non-fatal embolic stroke associated with atrial fibrillation. Results One hundred and sixty-one Thai patients with HCM (age 66 ± 16 years, 58% female) were enrolled. Forty-two patients (26%) died over a median follow-up period of 6.8 years including 25 patients (16%) with HCM-related deaths (2%/year). The HCM-related deaths included: heart failure (52% of HCM-related deaths; n = 13), SCD (44% of HCM-related deaths; n = 11), and stroke (4% of HCM-related deaths, n = 1). The SCDs occurred in 6.8% of patients (1%/year). Eighty-four major MACEs occurred in 65 patients (41, 5%/year). The MACEs included: 40 heart failures in which 2 patients underwent heart transplants; 22 SCDs and nonfatal ventricular arrhythmias; and 22 fatal or nonfatal strokes. Conclusions The most common mode of death in adult patients with HCM in Thailand was heart failure followed by SCD. About one-third of the patients experiencing heart failure died during the 6.8 years of follow-up. SCDs occurred in 7% of patients (1%/year), predominantly in the fourth decade or later.
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Affiliation(s)
- Nattakorn Songsirisuk
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Veraprapas Kittipibul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Nilubon Methachittiphan
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Vorawan Charoenattasil
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Nath Zungsontiporn
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Ittikorn Spanuchart
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Saranya Buppajarntham
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Charoen Mankongpaisarnrung
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Sudarat Satitthummanid
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Suphot Srimahachota
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Pairoj Chattranukulchai
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Smonporn Boonyaratavej Songmuang
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand.,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand
| | - Sarinya Puwanant
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, 10330, Thailand. .,Cardiac Center, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Rama IV Road, Bangkok, 10330, Thailand.
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12
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Geske JB, Ong KC, Siontis KC, Hebl VB, Ackerman MJ, Hodge DO, Miller VM, Nishimura RA, Oh JK, Schaff HV, Gersh BJ, Ommen SR. Women with hypertrophic cardiomyopathy have worse survival. Eur Heart J 2018; 38:3434-3440. [PMID: 29020402 DOI: 10.1093/eurheartj/ehx527] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/21/2017] [Indexed: 01/20/2023] Open
Abstract
Aims Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Methods and results Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were older (59 ± 16 vs. 52 ± 15 years, P < 0.0001) had more symptoms [New York Heart Association (NYHA) Class III-IV 45.0% vs. 35.3%, P < 0.0001], more obstructive physiology (77.4% vs. 71.8%, P = 0.0001), more mitral regurgitation (moderate or greater in 56.1% vs. 43.9%, P < 0.0001), higher E/e' ratio (n = 1649, 20.6 vs. 15.6, P < 0.0001), higher estimated pulmonary artery systolic pressure (n = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, P < 0.0001), worse cardiopulmonary exercise performance (n = 1267; percent VO2 predicted 62.8 ± 20% vs. 65.8 ± 19.2%, P = 0.007), and underwent more frequent alcohol septal ablation (4.9% vs. 3.0%, P = 0.004) but similar frequency of myectomy (28% vs. 30%, P = 0.24). Median follow-up was 10.9 (IQR 7.4-16.2) years. Kaplan-Meier analysis demonstrated lower survival in women compared with men (P < 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03-1.22], P = 0.01) when adjusted for age, NYHA Class III-IV symptoms, and cardiovascular comorbidities. Conclusion Women with HCM present at more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different haemodynamics than men. Sex is an important determinant in HCM management as women with HCM have worse survival. Women may require more aggressive diagnostic and therapeutic approaches.
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Affiliation(s)
- Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Kevin C Ong
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Konstantinos C Siontis
- Department of Internal Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Virginia B Hebl
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA.,Department of Pediatrics, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA.,Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - David O Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Virginia M Miller
- Women's Health Research Center, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Rick A Nishimura
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Bernard J Gersh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
| | - Steve R Ommen
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
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13
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Weissler-Snir A, Adler A, Williams L, Gruner C, Rakowski H. Prevention of sudden death in hypertrophic cardiomyopathy: bridging the gaps in knowledge. Eur Heart J 2018; 38:1728-1737. [PMID: 27371714 DOI: 10.1093/eurheartj/ehw268] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022] Open
Abstract
Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). Although the annual rate of SCD in the general HCM population is <1% per year according to contemporary series, there is still a small subset of patients who are at increased risk of SCD. The greatest challenge in the management of HCM is identifying those at increased risk as an implantable cardioverter defibrillator is a potentially life-saving therapy. In this review, we sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting European and American recommendations on risk stratification, with balanced guidance with regards to rational clinical decision making. Additionally, we sought to learn more on the actual implementation of the guidelines by HCM experts worldwide.
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Affiliation(s)
- Adaya Weissler-Snir
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Lynne Williams
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Christiane Gruner
- Division of Cardiology, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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14
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Bray JJH, Bucciarelli-Ducci C, Stuart G. Implantable cardioverter defibrillators in the context of hypertrophic cardiomyopathy: a lesson in patient autonomy. BMJ Case Rep 2018; 2018:bcr-2017-223352. [DOI: 10.1136/bcr-2017-223352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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15
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Abstract
Hypertrophic cardiomyopathy is a common, inherited heart disease with a heterogeneous clinical presentation and natural history. Recently, advances in diagnosis and treatment options have been instrumental in decreasing the frequency of adverse clinical events; however, complete elimination of sudden cardiac death still remains an elusive gain. This article discusses several aspects of this condition in the young: epidemiology, clinical phenotypes, risk factors, prevention of sudden cardiac death, and risks of athletic participation.
