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Nakagawa S, Okada A, Irie Y, Moriuchi K, Amano M, Amaki M, Kanzaki H, Kusano K, Noguchi T, Kitai T, Izumi C. Comparison Between Heart Failure Without Left Ventricular Systolic Dysfunction and Progression to End-Stage in Hypertrophic Cardiomyopathy. Circ J 2024:CJ-24-0049. [PMID: 38910134 DOI: 10.1253/circj.cj-24-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND The incidence and prognostic predictors of heart failure (HF) without left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM), particularly their differences in terms of developing LVSD (progression to end-stage) or sudden cardiac death (SCD), are not fully elucidated.Methods and Results: This study included 330 consecutive HCM patients with left ventricular ejection fraction (LVEF) ≥50%. HF hospitalization without LVSD and development of LVSD were evaluated as main outcomes. During a median follow-up of 7.3 years, the incidence of HF hospitalization without LVSD was 18.8%, which was higher than the incidence of developing LVSD (10.9%) or SCD (8.8%). Among patients who developed LVSD, only 19.4% experienced HF hospitalization without LVSD before developing LVSD. Multivariable analysis showed that predictors for HF hospitalization without LVSD (higher age, atrial fibrillation, history of HF hospitalization, and higher B-type natriuretic peptide concentrations) were different from those of developing LVSD (male sex, lower LVEF, lower left ventricular outflow tract gradient, and higher tricuspid regurgitation pressure gradient). Known risk factors for SCD did not predict either HF without LVSD or developing LVSD. CONCLUSIONS In HCM with LVEF ≥50%, HF hospitalization without LVSD was more frequently observed than development of LVSD or SCD during mid-term follow-up. The overlap between HF without LVSD and developing LVSD was small (19.4%), and these 2 HF events had different predictors.
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Affiliation(s)
- Shoko Nakagawa
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Atsushi Okada
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Yuki Irie
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Kenji Moriuchi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Makoto Amaki
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Hideaki Kanzaki
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Kitai
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
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Zhong Y, Li C, Yu Y, Du Y, Bai Y, Wang X, Dai X, Fan G, Wang G. Evaluation the relationship between myocardial fibrosis and left ventricular torsion measured by cardiac magnetic resonance feature-tracking in hypertrophic cardiomyopathy patients with preserved ejection fraction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03061-7. [PMID: 38448705 DOI: 10.1007/s10554-024-03061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
The relationship between left ventricular (LV) torsion and myocardial fibrosis (MF) in hypertrophic cardiomyopathy (HCM) patients with preserved ejection fraction was still not well understood. New developments in cardiac magnetic resonance (CMR) enable a much fuller assessment of cardiac characteristics. This study sought to assess the impact of HCM on myocardial function as assessed by LV torsion and its relationship with MF. HCM (n = 79) and healthy controls (n = 40) underwent CMR. According to whether there was late gadolinium enhancement (LGE), patients were divided into LGE+ group and LGE- group. LV torsion and torsion rate were measured by CMR feature-tracking (CMR-FT). MF was quantitatively evaluated through LGE imaging. LGE was present in 44 patients (56%). Compared with healthy controls, torsion increased in the LGE- group (P < 0.001). Compared with LGE+ group, torsion was higher in the LGE- group (P < 0.001). There was no significant difference in torsion between LGE+ group and healthy controls. Correlation analysis showed that torsion was correlated with LGE% (r = - 0.443) and LGE mass (r = - 0.435) respectively. On multivariable logistic regression analysis, LV torsion was the only feature that was independently associated with the presence of LGE (OR 0.130; 95% CI 0.040 to 0.420, P = 0.01). The best torsion value associated with MF was 1.91 (sensitivity 60.0%, specificity 77.3%, AUC = 0.733). In HCM patients with preserved ejection fraction, CMR-FT derived LV torsion analysis holds promise for myocardial fibrosis detection.
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Affiliation(s)
- Ying Zhong
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ce Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Yu
- Department of Cardio-surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yaqi Du
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Yun Bai
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xinrui Wang
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xu Dai
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Guoguang Fan
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China.
| | - Guan Wang
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China.
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Ribeiro P, Sá J, Paiva D, Rodrigues PM. Cardiovascular Diseases Diagnosis Using an ECG Multi-Band Non-Linear Machine Learning Framework Analysis. Bioengineering (Basel) 2024; 11:58. [PMID: 38247935 PMCID: PMC10813154 DOI: 10.3390/bioengineering11010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND cardiovascular diseases (CVDs), which encompass heart and blood vessel issues, stand as the leading cause of global mortality for many people. METHODS the present study intends to perform discrimination between seven well-known CVDs (bundle branch block, cardiomyopathy, myocarditis, myocardial hypertrophy, myocardial infarction, valvular heart disease, and dysrhythmia) and one healthy control group, respectively, by feeding a set of machine learning (ML) models with 10 non-linear features extracted every 1 s from electrocardiography (ECG) lead signals of a well-known ECG database (PTB diagnostic ECG database) using multi-band analysis performed by discrete wavelet transform (DWT). The ML models were trained and tested using a leave-one-out cross-validation approach, assessing the individual and combined capabilities of features, per each lead or combined, to distinguish between pairs of study groups and for conducting a comprehensive all vs. all analysis. RESULTS the Accuracy discrimination results ranged between 73% and 100%, the Recall between 68% and 100%, and the AUC between 0.42 and 1. CONCLUSIONS the results suggest that our method is a good tool for distinguishing CVDs, offering significant advantages over other studies that used the same dataset, including a multi-class comparison group (all vs. all), a wider range of binary comparisons, and the use of classical non-linear analysis under ECG multi-band analysis performed by DWT.