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16
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Kim SS, Ko SM, Choi SI, Choi BH, Stillman AE. Sudden cardiac death from structural heart diseases in adults: imaging findings with cardiovascular computed tomography and magnetic resonance. Int J Cardiovasc Imaging 2016; 32 Suppl 1:21-43. [PMID: 27139460 DOI: 10.1007/s10554-016-0891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Arthur E Stillman
- Department of Radiology, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA, USA
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17
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Villa ADM, Sammut E, Zarinabad N, Carr-White G, Lee J, Bettencourt N, Razavi R, Nagel E, Chiribiri A. Microvascular ischemia in hypertrophic cardiomyopathy: new insights from high-resolution combined quantification of perfusion and late gadolinium enhancement. J Cardiovasc Magn Reson 2016; 18:4. [PMID: 26767610 PMCID: PMC4714488 DOI: 10.1186/s12968-016-0223-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/05/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Microvascular ischemia is one of the hallmarks of hypertrophic cardiomyopathy (HCM) and has been associated with poor outcome. However, myocardial fibrosis, seen on cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE), can be responsible for rest perfusion defects in up to 30% of patients with HCM, potentially leading to an overestimation of the ischemic burden. We investigated the effect of left ventricle (LV) scar on the total LV ischemic burden using novel high-resolution perfusion analysis techniques in conjunction with LGE quantification. METHODS 30 patients with HCM and unobstructed epicardial coronary arteries underwent CMR with Fermi constrained quantitative perfusion analysis on segmental and high-resolution data. The latter were corrected for the presence of fibrosis on a pixel-by-pixel basis. RESULTS High-resolution quantification proved more sensitive for the detection of microvascular ischemia in comparison to segmental analysis. Areas of LGE were associated with significant reduction of myocardial perfusion reserve (MPR) leading to an overestimation of the total ischemic burden on non-corrected perfusion maps. Using a threshold MPR of 1.5, the presence of LGE caused an overestimation of the ischemic burden of 28%. The ischemic burden was more severe in patients with fibrosis, also after correction of the perfusion maps, in keeping with more severe disease in this subgroup. CONCLUSIONS LGE is an important confounder in the assessment of the ischemic burden in patients with HCM. High-resolution quantitative analysis with LGE correction enables the independent evaluation of microvascular ischemia and fibrosis and should be used when evaluating patients with HCM.
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Affiliation(s)
- Adriana D M Villa
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Eva Sammut
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Niloufar Zarinabad
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | | | - Jack Lee
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | | | - Reza Razavi
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Eike Nagel
- DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt / Main, Frankfurt am Main, Germany.
| | - Amedeo Chiribiri
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute - 4th Floor Lambeth Wing, St Thomas' Hospital, SE1 7EH, London, UK.
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18
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Trivedi A, Knight BP. ICD Therapy for Primary Prevention in Hypertrophic Cardiomyopathy. Arrhythm Electrophysiol Rev 2016; 5:188-196. [PMID: 28116084 DOI: 10.15420/aer.2016:30:2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common and heterogeneous disorder that increases an individual's risk of sudden cardiac death (SCD). This review article discusses the relevant factors that are involved in the challenge of preventing SCD in patients with HCM. The epidemiology of SCD in patients is reviewed as well as the structural and genetic basis behind ventricular arrhythmias in HCM. The primary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy is the cornerstone of modern treatment for individuals at high risk of SCD. The focus here is on the current and emerging predictors of SCD as well as risk stratification recommendations from both North American and European guidelines. Issues related to ICD implantation, such as programming, complications and inappropriate therapies, are discussed. The emerging role of the fully subcutaneous ICD and the data regarding its implantation are reviewed.
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Affiliation(s)
- Amar Trivedi
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
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19
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Agarwal A, Yousefzai R, Jan MF, Cho C, Shetabi K, Bush M, Khandheria BK, Paterick TE, Treiber S, Sra J, Allaqaband S, Bajwa T, Tajik AJ. Clinical Application of WHF-MOGE(S) Classification for Hypertrophic
Cardiomyopathy. Glob Heart 2015; 10:209-19. [DOI: 10.1016/j.gheart.2015.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 10/23/2022] Open
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20
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Maron BJ, Rowin EJ, Casey SA, Link MS, Lesser JR, Chan RHM, Garberich RF, Udelson JE, Maron MS. Hypertrophic Cardiomyopathy in Adulthood Associated With Low Cardiovascular Mortality With Contemporary Management Strategies. J Am Coll Cardiol 2015; 65:1915-28. [PMID: 25953744 DOI: 10.1016/j.jacc.2015.02.061] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) has been prominently associated with adverse disease complications, including sudden death or heart failure death and a generally adverse prognosis, with annual mortality rates of up to 6%. OBJECTIVES This study determined whether recent advances in management strategy, including implantable cardioverter-defibrillators (ICDs), heart transplantation, or other therapeutic measures have significantly improved survival and the clinical course of adult HCM patients. METHODS We addressed long-term outcomes in 1,000 consecutive adult HCM patients presenting at 30 to 59 years of age (mean 45±8 years) over 7.2±5.2 years of follow-up. RESULTS Of 1,000 patients, 918 (92%) survived to 53±9.2 years of age (range 32 to 80 years) with 91% experiencing no or only mild symptoms at last evaluation. HCM-related death occurred in 40 patients (4% [0.53%/year]) at 50±10 years from the following events: progressive heart failure (n=17); arrhythmic sudden death (SD) (n=17); and embolic stroke (n=2). In contrast, 56 other high-risk patients (5.6%) survived life-threatening events, most commonly with ICD interventions for ventricular tachyarrhythmias (n=33) or heart transplantation for advanced heart failure (n=18 [0.79%/year]). SD occurred in patients who declined ICD recommendations, had evaluations before application of prophylactic ICDs to HCM, or were without conventional risk factors. The 5- and 10-year survival rates (confined to HCM deaths) were 98% and 94%, respectively, not different from the expected all-cause mortality in the general U.S. population (p=0.25). Multivariate independent predictors of adverse outcome were younger age at diagnosis, female sex, and increased left atrial dimension. CONCLUSIONS In a large longitudinally assessed adult HCM cohort, we have demonstrated that contemporary management strategies and treatment interventions, including ICDs for SD prevention, have significantly altered the clinical course, now resulting in a low disease-related mortality rate of 0.5%/year and an opportunity for extended longevity.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| | - Susan A Casey
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Mark S Link
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| | - John R Lesser
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Raymond H M Chan
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| | - Ross F Garberich
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - James E Udelson
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
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21
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Sedehi D, Finocchiaro G, Tibayan Y, Chi J, Pavlovic A, Kim YM, Tibayan FA, Reitz BA, Robbins RC, Woo J, Ha R, Lee DP, Ashley EA. Long-term outcomes of septal reduction for obstructive hypertrophic cardiomyopathy. J Cardiol 2015; 66:57-62. [DOI: 10.1016/j.jjcc.2014.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/16/2014] [Accepted: 08/14/2014] [Indexed: 11/15/2022]