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Affiliation(s)
| | | | | | - Pedro Miguel Rodrigues
- CBQF—Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal; (P.R.); (J.S.); (D.P.)
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4
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Cardoso I, Viegas JM, Rosa SA, Brás PG, Grazina A, Cruz I, Branco LM, Galrinho A, Fiarresga A, Lopes LR, Ferreira RC. Three-dimensional echocardiography for the evaluation of hypertrophic cardiomyopathy patients: relation to symptoms and exercise capacity. Int J Cardiovasc Imaging 2023; 39:2475-2481. [PMID: 37821713 PMCID: PMC10691975 DOI: 10.1007/s10554-023-02952-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
Patients with hypertrophic cardiomyopathy may exhibit impaired functional capacity, associated with increased morbidity and mortality. Systolic function is one of the determinants of functional capacity. Early identification of systolic disfunction may identify patients at risk for adverse outcomes. Myocardial deformation parameters, derived from three-dimensional (3D) speckle-tracking echocardiography (3DSTE) are useful tools to assess left ventricular systolic function, and are often abnormal before a decline in ejection fraction is seen. The aim of this study was to evaluate the correlation between myocardial deformation parameters obtained by 3DSTE and functional capacity in patients with hypertrophic cardiomyopathy. Seventy-four hypertrophic cardiomyopathy adult patients were prospectively evaluated. All patients underwent a dedicated 2D and 3D echocardiographic examination and cardiopulmonary exercise testing (CPET). Values of 3D global radial (GRS), longitudinal (3DGLS) and circumferential strain (GCS) were overall reduced in our population: 99% (n = 73) of the patients had reduced GLS, 82% (n = 61) had reduced GRS and all patients had reduced GCS obtain by 3DSTE. Average peak VO2 was 21.01 (6.08) ml/Kg/min; 58% (n = 39) of the patients showed reduced exercise tolerance (predicted peak VO2 < 80%). The average VE/VCO2 slope was 29.0 (5.3) and 16% (n = 11) of the patients had impaired ventilatory efficiency (VE/VCO2 > 34). In multivariable analysis, 3D GLS (β1 = 0.10, 95%CI: 0.03;0.23, p = 0.014), age (β1 = -0.15, 95%CI: -0.23; -0.05, p = 0.002) and female gender (β1 = -5.10, 95%CI: -7.7; -2.6, p < 0.01) were independently associated with peak VO2. No association was found between left ventricle ejection fraction obtain and peak VO2 (r = 0.161, p = 0.5). Impaired myocardial deformation parameters evaluated by 3DSTE were associated with worse functional capacity assessed by peak VO2.
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Affiliation(s)
- Isabel Cardoso
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal.
| | - José Miguel Viegas
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Sílvia Aguiar Rosa
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Pedro Garcia Brás
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - André Grazina
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Inês Cruz
- Hospital Garcia de Orta, Almada, Portugal
| | - Luísa Moura Branco
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Ana Galrinho
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - António Fiarresga
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Luís R Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre, St Bartholomew´s Hospital, London, UK
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Rui Cruz Ferreira
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
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5
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Zhang K, Wang S, Li X, Cui H, Lai Y. Mechanism of Ion Channel Impairment in the Occurrence of Arrhythmia in Patients with Hypertrophic Cardiomyopathy. Cardiol Rev 2023:00045415-990000000-00161. [PMID: 37812010 DOI: 10.1097/crd.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Sudden cardiac death is the most unpredictable and devastating consequence of hypertrophic cardiomyopathy, most often caused by persistent ventricular tachycardia or ventricular fibrillation. Although myocardial hypertrophy, fibrosis, and microvascular disorders are the main mechanisms of persistent reentrant ventricular arrhythmias in patients with advanced hypertrophic cardiomyopathy, the cardiomyocyte mechanism based on ion channel abnormalities may play an important role in the early stages of the disease.