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22
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Maron BJ, Ommen SR, Semsarian C, Spirito P, Olivotto I, Maron MS. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol 2014; 64:83-99. [PMID: 24998133 DOI: 10.1016/j.jacc.2014.05.003] [Citation(s) in RCA: 448] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/05/2014] [Indexed: 12/12/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a common inherited heart disease with diverse phenotypic and genetic expression, clinical presentation, and natural history. HCM has been recognized for 55 years, but recently substantial advances in diagnosis and treatment options have evolved, as well as increased recognition of the disease in clinical practice. Nevertheless, most genetically and clinically affected individuals probably remain undiagnosed, largely free from disease-related complications, although HCM may progress along 1 or more of its major disease pathways (i.e., arrhythmic sudden death risk; progressive heart failure [HF] due to dynamic left ventricular [LV] outflow obstruction or due to systolic dysfunction in the absence of obstruction; or atrial fibrillation with risk of stroke). Effective treatments are available for each adverse HCM complication, including implantable cardioverter-defibrillators (ICDs) for sudden death prevention, heart transplantation for end-stage failure, surgical myectomy (or selectively, alcohol septal ablation) to alleviate HF symptoms by abolishing outflow obstruction, and catheter-based procedures to control atrial fibrillation. These and other strategies have now resulted in a low disease-related mortality rate of <1%/year. Therefore, HCM has emerged from an era of misunderstanding, stigma, and pessimism, experiencing vast changes in its clinical profile, and acquiring an effective and diverse management armamentarium. These advances have changed its natural history, with prevention of sudden death and reversal of HF, thereby restoring quality of life with extended (if not normal) longevity for most patients, and transforming HCM into a contemporary treatable cardiovascular disease.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | | | - Christopher Semsarian
- Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Sydney, Australia
| | | | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Martin S Maron
- Tufts Medical Center and School of Medicine, Boston, Massachusetts
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23
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O'Mahony C, Elliott P, McKenna W. Sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 2012; 6:443-51. [PMID: 23022709 DOI: 10.1161/circep.111.962043] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Constantinos O'Mahony
- The Inherited Cardiac Diseases Unit, The Heart Hospital/University College London, London, United Kingdom
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Abstract
Thirty-eight non-operated patients with hypertrophic obstructive cardiomyopathy (HOCM) were followed for 1--18 years (mean 8). Twelve patients died, nine of them instantaneously without any other apparent cause of death. The symptoms on the first admission did not discriminate between those who died and those who survived during the observation period, nor did the findings at heart catheterization at rest or left ventricular angiocardiography. However, cardiac enlargement on the first chest X-ray was significantly more common in the decreased group, 75% against 27%, as was the complete absence of a q-wave in lead III on the first ECG, 83% against 42%. The combination of complete lack of q in lead III and cardiac enlargement on chest X-ray at the initial examination was present in 9 of the 12 deceased (75%) and in only 3 of 24 survivors (13%). This can be used to select patients for long-term prophylaxis against ventricular fibrillation which, according to the literature, is the main mechanism of instantaneous death in HOCM.
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25
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Abstract
Hypertrophic cardiomyopathy is characterized by a hypertrophic and non-dilated left ventricle with disproportionate involvement of the intraventricular septum compared to the free walls, and by varying degrees of outflow obstruction during systole. Its symptoms and clinical course, pathogenesis and treatment are briefly discussed. It is speculated whether hypertrophic cardiomyopathy and hypertension are both caused by systemic disorders of calcium channels and calcium uptake and binding by cardiac and smooth muscle membranes, respectively.
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Ikeda U, Yamamoto K, Shimada K. Biochemical markers of coagulation activation in mitral stenosis, atrial fibrillation, and cardiomyopathy. Clin Cardiol 2009; 20:7-10. [PMID: 8994731 PMCID: PMC6656130 DOI: 10.1002/clc.4960200104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Advances in the understanding of the biochemistry of the mechanism of hemostasis have led to the development of sensitive methods for determining levels of markers which reflect thrombin activity (thrombin-antithrombin III complex, fibrinopeptide A, F1 + 2 fragment), active fibrinolysis (D-dimer, plasmin-alpha 2-plasmin inhibitor complex), and platelet activity (platelet factor 4, beta-thromboglobulin) in vivo. Measurement of these markers may be useful in identifying patients with various cardiovascular disorders at high risk of thromboembolism.
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Affiliation(s)
- U Ikeda
- Department of Cardiology, Jichi Medical School, Tochigi, Japan
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Cambronero F, Marín F, Roldán V, Hernández-Romero D, Valdés M, Lip GYH. Biomarkers of pathophysiology in hypertrophic cardiomyopathy: implications for clinical management and prognosis. Eur Heart J 2009; 30:139-51. [PMID: 19136482 DOI: 10.1093/eurheartj/ehn538] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The study of biomarkers and their signalling pathways has allowed the development of new therapeutic strategies in a range of disorders. The aim of the present systematic review is to provide an overview of different biomarkers in patients with hypertrophic cardiomyopathy that could give some insight into the pathophysiologic mechanism(s) underlying the typical clinical and histological manifestations of the disease. Several pathophysiological models are presented and discussed, including studies that have investigated these biomarkers for diagnostic and prognostic reasons, in relation to disease progression and/or mortality.
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Affiliation(s)
- Francisco Cambronero
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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You JJ, Woo A, Ko DT, Cameron DA, Mihailovic A, Krahn M. Life expectancy gains and cost-effectiveness of implantable cardioverter/defibrillators for the primary prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy. Am Heart J 2007; 154:899-907. [PMID: 17967596 DOI: 10.1016/j.ahj.2007.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) is a devastating complication of hypertrophic cardiomyopathy (HCM). The optimal strategy for the primary prevention of SCD in HCM remains controversial. METHODS Using a Markov model, we compared the health benefits and cost-effectiveness of 3 strategies for the primary prevention of SCD: implantable cardioverter/defibrillator (ICD) insertion, amiodarone therapy, or no therapy. We modeled hypothetical cohorts of 45-year-old patients with HCM with no history of cardiac arrest but at significant risk of SCD (3%/y). RESULTS Over a lifetime, compared with no therapy, ICD therapy increased quality-adjusted survival by 4.7 quality-adjusted life years (QALYs) at an additional cost of $142,800 ($30,000 per QALY), whereas amiodarone increased quality-adjusted survival by 2.8 QALYs at an additional cost of $104,900 ($37,300 per QALY). Compared with no therapy, ICD therapy would cost < $50,000 per QALY for patients (i) aged 25, with > or = 1 risk factors for SCD, and (ii) aged 45 or 65, with > or = 2 risk factors for SCD. CONCLUSIONS An ICD strategy is projected to yield the greatest increase in quality-adjusted life expectancy of the 3 treatment strategies evaluated. Combined consideration of age and the number of risk factors for SCD may allow more precise tailoring of ICD therapy to its expected benefits.