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Affiliation(s)
- Ke Zhang
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shengwei Wang
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaoyan Li
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Hao Cui
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongqiang Lai
- From the Department of Cardiovascular Surgery
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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6
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Calderon Martinez E, Ortiz-Garcia NY, Herrera Hernandez DA, Arriaga Escamilla D, Diaz Mendoza DL, Othon Martinez D, Ramirez LM, Reyes-Rivera J, Choudhari J, Michel G. Hypertrophic Cardiomyopathy Diagnosis and Treatment in High- and Low-Income Countries: A Narrative Review. Cureus 2023; 15:e46330. [PMID: 37916234 PMCID: PMC10618028 DOI: 10.7759/cureus.46330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a hereditary cardiac condition characterized by unexplained left ventricular hypertrophy without a hemodynamic cause. This condition is prevalent in the United States, resulting in various clinical manifestations, including diastolic dysfunction, left ventricular outflow obstruction, cardiac ischemia, and atrial fibrillation. HCM is associated with several genetic mutations, with sarcomeric mutations being the most common and contributing to a more complex disease course. Early diagnosis of HCM is essential for effective management, as late diagnosis often requires invasive treatments and creates a substantial financial burden. Disparities in HCM diagnosis and treatment exist between high-income and low-income countries. High-income countries have more resources to investigate and implement advanced diagnostic and treatment modalities. In contrast, low-income countries face challenges in accessing diagnostic equipment, trained personnel, and affordable medications, leading to a lower quality of life and life expectancy for affected individuals. Diagnostic tools for HCM include imaging studies such as 2D echocardiography, cardiovascular magnetic resonance (CMR), and electrocardiograms (ECGs). CMR is considered the gold standard but remains inaccessible to a significant portion of the world's population, especially in low-income countries. Genetics plays a crucial role in HCM, with numerous mutations identified in various genes. Genetic counseling is essential but often limited in low-income countries due to resource constraints. Disparities in healthcare access and adherence to treatment recommendations exist between high-income and low-income countries, leading to differences in patient outcomes. Addressing these disparities is essential to improve the overall management of HCM on a global scale. In conclusion, this review highlights the complex nature of HCM, emphasizing the importance of early diagnosis, genetic counseling, and access to appropriate diagnostic and therapeutic interventions. Addressing healthcare disparities is crucial to ensure that all individuals with HCM receive timely and effective care, regardless of their geographic location or socioeconomic status.
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Affiliation(s)
| | | | | | | | | | | | - Luz M Ramirez
- Pulmonology and Critical Care, Benemerita Universidad Autonoma de Puebla, Puebla, MEX
| | - Jonathan Reyes-Rivera
- Medicine, Facultad de Medicina Universidad Autónoma de San Luis Potosí, San Luis Potosi, MEX
| | - Jinal Choudhari
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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7
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Santoro F, Mango F, Mallardi A, D'Alessandro D, Casavecchia G, Gravina M, Correale M, Brunetti ND. Arrhythmic Risk Stratification among Patients with Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:jcm12103397. [PMID: 37240503 DOI: 10.3390/jcm12103397] [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: 02/16/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a cardiac muscle disorder characterized by generally asymmetric abnormal hypertrophy of the left ventricle without abnormal loading conditions (such as hypertension or valvular heart disease) accounting for the left ventricular wall thickness or mass. The incidence of sudden cardiac death (SCD) in HCM patients is about 1% yearly in adults, but it is far higher in adolescence. HCM is the most frequent cause of death in athletes in the Unites States of America. HCM is an autosomal-dominant genetic cardiomyopathy, and mutations in the genes encoding sarcomeric proteins are identified in 30-60% of cases. The presence of this genetic mutation carries more than 2-fold increased risk for all outcomes, including ventricular arrhythmias. Genetic and myocardial substrate, including fibrosis and intraventricular dispersion of conduction, ventricular hypertrophy and microvascular ischemia, increased myofilament calcium sensitivity and abnormal calcium handling, all play a role as arrhythmogenic determinants. Cardiac imaging studies provide important information for risk stratification. Transthoracic echocardiography can be helpful to evaluate left ventricular (LV) wall thickness, LV outflow-tract gradient and left atrial size. Additionally, cardiac magnetic resonance can evaluate the prevalence of late gadolinium enhancement, which when higher than 15% of LV mass is a prognostic maker of SCD. Age, family history of SCD, syncope and non-sustained ventricular tachycardia at Holter ECG have also been validated as independent prognostic markers of SCD. Arrhythmic risk stratification in HCM requires careful evaluation of several clinical aspects. Symptoms combined with electrocardiogram, cardiac imaging tools and genetic counselling are the modern cornerstone for proper risk stratification.
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Affiliation(s)
- Francesco Santoro
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Federica Mango
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Adriana Mallardi
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Damiano D'Alessandro
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Matteo Gravina
- Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
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Muacevic A, Adler JR, Unlu S, Boyuk F. A Cardiac Magnetic Resonance Study: Comparison of Biventricular Longitudinal Function in Hypertrophic Cardiomyopathy Patients and Normal Individuals. Cureus 2023; 15:e34165. [PMID: 36843682 PMCID: PMC9949903 DOI: 10.7759/cureus.34165] [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] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is a genetic disease with an incidence of 0.2%-0.5%. It has a wide range of clinical presentations varying from coincidental diagnoses to heart failure, ventricular arrhythmias and sudden cardiac death. Mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) are M-mode-derived practical and reproducible measurements of systolic longitudinal displacement of the annular plane. These two measures may be used as markers of the left ventricular and right ventricular longitudinal functions. Currently, there are only a few studies on cardiac magnetic resonance (CMR)-derived TAPSE and MAPSE measurement comparison between the HCM group and normal control group. The aim of our study is to show the differences in CMR-derived TAPSE and MAPSE values between the HCM and normal population. METHODS We evaluated CMR exams of patients diagnosed with HCM and of normal individuals scanned between 2020 and 2021 retrospectively. The patients were from our own institution's and other hospitals' in- and out-patient departments. Data was collected on 36 HCM patients and 34 adults with no known history of cardiac and non-cardiac diseases. All CMR exams were performed on a 1.5 T (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany) scanner. CMR-derived MAPSE and TAPSE were measured on standard four-chamber steady-state free precession (SSFP) cine images and given in millimeters. RESULTS From February 2020 to December 2021, a total of 150 patients were diagnosed with hypertrophic cardiomyopathy. After exclusion, 36 patients with HCM were included in the study and the normal control group comprised 34 individuals. The mean age of the HCM group was 43.2 + 13.5 years, while it was 37.5 + 11.3 in the control group. The female ratio of the HCM group was found to be 36%, while it was 56% in the healthy control group. MAPSE values were significantly higher in the normal control group when compared to the HCM patient group (MAPSE: 14.5 ± 2.9 mm vs. 11.7 ± 3.2 mm; p<0.001), while TAPSE values did not depict a significant difference between the two groups (p=0.627). CONCLUSIONS This study suggests that MAPSE values are significantly lower in the HCM patient group in comparison with the normal control group on CMR scans. Although not statistically significant, TAPSE values are also lower in the HCM group.
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Iavarone M, Monda E, Vritz O, Albert DC, Rubino M, Verrillo F, Caiazza M, Lioncino M, Amodio F, Guarnaccia N, Gragnano F, Lombardi R, Esposito G, Bossone E, Calabrò P, Losi MA, Limongelli G. Medical treatment of patients with hypertrophic cardiomyopathy: An overview of current and emerging therapy. Arch Cardiovasc Dis 2022; 115:529-537. [DOI: 10.1016/j.acvd.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
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GÜLER A, ŞAHİN AA, AYDİN S, UÇAR SU, UYGUR B, ÇELİK Ö, ERTURK M. Hipertrofik kardiyomiyopati hastalarında atriyal fibrilasyon gelişimini öngörmede kardiyak manyetik rezonans görüntülemenin rolü. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1086581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç:, Bu çalışmada Hipertrofik kardiyomiyopati (HKMP) hastalarında geç kontrast tututulmu (GKT), toplam sol ventrikül kütlesi (TSVK), mitral yetersizlik ve sol atriyum (SA) hacmi dahil olmak üzere Kardiyak manyetik rezonans (KMR) görüntüleme parametreleri ile atriyal fibrilasyon (AF) arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Bu çalışmaya HKMP tanısı alan, KMR çekimi yapılmış ve 48 saatlik Holter monitorizasyonu olan ardışık 122 hasta dahil edilmiştir. KMR tecrübesine sahip Radyoloji ve Kardiyoloji uzman hekimleri tarafından KMR görüntüleri değerlendirilmiştir. TSVK, SA hacmi, GKT varlığı ve yaygınlığı, mitral yetersizliği ve maksimum sol ventrikül kalınlığını içeren KMR parametreleri ile AF arasındaki korelasyon değerlendirilmiştir.
Bulgular: SA hacmi ve AF arasında anlamlı bir korelasyon gözlendi. Ek olarak TSVK, AF ile ilişkili bulundu. TSVK, SA hacmi ve GKT'nin kapsamını değerlendiren lojistik çok değişkenli analiz, yalnızca sol atriyal hacmin bağımsız öngörücü olduğunu ortaya koydu. GKT, TSVK, mitral yetersizlik ve SA hacminin varlığı ve yaygınlığı arasında anlamlı korelasyonlar gözlendi.
Sonuç: GKT'nin varlığı, SA hacmi ile pozitif korelasyon gösterdi. SA hacmi, HKMP hastalarında AF'nin en önemli bağımsız belirleyicisi gibi görünmektedir.
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Affiliation(s)
- Arda GÜLER
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | | | - Sinem AYDİN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Servet Umut UÇAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Begüm UYGUR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Ömer ÇELİK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Mehmet ERTURK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Sudden Cardiac Death Risk over Time in HCM Patients with Implantable Cardioverter-Defibrillator. J Clin Med 2022; 11:jcm11061633. [PMID: 35329959 PMCID: PMC8954740 DOI: 10.3390/jcm11061633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 12/07/2022] Open
Abstract
Background: In patients with HCM at high risk of SCD, an ICD should be considered as a standard of care. Current risk approximation algorithms recommended by ESC 2014 criteria indicate that SCD risk is not stable. The aim of the study was to investigate how the calculated SCD risk in HCM patients with an ICD implanted in the past changed over time. Methods: We analyzed 64 HCM patients with ICD for primary prevention, referred for ICD re-implantation, and 32 HCM patients referred for a first-time ICD placement during the same period. The 5-year-SCD risk was assessed for suitable patients using the recommended ESC calculator. Results: The first-time group had a higher 5-year-SCD risk than those referred for ICD re-implantation: 7.50 (IQR 5.98−10.46) vs. 4.88 (IQR 3.42−7.25), p < 0.05. Out of the patients with an initial calculated risk below 4%, the risk increased in 22% of cases, reaching the 4−6% range. In 78% of patients, the risk remained stable and low. In 31% of patients with an initial calculated SCD risk ≥ 6%, the risk decreased over time to below 6%, and in 14% of the cases, below 4%. Conclusions: SCD risk in HCM patients is usually stable or gets lower. Our data suggest it is important to re-evaluate the risk profile for patients with HCM when ICD re-implantation is considered.