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Elliott PM, Gimeno JR, Thaman R, Shah J, Ward D, Dickie S, Tome Esteban MT, McKenna WJ. Historical trends in reported survival rates in patients with hypertrophic cardiomyopathy. Heart 2005; 92:785-91. [PMID: 16216855 PMCID: PMC1860645 DOI: 10.1136/hrt.2005.068577] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the range of survival rates of patients with hypertrophic cardiomyopathy (HCM) by comparing and contrasting the natural history of a cohort of patients seen between 1988 and 2002 with that of other published series. METHODS 956 adult (> or = 16 years old) patients with HCM (572 men, mean (SD) age 42 (15) years, range 16-88) were evaluated by ECG, Holter, exercise testing, and echocardiography. Patient characteristics and survival data were compared with those in natural history studies from referral and non-referral centres published between 1960 and January 2003. RESULTS The duration of follow up was 69 (45) months. 120 (12.6%) patients died or underwent cardiac transplantation. Sudden cardiac death (n = 48) was the most common mode of death. The annual rate of sudden death or implantable cardioverter-defibrillator discharge was 1.02 (95% confidence interval (CI) 0.76 to 1.26). Annual rates for heart failure death or transplantation and stroke related death were 0.55% (95% CI 0.37% to 0.78%) and 0.07% (95% CI 0.02% to 0.19%), respectively. When studies published within the last 10 years of the study period were compared with earlier reports, the size of individual study cohorts was larger (309 (240.6) v 136.5 (98.8), p = 0.058) and the proportion with severe functional limitation NYHA class III/IV lower (12.4% v 24.8%, p < 0.0001), and fewer patients underwent septal myotomy-myectomy (5.2% v 18.7%, p < 0.0001). Published sudden death rates over the last 10 years were lower than previously published figures (median 1.0% (range 0.1-1.7) v 2.0% (0-3.5)). CONCLUSION Published survival rates in HCM cohorts have improved progressively over the past 40 years. In the modern era the prevalence of disease related complications is similar in all reporting centres.
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Affiliation(s)
- P M Elliott
- The Heart Hospital, University College London, London, UK.
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Wald DS, Law M, Morris JK. Mortality from hypertrophic cardiomyopathy in England and Wales: clinical and screening implications. Int J Cardiol 2005; 97:479-84. [PMID: 15561336 DOI: 10.1016/j.ijcard.2003.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2003] [Revised: 11/14/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy is considered a relatively common cause of death in the young. Screening for the disorder has been advocated, but its potential value cannot be assessed because the number of deaths in asymptomatic cases in the general population has not been investigated. We determined the annual number of deaths (and death rates) from hypertrophic cardiomyopathy in England and Wales according to age, sex and the presence or absence of symptoms so that an affected individual's risk of dying from the disorder and the implications of screening could be assessed. METHODS Ascertainment of all deaths from hypertrophic cardiomyopathy over a 3-year period (1996-1998), using death certification data from the Office of National Statistics. Deaths in people without symptoms were identified from coroner's reports and correspondence with pathologists who conducted the necropsies. RESULTS There were 184 deaths per year from hypertrophic cardiomyopathy in England and Wales (about 15% of all deaths from cardiomyopathy) of which one third (65) were in people without symptoms. Most (110) of the 184 deaths each year were in people over age 55. Under age 55 there were only 37 deaths each year in asymptomatic people, out of an estimated 60,000 people with the disorder in the population. Of the 37 deaths, 14 (20%) occurred in relation to physical activity and 2 after competitive sport. CONCLUSIONS In young people without symptoms hypertrophic cardiomyopathy is fairly common (1 in 500) but it rarely causes death; the case-fatality rate is about 6 per 10,000 per year. Current risk estimates from the study of patients in tertiary referral centers or general hospital clinics (420 and 110 deaths per 10,000 per year, respectively) are not applicable to asymptomatic people in the general population; such people, if incidentally identified can be reassured of their low risk of death. Screening would not be worthwhile unless a satisfactory test becomes available that can detect those few cases likely to die.
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Affiliation(s)
- David S Wald
- Department of Cardiology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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Kawasaki T, Azuma A, Sakatani T, Hadase M, Kamitani T, Kawasaki S, Kuribayashi T, Sugihara H. Prognostic value of heart rate variability in patients with hypertrophic cardiomyopathy. J Electrocardiol 2005; 36:333-8. [PMID: 14661170 DOI: 10.1016/j.jelectrocard.2003.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) have been reported to display impaired heart rate variability, although little is known regarding its prognostic value. By using fast Fourier transformation of 24-hour Holter recordings in 73 HCM patients at a stable clinical condition, we computed 4 spectral components: very low frequency, low frequency, high frequency, and total power. During 28 months, 7 HCM patients experienced death or acquired hospitalization for heart failure. Sudden death did not occurred. High frequency component was lower in HCM patients with cardiac events than that in patients without cardiac events (3.78 +/- 0.66 vs. 4.43 +/- 0.92 In(ms(2)), P =.045). There were no significant differences in other heart rate variability variables between HCM patients with and without cardiac events. In multivariate analysis, high frequency component remained to be an independent predictor of cardiac events (relative risk=0.10, 95% CI 0.01-0.73, P =.023). Heart rate variability analysis is predictive of heart failure in our cohort of HCM patients, whereas its predictive value of sudden death remains unclear.
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Affiliation(s)
- Tatsuya Kawasaki
- Department of Cardiology, Matushita Memorial Hospital, Morigu-chi city, Osaka, Japan.
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Yang HS, Song JK, Song JM, Kang DH, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Comparison of the clinical features of apical hypertrophic cardiomyopathy versus asymmetric septal hypertrophy in Korea. Korean J Intern Med 2005; 20:111-5. [PMID: 16134764 PMCID: PMC3891378 DOI: 10.3904/kjim.2005.20.2.111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We sought to test whether patients with apical hypertrophic cardiomyopathy (APH) have different clinical features compared to those with typical asymmetric septal hypertrophy (ASH). METHODS Among 32,534 patients who underwent routine echocardiography at Asan Medical Center from January 2000 to December 2001, 305 patients (0.9%), who were finally diagnosed with hypertrophic cardiomyopathy (HCMP), were evaluated. The type of HCMP was classified according to the echocardiographic findings. RESULTS ASH was the most frequent type (n=160, 53%, group I), and APH was the second most frequent (n=91, 30%, group II). Mean age (60.8 +/- 10 vs. 48.2 +/- 14 years, p<0.001) and prevalence of hypertension (32% vs. 19%, p=0.022) were significantly higher in group II than in group I. Family history of HCMP (4.4% vs. 0% p=0.043) and sudden cardiac death (8.8% vs. 1.1% p=0.014) was more prevalent in group I. During the follow-up period of 32.0 +/- 37.2 months, cardiac events occurred at a significantly higher rate in group I (25.5% vs. 8.8%, p=0.003). CONCLUSION APH comprises a significant proportion of HCMP in Korea and patients with APH show different clinical features compared to those with ASH.
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Affiliation(s)
- Hyun Suk Yang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Whan Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Wook Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Maron BJ, Casey SA, Hauser RG, Aeppli DM. Clinical course of hypertrophic cardiomyopathy with survival to advanced age. J Am Coll Cardiol 2003; 42:882-8. [PMID: 12957437 DOI: 10.1016/s0735-1097(03)00855-6] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study was designed to clarify and resolve the clinical profile of older patients with hypertrophic cardiomyopathy (HCM). BACKGROUND Adverse consequences of HCM such as sudden death and incapacitating symptoms have been emphasized for the young and middle-aged. METHODS Long-term outcome of HCM was assessed in a community-based cohort not subject to tertiary center referral bias. RESULTS Of 312 patients, 73 (23%) achieved normal life expectancy (> or =75 years; range to 96); 44 (14%) were > or =80 years old. Most patients > or =75 years (47; 64%) experienced no or only mild limiting symptoms and lived virtually their entire lives with few HCM-related clinical consequences; 26 patients (36%) experienced severe progressive symptoms. In elderly patients with HCM, diagnosis and symptom onset were considerably delayed to 74 +/- 8 and 70 +/- 11 years, respectively. For patients > or =50 years at diagnosis, the probability of survival for 5, 10, and 15 years was 85 +/- 3%, 74 +/- 4%, and 57 +/- 6%, respectively, and did not significantly differ from a matched general population (p = 0.20). Patients > or =75 years were predominantly women, and had less marked wall thickness and more frequently showed basal outflow obstruction > or =30 mm Hg (compared with those <75 years; p < 0.01 and 0.001, respectively). CONCLUSIONS Hypertrophic cardiomyopathy is frequently well tolerated and compatible with normal life expectancy, and may remain clinically dormant for long periods of time with symptoms and initial diagnosis deferred until late in life. These observations afford a measure of reassurance to many patients with HCM, a disease for which clinical course is often unfavorable and unpredictable.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, 920 E. 28th Street, Suite 60, Minneapolis, MN 55407, USA.
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Kofflard MJM, Ten Cate FJ, van der Lee C, van Domburg RT. Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration. J Am Coll Cardiol 2003; 41:987-93. [PMID: 12651046 DOI: 10.1016/s0735-1097(02)03004-8] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study evaluates the clinical course and identifies risk factors for sudden cardiac death (SCD) and clinical deterioration in hypertrophic cardiomyopathy (HCM) in a large community-based population. Comparison was made with data from six tertiary referral and six nonreferral institutions. BACKGROUND Hypertrophic cardiomyopathy is a disease with marked heterogeneity in clinical presentation and prognosis. Risk factors for SCD are not well defined in patients free of referral bias. METHODS Between 1970 and 1999, 225 consecutive patients (mean age [+/-SD] 41+/-16 years) were examined and followed at yearly intervals. RESULTS Forty-four deaths were recorded of which 27 cases were cardiovascular. Fourteen patients died suddenly, six were successfully resuscitated, and seven patients died of congestive heart failure. The annual mortality, annual cardiac mortality, and annual mortality due to sudden death were 1.3%, 0.8%, and 0.6%, respectively. At least one New York Heart Association (NYHA) functional class deterioration was reported in 33% of the patients with a significant (> or =50 mm Hg) left ventricular outflow tract (LVOT) gradient in contrast to 7% without obstruction. The presence of syncope was related to SCD (p < 0.05). Younger age and more severe functional limitation distinguishes patients from in hospital-based centers from the ones in community-based centers. CONCLUSIONS Hypertrophic cardiomyopathy is a benign disease in an unselected population with a low incidence of cardiac death. Syncope was associated with a higher incidence of SCD and patients with a significant LVOT obstruction were more susceptible to clinical deterioration.
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Affiliation(s)
- Marcel J M Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Abstract
The clinical diagnostic hallmark of hypertrophic cardiomyopathy (HCM) is unexplained cardiac hypertrophy, commonly found on an echocardiogram and in unfortunate occasions, in an autopsy. The latter is most tragic as HCM, a relatively common disease (1 ) often presenting with sudden cardiac death (SCD) in apparently healthy young individuals (2 ,3 ). Indeed, HCM is considered the most common cause of SCD in young competitive athletes (2 ). The unexpected SCD of young athletic individuals in conjunction with the results of earlier studies from major referral centers, reporting an annual mortality rate of approximately 2% to 6% (3 –5 ), led to the impression that HCM is a relatively malignant disease. Population-based studies, however, suggested a more benign course with an annual mortality rate of approximately 1% (6 –9 ). In the largest series comprised of 744 patients, the annual mortality rate was 1.2% of which approximately half were sudden unexpected deaths (9 ).
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Affiliation(s)
- Ali J Marian
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza 519D, Houston, Texas 77030, USA.
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Tekten T, Onbaşili OA, Ceylan C, Ercan E. Left atrial free floating ball thrombus in hypertrophic cardiomyopathy: a case report. J Am Soc Echocardiogr 2002; 15:1018-20. [PMID: 12221426 DOI: 10.1067/mje.2002.120980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this article we reported a 33-year-old female patient who was referred to our emergency department with atrial fibrillation, congestive heart failure, and cardiogenic shock. In her transthoracic echocardiography, a free-floating ball-type mass was seen in the left atrial cavity with a hypertrophic cardiomyopathy. An emergency open-heart surgery was performed. The mass was removed, and pathologic examination confirmed the thrombotic material.
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Affiliation(s)
- Tarkan Tekten
- Adnan Menderes University, Faculty of Medicine, Department of Cardiology, Aydin, Turkey.
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Buell HE, Stables RH, DeLong ER, Shuping KB, Killip DM, Lever HM, McKenna WJ, Rubin D, Sigwart U, Takayama M, Wagner GS, Eisenstein EL, Spencer WH. Percutaneous transluminal septal reduction for hypertrophic obstructive cardiomyopathy: report from an international pilot study. J Med Syst 2002; 26:293-300. [PMID: 12118813 DOI: 10.1023/a:1015812603042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Assessing the effectiveness of newer treatments for rare diseases can be challenging because of the small number of patients treated at individual centers. We enrolled patients undergoing percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) at five international centers (1 Japan, 2 United Kingdom, and 2 United States). Our study group developed standard data definitions regarding clinical symptom severity, previous HOCM treatment, procedure status, and outcome, and entered patient data directly into a shared, web-based registry system. In the first 10 months of 1998, 51 patients were enrolled in our registry, with 47 ultimately receiving the PTSMA procedure. Although HOCM is consider a single disease, there were significant differences among centers in patient characteristics (age, gender, and family history of HOCM), symptom severity, diagnostic techniques (measurements taken after provocation), and treatment (amount of alcohol used, timing of injection, and number of branches attempted).