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de la Rosa A, Shah M, Shiota T, Siegel R, Rader F. Comparing echocardiographic characteristics in genotype positive-phenotype positive hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2022; 23:340-348. [PMID: 34694376 DOI: 10.1093/ehjci/jeab217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS There is little information about hypertrophic cardiomyopathy (HCM) with pathologic genetic mutations and concurrent hypertension (HTN). Hypertensive left ventricular hypertrophy (LVH) does not exclude an underlying genetic aetiology. METHODS AND RESULTS This was a single-centre case-control study of 39 adults with pathologic HCM mutations, confirmed by genetic testing, compared to 39 age- and gender-matched patients with hypertensive LVH. The gene-positive HCM cohort was further stratified by the coexisting presence or absence of HTN. Clinical and echocardiographic characteristics were compared. Of 39 gene-positive HCM, 43.6% (17/39) had concurrent HTN. The gene-positive HCM cohort had larger left atrial (LA) area (22.1 cm2 vs. 18.9 cm2, P = 0.002), more diastolic predominant pulmonary vein flow (38.5% vs. 7.7%, P = 0.001), and more moderate diastolic dysfunction (33.3% vs. 12.8%, P = 0.032) when compared with the hypertensive LVH cohort. Greater left ventricular (LV) mass (277.7 g vs. 207.7 g, P = 0.025), increased frequency of severe LVH (58.8% vs. 27.3%, P = 0.047), and more abnormal global longitudinal strain (GLS) (-14.1% vs. -16.9%, P = 0.049) was observed in the gene-positive HCM cohort with concurrent HTN. CONCLUSION Gene-positive HCM, compared to hypertensive LVH, is characterized by more advanced diastolic dysfunction and larger LA size. Gene-positive HCM patients with concomitant HTN had greater LV mass, more severe LVH, and more abnormal GLS, suggesting HTN may negatively affect the progression of myocardial dysfunction in genetic HCM. LVH out-of-proportion to pressure burden in HTN patients should raise suspicion of underlying genetic HCM.
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Affiliation(s)
- Angelo de la Rosa
- Department of Internal Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 5512, Los Angeles, CA 90048, USA
| | - Maulin Shah
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
| | - Takahiro Shiota
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
| | - Robert Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
| | - Florian Rader
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
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Okune M, Yasuda M, Soejima N, Kakehi K, Kawamura T, Kurita T, Nakazawa G, Iwanaga Y. Not Baseline Atrial Fibrillation but New-Onset Atrial Fibrillation and the Loss of Left Atrial Function Are Essential for Predicting Poor Outcomes in Non-ischemic Cardiomyopathy. Front Cardiovasc Med 2022; 8:781125. [PMID: 34970609 PMCID: PMC8712486 DOI: 10.3389/fcvm.2021.781125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The clinical impact of the type of atrial fibrillation (AF) has not been completely elucidated in non-ischemic cardiomyopathy (NICM). Although the structure and function of the left atrium (LA) provide prognostic information in patients with heart failure, the relationship of the AF type with LA structure and function in NICM is unclear. Methods: Consecutive patients with NICM who underwent cardiac magnetic resonance were evaluated and followed. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for major adverse cardiovascular events (MACE) related to the AF type, such as paroxysmal AF, chronic AF, and new-onset AF (NOAF). Results: Among 625 patients with NICM (mean age, 64.4 ± 14.2 years; women, 39.7%), 133 had a history of AF at baseline; of these, 60 had paroxysmal AF. Each baseline AF type was associated with higher LA volume and lower LA emptying fraction but not with an increased incidence of MACE (p = 0.245). New-onset AF developed in 5.9% of patients with sinus rhythm over a median follow-up period of 609 days, and maximum LA volume was a strong and independent predictor [p < 0.001, area under the ROC curve (AUC): 0.795]. Maximum LA volume was superior to LA emptying fraction and B-type natriuretic peptide (AUC: 0.683 and 0.680, respectively). The use of β-blocker and the age of the patient were associated with the incidence of NOAF (HR: 0.37, 95% CI: 0.16-0.84 and HR: 1.05, 95% CI: 1.01-1.09, respectively). Kaplan-Meier analysis showed that patients with NOAF had a higher incidence of MACE than those with sinus rhythm or baseline AF (p = 0.002). NOAF and LA emptying fraction were independent predictors of MACE (HR: 2.28, 95% CI: 1.20-3.97 and HR: 0.98, 95% CI: 0.96-0.99, respectively) after adjusting for age, sex, body mass index, and diagnosis. Conclusions: Paroxysmal and chronic AF in patients with NICM were not associated with an increased incidence of MACE despite their association with LA volume and function. NOAF was independently associated with poor prognosis. Higher maximum LA volume predicted the onset and lower LA emptying fraction was independently associated with poor prognosis.
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Affiliation(s)
- Mana Okune
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Naoko Soejima
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan.,Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
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14
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Ran H, Schneider M, Wan LL, Ren JY, Ma XW, Zhang PY. Quantitative Differentiation of Left Atrial Performance in Hypertrophic Cardiomyopathy: Comparison Between Nonobstruction and Occult Obstruction With 4-dimensional Volume-strain. J Thorac Imaging 2022; 37:34-41. [PMID: 33350718 PMCID: PMC8667794 DOI: 10.1097/rti.0000000000000575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to describe the different components of left atrial (LA) dysfunction predictors in nonobstructive and occult obstructive hypertrophy cardiomyopathy (HCM) patients especially with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (D) longitudinal and circumferential strains. METHODS Twenty-eight nonobstructive HCM patients and 30 occult obstructive HCM patients according to LV outflow tract gradient at rest and after exercise were prospectively enrolled. 4D echocardiographic evaluation was performed in 58 HCM patients, both nonobstructive and occult obstructive, and 38 control subjects. LA reservoir, conduit, contractile functions were performed by 4D volume-strain with volumes and longitudinal, circumferential strains. RESULTS Optimal correlation coefficients obtained between LV 4D mass (index) and LA 4D longitudinal/circumferential strain (r=-0.860 to 0.518, all P<0.001). Both nonobstructive and occult obstructive HCM patients had increased volumes and significantly decreased longitudinal, circumferential strain values with lower reservoir, conduit, contractile functions than the controls (all P<0.001). Occult obstructive HCM patients presented incremented volumes compared with nonobstructive ones (P<0.001 to 0.003). Lower conduit function and higher contractile function indicated with lower reservoir function revealed by circumferential strain in occult obstructive HCM patients than nonobstructive ones (P<0.001 to 0.017). Interclass correlation coefficients of intraobserver and interobserver in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. CONCLUSIONS LA volumes were significantly increased and LA reservoir, conduit, and contractile functions were significantly impaired in HCM patients. Furthermore, different performances of LA functional analyses in nonobstruction and occult obstruction patients with 4D volume-strain echocardiography may facilitate the recognition of subtle LA dysfunctional differentiation in HCM patients.
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Affiliation(s)
- Hong Ran
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Lin-lin Wan
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jun-yi Ren
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiao-wu Ma
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ping-yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
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15
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Francia P, Olivotto I, Lambiase PD, Autore C. Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin'. Europace 2021; 24:1384-1394. [PMID: 34966939 DOI: 10.1093/europace/euab309] [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: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden cardiac death. The heterogeneity of clinical scenarios in HCM and the availability of ICDs with distinct characteristics emphasizes the need for selecting the right device for the right patient. There is growing awareness that unnecessarily complex devices can lead to short- and long-term complications without adding significant clinical benefits. Young patients have the greatest potential years of life gained from the ICD but are also most exposed to device-related complications. This increases the complexity of decision-making of ICD prescription in these often otherwise well patients in whom device selection should be tailored to preserve survival benefit without introducing morbidity. In the light of the multiple clinical phenotypes characterizing HCM, the present article offers evidence-based perspectives helpful in predicting the individual impact of the ICD and choosing the most appropriate device.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital. Dept of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pier D Lambiase
- Institute of Cardiovascular Science, UCL Department of Cardiology, Barts Heart Centre, London, UK
| | - Camillo Autore
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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16
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Trongtorsak A, Polpichai N, Thangjui S, Kewcharoen J, Yodsuwan R, Devkota A, Friedman HJ, Estrada AQ. Gender-Related Differences in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. Pulse (Basel) 2021; 9:38-46. [PMID: 34722354 DOI: 10.1159/000517618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/29/2021] [Indexed: 12/21/2022] Open
Abstract
Background Gender-related differences in phenotypic expression and outcomes have been established in many cardiac conditions; however, the impact of gender in hypertrophic cardiomyopathy (HCM) remains unclear. We conducted a systematic review and meta-analysis to assess the differences in clinical outcomes between female and male HCM patients. Methods We searched MEDLINE and EMBASE from inception to October 2020. Included were cohort studies that compared outcomes of interest including all-cause mortality, HCM-related mortality, and worsening heart failure (HF) or HF hospitalization between male and female. Data from each study were combined using the random effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Results Eleven retrospective cohort studies with a total of 9,427 patients (3,719 females) were included. Female gender was significantly associated with an increased risk of all-cause mortality (pooled OR = 1.63, 95% CI: 1.26-2.10, p ≤ 0.001), HCM-related mortality (pooled OR = 1.47, 95% CI: 1.08-2.01, p = 0.015), and worsening HF or HF hospitalization (pooled OR = 2.05, 95% CI: 1.76-2.39, p ≤ 0.001). Conclusions Female gender was associated with a worse prognosis in HCM. These findings suggest the need for improved care in women including early identification of disease and more possible aggressive management. Moreover, gender-based strategy may benefit in HCM patients.