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Affiliation(s)
- Hope E Buell
- The Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
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Maron BJ, Olivotto I, Spirito P, Casey SA, Bellone P, Gohman TE, Graham KJ, Burton DA, Cecchi F. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation 2000; 102:858-64. [PMID: 10952953 DOI: 10.1161/01.cir.102.8.858] [Citation(s) in RCA: 528] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Death resulting from hypertrophic cardiomyopathy (HCM), particularly when sudden, has been reported to be largely confined to young persons. These data emanated from tertiary HCM centers with highly selected referral patterns skewed toward high-risk patients. METHODS AND RESULTS The present analysis was undertaken in an international population of 744 consecutively enrolled and largely unselected patients more representative of the overall HCM spectrum. HCM-related death occurred in 86 patients (12%) over 8+/-7 years (mean+/-SD). Three distinctive modes of death were as follows: (1) sudden and unexpected (51%; age, 45+/-20 years); (2) progressive heart failure (36%; age, 56+/-19 years); and (3) HCM-related stroke associated with atrial fibrillation (13%; age, 73+/-14 years). Sudden death was most common in young patients, whereas heart failure- and stroke-related deaths occurred more frequently in midlife and beyond. However, neither sudden nor heart failure-related death showed a statistically significant, disproportionate age distribution (P=0.06 and 0.5, respectively). Stroke-related deaths did occur disproportionately in older patients (P=0.002). Of the 45 patients who died suddenly, most (71%) had no or mild symptoms, and 7 (16%) participated in moderate to severe physical activities at the time of death. CONCLUSIONS HCM-related cardiovascular death occurred suddenly, or as a result of heart failure or stroke, largely during different phases of life in a prospectively assembled, regionally based, and predominantly unselected patient cohort. Although most sudden deaths occurred in adolescents and young adults, such catastrophes were not confined to patients of these ages and extended to later phases of life. This revised clinical profile suggests that generally held epidemiological tenants for HCM have been influenced considerably by skewed reporting from highly selected populations. These data are likely to importantly affect risk stratification and treatment strategies importantly for the prevention of sudden death in HCM.
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Affiliation(s)
- B J Maron
- Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
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Yamanari H, Fukushima K, Miyaji K, Yamamoto M, Nagase S, Otsuka FM, Nakayama K, Matsubara H, Emori T, Ohe T. Effects of Myocardial Perfusion on QT Dispersion in Patients with Hypertrophic Cardiomyopathy. Ann Noninvasive Electrocardiol 2000. [DOI: 10.1111/j.1542-474x.2000.tb00247.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Takagi E, Yamakado T, Nakano T. Prognosis of completely asymptomatic adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999; 33:206-11. [PMID: 9935031 DOI: 10.1016/s0735-1097(98)00555-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We investigated the long-term prognosis of completely asymptomatic adult patients with hypertrophic cardiomyopathy (HC). Diagnosis of HC was suspected because of an abnormal electrocardiogram and/or cardiac murmur and confirmed by echocardiography and/or left ventricular angiography, and hemodynamic investigation. BACKGROUND Hypertrophic cardiomyopathy shows marked heterogeneity in clinical expression and prognosis. The prognosis of asymptomatic patients with HC has not been fully defined. METHODS Of 128 consecutive adult patients with HC, 58 asymptomatic patients (Group 1, mean age 42.8 years) and 70 symptomatic patients (Group 2, mean age 50.4 years) were studied to assess cardiac mortality. Mean follow-up periods were 11.0 years for Group 1 and 9.1 years for Group 2. RESULTS At presentation, Group 1 patients were younger and had smaller left atrial dimensions than did Group 2 patients. The annual cardiac mortality rate and the rate for sudden death alone in Group 1 were significantly lower than in Group 2 (0.9% vs. 1.9%, p < 0.05, 0.1% vs. 1.4%, p < 0.05, respectively). Although about one-third of the survivors in Group 1 had cardiac symptoms at their most recent evaluation, only one patient died suddenly compared with eight in Group 2. The annual mortality rate due to heart failure was similar in each group. Only a syncopal episode was associated with both cardiac death and sudden death for both groups combined. CONCLUSIONS The cardiac mortality rate for completely asymptomatic adult patients with HC was very low, significantly lower than that of symptomatic patients, and there was a disproportionately low incidence of sudden death.
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Affiliation(s)
- E Takagi
- First Department of Internal Medicine, Mie University, Tsu, Japan
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Maki S, Ikeda H, Muro A, Yoshida N, Shibata A, Koga Y, Imaizumi T. Predictors of sudden cardiac death in hypertrophic cardiomyopathy. Am J Cardiol 1998; 82:774-8. [PMID: 9761089 DOI: 10.1016/s0002-9149(98)00455-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patients with hypertrophic cardiomyopathy (HC) die suddenly. Proposed risk factors for sudden cardiac death (SCD) in HC are youth, a family history of SCD, syncope, and ventricular tachycardia. Hemodynamic variables have not convincingly proved to be risk factors for SCD. Therefore, this study was designed to examine predictors of SCD in a large number of patients with HC during long-term follow-up periods. The relation of studied variables (clinical, electrocardiographic, echocardiographic, hemodynamic, and exercise test findings) to SCD in 309 patients with HC who were initially diagnosed during 1971 through 1994 (mean follow-up 9.4 years) was examined by multivariate analysis. SCD occurred in 28 patients. Independent predictors of SCD were a smaller difference between peak and rest systolic blood pressure during exercise testing (p=0.006), and higher left ventricular outflow tract pressure gradient at rest (p=0.003). Exercise-related SCD occurred in 8 patients and exercise-unrelated SCD in 20 patients (mean age 28 vs 47 years, p <0.05). Thus, patients of exercise-related SCD were younger and had smaller increases in systolic blood pressure during exercise testing, whereas patients with exercise-unrelated SCD were older and had higher left ventricular outflow tract pressure gradient.