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Affiliation(s)
- Angkawipa Trongtorsak
- Internal Medicine Residency Program, AMITA Health Saint Francis Hospital, Chicago, Illinois, USA
| | - Natchaya Polpichai
- Faculty of Medicine Songklanagarin Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Sittinun Thangjui
- Internal Medicine Residency Program, Bassett Healthcare Network, New York, New York, USA
| | - Jakrin Kewcharoen
- Internal Medicine Residency Program, University of Hawaii, Honolulu, Hawaii, USA
| | - Ratdanai Yodsuwan
- Internal Medicine Residency Program, Bassett Healthcare Network, New York, New York, USA
| | - Amrit Devkota
- Internal Medicine Residency Program, AMITA Health Saint Francis Hospital, Chicago, Illinois, USA
| | - Harvey J Friedman
- Department of Pulmonary Medicine and Critical Care, AMITA Health Saint Francis Hospital, Chicago, Illinois, USA
| | - Alfonso Q Estrada
- Department of Cardiovascular Medicine, AMITA Health Saint Francis Hospital, Chicago, Illinois, USA
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17
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Enzan N, Matsushima S, Ide T, Kaku H, Tohyama T, Funakoshi K, Higo T, Tsutsui H. Sex Differences in Time-Dependent Changes in B-Type Natriuretic Peptide in Hypertrophic Cardiomyopathy. Circ Rep 2021; 3:594-603. [PMID: 34703937 PMCID: PMC8492405 DOI: 10.1253/circrep.cr-21-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background:
Female sex is reported to be associated with poor prognosis in hypertrophic cardiomyopathy (HCM). The plasma B-type natriuretic peptide (BNP) concentration is a prognostic predictor in HCM. However, the effect of sex on BNP concentrations remains unclear among HCM patients. Methods and Results:
Patient records in the Clinical Personal Records of HCM national database of the Japanese Ministry of Health, Labour and Welfare from 2009 to 2014 were analyzed. Of 3,570 HCM patients, 611 in whom BNP concentrations were assessed at both baseline and the 2-year follow-up were included in this analysis. The mean age was 60.4 years and 254 (41.6%) patients were female. Median (interquartile range) BNP concentrations were higher in females than males at both baseline (320.3 [159.0–583.1] vs. 182.8 [86.1–363.9] pg/mL; P<0.001) and the 2-year follow-up (299.2 [147.0–535.3] vs. 161.0 [76.2–310.0] pg/mL; P<0.001). Female sex was associated with higher natural log-transformed BNP at the 2-year follow-up regardless of clinical characteristics, including echocardiographic findings and BNP concentrations at baseline (coefficient 0.31; 95% confidence interval 0.13–0.48; P<0.001). Cubic spline analysis showed that, among patients with high BNP concentrations at baseline, females had higher BNP concentrations at the 2-year follow-up than males. Conclusions:
In HCM, female sex was associated with higher BNP concentrations than male sex, independent of clinical characteristics, including BNP concentrations at baseline.
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Affiliation(s)
- Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Hidetaka Kaku
- Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital Fukuoka Japan
| | - Takeshi Tohyama
- Center for Clinical and Translational Research, Kyushu University Hospital Fukuoka Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital Fukuoka Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, National Hospital Organization, Kyushu Medical Center Fukuoka Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
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18
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Nauffal V, Marstrand P, Han L, Parikh VN, Helms AS, Ingles J, Jacoby D, Lakdawala NK, Kapur S, Michels M, Owens AT, Ashley EA, Pereira AC, Rossano JW, Saberi S, Semsarian C, Ware JS, Wittekind SG, Day S, Olivotto I, Ho CY. Worldwide differences in primary prevention implantable cardioverter defibrillator utilization and outcomes in hypertrophic cardiomyopathy. Eur Heart J 2021; 42:3932-3944. [PMID: 34491319 PMCID: PMC8497072 DOI: 10.1093/eurheartj/ehab598] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/06/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Risk stratification algorithms for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) and regional differences in clinical practice have evolved over time. We sought to compare primary prevention implantable cardioverter defibrillator (ICD) implantation rates and associated clinical outcomes in US vs. non-US tertiary HCM centres within the international Sarcomeric Human Cardiomyopathy Registry. METHODS AND RESULTS We included patients with HCM enrolled from eight US sites (n = 2650) and five non-US (n = 2660) sites and used multivariable Cox-proportional hazards models to compare outcomes between sites. Primary prevention ICD implantation rates in US sites were two-fold higher than non-US sites (hazard ratio (HR) 2.27 [1.89-2.74]), including in individuals deemed at high 5-year SCD risk (≥6%) based on the HCM risk-SCD score (HR 3.27 [1.76-6.05]). US ICD recipients also had fewer traditional SCD risk factors. Among ICD recipients, rates of appropriate ICD therapy were significantly lower in US vs. non-US sites (HR 0.52 [0.28-0.97]). No significant difference was identified in the incidence of SCD/resuscitated cardiac arrest among non-recipients of ICDs in US vs. non-US sites (HR 1.21 [0.74-1.97]). CONCLUSION Primary prevention ICDs are implanted more frequently in patients with HCM in US vs. non-US sites across the spectrum of SCD risk. There was a lower rate of appropriate ICD therapy in US sites, consistent with a lower-risk population, and no significant difference in SCD in US vs. non-US patients who did not receive an ICD. Further studies are needed to understand what drives malignant arrhythmias, optimize ICD allocation, and examine the impact of different ICD utilization strategies on long-term outcomes in HCM.