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Affiliation(s)
- S Maki
- The Department of Internal Medicine III, The Kurume University Medical Center, Japan
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Cecchi F, Olivotto I, Montereggi A, Squillatini G, Dolara A, Maron BJ. Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population. Heart 1998; 79:331-6. [PMID: 9616338 PMCID: PMC1728662 DOI: 10.1136/hrt.79.4.331] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Amiodarone has been reported to reduce the likelihood of sudden death in patients with hypertrophic cardiomyopathy (HCM). However, data regarding the clinical course in HCM have traditionally come from selected referral populations biased toward assessment of high risk patients. AIMS To evaluate antiarrhythmic treatment for sudden death in an HCM population not subject to tertiary referral bias, closely resembling the true disease state present in the community. METHODS Cardiovascular mortality was assessed in relation to the occurrence of non-sustained ventricular tachycardia (NSVT) on 24 or 48 hour ambulatory Holter recording, a finding previously regarded as a marker for sudden death, particularly when the arrhythmia was frequent, repetitive or prolonged. 167 consecutive patients were analysed by multiple Holter ECG recordings (mean (SD) 157 (129) hours) and followed for a mean of 10 (5) years. Only patients with multiple repetitive NSVT were treated with amiodarone, and in relatively low. doses (220 (44) mg/day). RESULTS Nine HCM related deaths occurred: 8 were the consequence of congestive heart failure, but only 1 was sudden and unexpected. Three groups of patients were segregated based on their NSVT profile: group 1 (n = 39), multiple (> or = 2 runs) and repetitive bursts (on > or = 2 Holters) of NSVT, or prolonged runs of ventricular tachycardia, included 4 deaths due to heart failure; group 2 (n = 38), isolated infrequent bursts of NSVT, included 1 sudden death; group 3 (n = 90), without NSVT, included 4 heart failure deaths. Kaplan-Meier survival analysis showed no significant differences in survival between the three groups throughout follow up. CONCLUSIONS In an unselected patient population with HCM, isolated, non-repetitive bursts of NSVT were not associated with adverse prognosis and so this arrhythmia does not appear to justify chronic antiarrhythmic treatment. Amiodarone, administered in relatively low doses, did not carry an independent and additive risk for cardiac mortality. Amiodarone may have contributed to the absence of sudden cardiac death in patients believed to be at higher risk because of multiple repetitive NSVT.
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MESH Headings
- Adult
- Aged
- Amiodarone/therapeutic use
- Anti-Arrhythmia Agents/therapeutic use
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/drug therapy
- Cardiomyopathy, Hypertrophic/mortality
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Echocardiography
- Electrocardiography, Ambulatory
- Evaluation Studies as Topic
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Patient Selection
- Prognosis
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Treatment Outcome
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Affiliation(s)
- F Cecchi
- Ospedale di Careggi, Florence, Italy
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45
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Abstract
Supraventricular and ventricular arrhythmias, particularly nonsustained ventricular tachycardia, and ventricular premature beats are a common finding in patients with hypertrophic cardiomyopathy. Several investigations have demonstrated that nonsustained ventricular tachycardia on Holter monitoring is associated with an increased risk of sudden cardiac death. It has been a long lasting controversial discussion whether suppression of these arrhythmias with drugs, such as amiodarone is capable to reduce the incidence of sudden cardiac death. While recent studies have indicated that nonsustained ventricular tachycardia in asymptomatic patients without additional risk factors, such as a positive family history of sudden cardiac death or syncope should not be treated prophylactically with amiodarone. Symptomatic patients with sustained ventricular tachycardias and/or syncope related to ventricular arrhythmias should undergo ICD implantation. The implantation of an ICD in asymptomatic patients should be limited to those who have several risk factors for sudden cardiac death. It is questionable whether other risk stratifiers, such as programmed electrical stimulation may be helpful to identify asymptomatic patients who are at risk to die suddenly. Moreover, whether the demonstration of electrocardiogram fractionation during electrophysiological study is superior to the induction of sustained ventricular arrhythmias for risk stratification, needs further investigation.
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MESH Headings
- Anti-Arrhythmia Agents/adverse effects
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Cardiac Pacing, Artificial
- Cardiomyopathy, Hypertrophic/complications
- Death, Sudden, Cardiac/etiology
- Defibrillators, Implantable
- Electrocardiography, Ambulatory
- Humans
- Risk Assessment
- Risk Factors
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/diagnosis
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Ponoth P, Kerr A, Raudkivi PJ, Grahm K, Hydock D, Milson P. Surgical correction of hypertrophic obstructive cardiomyopathy: seventeen-year Green Lane experience. J Card Surg 1997; 12:294-9. [PMID: 9635266 DOI: 10.1111/j.1540-8191.1997.tb00142.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Between 1977 and 1994, 42 patients were treated surgically for hypertrophic obstructive cardiomyopathy (HOCM). Patients have been followed up between 2 months to 17 years, mean of 107 months. There were 26 (62%) males and 16 (38%) females. There was only one pediatric case. There was no correlating factor among the ethnic groups (Maori, European, Indian, Asian, etc.). Family history was noted in 12% of the cases. Seventy-one percent of patients had aortic/left ventricular (LV) combined approach while 29% had aortic approach alone at the time of surgery. Five patients underwent other procedures, along with coronary artery bypass grafting in 3, mitral valve replacement in 1, and aortic valve replacement in 1. Persistent postoperative arrhythmias were found in 7 cases, atrial fibrillation (AF) in 3, and left bundle branch block in 4.
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Affiliation(s)
- P Ponoth
- Department of Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand
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47
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Lip GY. Intracardiac thrombus formation in cardiac impairment: the role of anticoagulant therapy. Postgrad Med J 1996; 72:731-8. [PMID: 9015466 PMCID: PMC2398676 DOI: 10.1136/pgmj.72.854.731] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The presence of intracardiac thrombus has been associated with many diseases and clinical states, although cardiac impairment is commonly also present. Despite this, there continues to be a lack of consensus on which patients with cardiac impairment should have anticoagulant therapy. This review discusses the relationship between thromboembolism and cardiac impairment secondary to ischaemic heart disease, and suggests possible mechanisms, methods of diagnosis and therapeutic strategies for anticoagulation in such patients. In particular, warfarin has been established as thromboprophylaxis in certain subgroups of patients with cardiac impairment secondary to ischaemic heart disease. A large-scale randomised controlled trial in ambulant patients with cardiac impairment to evaluate the effectiveness of anticoagulant therapy and antiplatelet therapy is, however, long overdue.
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Affiliation(s)
- G Y Lip
- University Department of Medicine, City Hospital, Birmingham
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48
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Cecchi F, Olivotto I, Montereggi A, Santoro G, Dolara A, Maron BJ. Hypertrophic cardiomyopathy in Tuscany: clinical course and outcome in an unselected regional population. J Am Coll Cardiol 1995; 26:1529-36. [PMID: 7594081 DOI: 10.1016/0735-1097(95)00353-3] [Citation(s) in RCA: 215] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Our aim was to study a population of patients with hypertrophic cardiomyopathy from the well defined geographic region of Tuscany in central Italy, a group virtually free of selective referral bias and therefore probably closely representative of the true patient population with this disease. BACKGROUND Most available information on clinical course, natural history and prognosis of hypertrophic cardiomyopathy is based on data generated from tertiary referral centers and therefore constitutes a potentially biased perspective of the disease process in this complex and diverse condition. METHODS The study group comprised 202 patients aged 1 to 74 years (mean +/- SD 41 +/- 17) at initial diagnosis and followed up for 1 to 30 years (mean 10 +/- 5). RESULTS Largely with the use of single or multiple drug therapy, the vast majority of patients (n = 154 [76%]) were asymptomatic or mildly symptomatic and in stable or improved condition over the period of follow-up, whereas the remaining patients (n = 48 [24%]) experienced deterioration, had substantial functional impairment or died. Of the 13 patients (6%) who died of cardiovascular causes related to hypertrophic cardiomyopathy, 11 had progressive congestive heart failure (including 6 in the end-stage phase) and only 2 died suddenly. The annual mortality rate for cardiovascular disease was 0.6% and that due to sudden cardiac death was only 0.1%; the cumulative survival rate was 97%, 95% and 92%, respectively, at 5, 10 and 15 years of follow-up. Atrial fibrillation proved to be a relatively common (n = 57 [28%]) and particularly unfavorable clinical feature, with premature death occurring in 9 of the 57 patients. The cumulative survival rate after 15 years was 76% for patients with atrial fibrillation versus 97% for patients with sinus rhythm. Syncope occurred in 33 patients (16%) but did not appear to be of prognostic significance. CONCLUSIONS In an unselected regional population, hypertrophic cardiomyopathy had a relatively benign prognosis inconsistent with its prior characterization as a generally progressive disorder, based primarily on the experience of selected referral institutions. Sudden unexpected cardiac death was distinctly uncommon, although a sizable proportion of patients (particularly the subset prone to atrial fibrillation), did experience clinical deterioration.
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Affiliation(s)
- F Cecchi
- Cardiologia di San Luca, Ospedale di Careggi, Florence, Italy
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49
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Cannan CR, Reeder GS, Bailey KR, Melton LJ, Gersh BJ. Natural history of hypertrophic cardiomyopathy. A population-based study, 1976 through 1990. Circulation 1995; 92:2488-95. [PMID: 7586349 DOI: 10.1161/01.cir.92.9.2488] [Citation(s) in RCA: 170] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a disease entity characterized by marked heterogeneity in morphology and natural history. Most of our knowledge of the natural history of this disorder derives from the study of hospital-based populations and is influenced by referral bias. Therefore, this population-based study was undertaken to examine the natural history of hypertrophic cardiomyopathy among unselected residents of Olmsted County, Minnesota. METHODS AND RESULTS Patients with hypertrophic cardiomyopathy, confirmed by echocardiography, were identified by use of the resources of the Rochester Epidemiology Project. Patients with the echocardiographic features of hypertrophic cardiomyopathy but with long-standing hypertension requiring drug therapy were categorized as having hypertensive hypertrophic cardiomyopathy. Baseline clinical details and follow-up events were obtained by retrospective chart review. Thirty-seven patients were diagnosed with hypertrophic cardiomyopathy and 24 with hypertensive hypertrophic cardiomyopathy. Eight additional patients were first diagnosed at autopsy. The mean age of the 37 patients with hypertrophic cardiomyopathy was 59 +/- 20 years (range, 1 week to 92 years); the mean ventricular septal thickness was 17.5 +/- 3 mm. Follow-up was obtained for a median of 7.7 years (range, 45 days to 17.2 years). The 1- and 5-year survival rates were 95% and 92%, respectively; these rates did not differ from those of an age- and sex-matched population (P = NS). The annual risk of cardiac death was 0.7%. The mean age of patients with hypertensive hypertrophic cardiomyopathy was 79 +/- 8 years (range, 62 to 91 years), and the mean ventricular septal thickness was 19 +/- 2.5 mm. Follow-up was obtained for a median of 2.8 years (range, 4 days to 16.7 years). The 1- and 5-year survival rates were 75% and 43%, respectively, which differed sharply from the expected rates of 94% and 70% (P = .0028). The annual risk of cardiac death was 5%. Atrial fibrillation and evidence for myocardial infarction on ECG, use of digoxin and diuretics, and a high New York Heart Association functional class at presentation were all associated with decreased survival by multivariate analysis for both groups combined. A history of myocardial infarction, atrial fibrillation, and mitral annual calcification at presentation were associated with cardiac death. CONCLUSIONS Hypertrophic cardiomyopathy is a more benign disease than previously reported from tertiary referral centers. Patients assessed as having hypertensive hypertrophic cardiomyopathy represent a subset at higher risk for cardiac and noncardiac death, with an overall decreased survival rate.
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Affiliation(s)
- C R Cannan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Yamamoto K, Ikeda U, Furuhashi K, Irokawa M, Nakayama T, Shimada K. The coagulation system is activated in idiopathic cardiomyopathy. J Am Coll Cardiol 1995; 25:1634-40. [PMID: 7539015 DOI: 10.1016/0735-1097(95)00049-a] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We investigated the plasma levels of molecular markers for platelet activity and the thrombotic and fibrinolytic status in patients with hypertrophic cardiomyopathy and dilated cardiomyopathy to determine the activating site of coagulation in these disorders. BACKGROUND A thromboembolic event is a serious complication in patients with idiopathic cardiomyopathy. However, the activating site of the coagulation system in idiopathic cardiomyopathy has not been fully investigated. METHODS We determined the plasma levels of molecular markers for platelet activity (platelet factor 4 and beta-thromboglobulin), thrombotic status (fibrinopeptide A and thrombin-antithrombin III complex) and fibrinolytic status (D-dimer and plasmin-alpha 2-plasmin inhibitor complex) in 13 patients with hypertrophic cardiomyopathy, 17 patients with dilated cardiomyopathy and 20 normal subjects. RESULTS Plasma levels of platelet factor 4, beta-thromboglobulin and plasmin-alpha 2-plasmin inhibitor complex did not differ significantly among the three groups, whereas plasma levels of fibrinopeptide A and thrombin-antithrombin III complex in both patient groups were significantly higher than those in normal subjects. Plasma levels of D-dimer in patients with dilated cardiomyopathy were significantly higher than those in patients with hypertrophic cardiomyopathy and normal groups. In patients with hypertrophic cardiomyopathy, both fibrinopeptide A and thrombin-antithrombin III complex levels were significantly correlated with left atrial diameter. In patients with dilated cardiomyopathy, fibrinopeptide A and thrombin-antithrombin III complex levels showed a positive correlation with left ventricular end-diastolic volume and a negative correlation with fractional shortening of the left ventricle. CONCLUSIONS The activated coagulation system in patients with hypertrophic and dilated cardiomyopathy may be triggered by left atrial dilation in hypertrophic cardiomyopathy and left ventricular enlargement and dysfunction in dilated cardiomyopathy.
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Affiliation(s)
- K Yamamoto
- Department of Cardiology, Jichi Medical School, Tochigi, Japan
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