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Affiliation(s)
- Victor Nauffal
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
| | - Peter Marstrand
- Department of Cardiology, Herlev-Gentofte Hospital, University Hospital of Copenhagen, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Victoria N Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Adam S Helms
- Department of Medicine, Cardiovascular Medicine Division, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Jodie Ingles
- Department of Cardiology, Cardio Genomics Program at Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Rd, Sydney NSW 2050, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Sydney NSW 2050, Australia
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, 20 York St, New Haven, CT 06510, USA
| | - Neal K Lakdawala
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
| | - Sunil Kapur
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus, Dr. Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Anjali T Owens
- Division of Cardiovascular Medicine, Department of Medicine, Center for Inherited Cardiovascular Disease, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Alexandre C Pereira
- Department of Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, São Paulo - SP, 05403-900, Brazil
| | - Joseph W Rossano
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara Saberi
- Department of Medicine, Cardiovascular Medicine Division, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Sydney NSW 2050, Australia
- Department of Cardiology, Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia
| | - James S Ware
- Department of Medicine, National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, Du Cane Rd, London W12 0NN, UK
- Division of Cardiovascular Medicine, Department of Medicine, Royal Brompton & Harefield Hospitals, Sydney St, London SW3 6NP, UK
| | - Samuel G Wittekind
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
- The Heart Institute, Cincinnati Children’s, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Sharlene Day
- Division of Cardiovascular Medicine, Department of Medicine, Center for Inherited Cardiovascular Disease, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Firenze FI, Italy
| | - Carolyn Y Ho
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
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19
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Fauchier L, Bisson A, Bodin A, Herbert J, Spiesser P, Pierre B, Clementy N, Bernard A, Babuty D, Lip GYH. Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy According to Presence or Absence of Atrial Fibrillation. Stroke 2021; 53:497-504. [PMID: 34601900 DOI: 10.1161/strokeaha.121.034213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Patients with hypertrophic cardiomyopathy (HCM) have high risk of ischemic stroke (IS), especially if atrial fibrillation (AF) is present. Improvements in risk stratification are needed to help identify those patients with HCM at higher risk of stroke, whether AF is present or not. METHODS This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adults hospitalized with isolated HCM. A logistic regression model was used to construct a French HCM score, which was compared with the HCM Risk-CVA and CHA2DS2-VASc scores using c-indexes and calibration analysis. RESULTS In 32 206 patients with isolated HCM, 12 498 (38.8%) had AF, and 2489 (7.7%) sustained an IS during follow-up. AF in patients with HCM was independently associated with a higher risk for death (hazard ratio, 1.129 [95% CI, 1.088-1.172]), cardiovascular death (hazard ratio, 1.254 [95% CI, 1.177-1.337]), IS (hazard ratio, 1.210 [95% CI, 1.111-1.317]), and other major cardiovascular events. Independent predictors of IS in HCM were older age, heart failure, AF, prior IS, smoking and poor nutrition (all P<0.05). For the HCM Risk-CVA score, CHA2DS2-VASc score and a French HCM score, all c-indexes were 0.65 to 0.70, with good calibration. Among patients with AF, the CHA2DS2-VASc score had marginal improvement over the HCM Risk-CVA score but was less predictive compared with the French HCM score (P=0.001). In patients without AF, both HCM Risk-CVA score and the French HCM score had significantly better prediction compared with CHA2DS2-VASc (both P<0.0001). Decision curve analysis demonstrated that the French HCM score had the best clinical usefulness of the 3 tested risk scores. CONCLUSIONS Patients with HCM have a high prevalence of AF and a significant risk of IS, and the presence of AF in patients with HCM was independently associated with worse outcomes. A simple French HCM score shows good prediction of IS in patients with HCM and clinical usefulness, with good calibration.
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Affiliation(s)
- Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.).,Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (J.H.)
| | - Pascal Spiesser
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Bertrand Pierre
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Anne Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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20
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Zhang H, Hua X, Song J. Phenotypes of Cardiovascular Diseases: Current Status and Future Perspectives. PHENOMICS (CHAM, SWITZERLAND) 2021; 1:229-241. [PMID: 36939805 PMCID: PMC9590492 DOI: 10.1007/s43657-021-00022-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Cardiovascular diseases (CVDs) are a large group of diseases and have become the leading cause of morbidity and mortality worldwide. Although considerable progresses have been made in the diagnosis, treatment and prognosis of CVD, communication barriers between clinicians and researchers still exist because the phenotypes of CVD are complex and diverse in clinical practice and lack of unity. Therefore, it is particularly important to establish a standardized and unified terminology to describe CVD. In recent years, there have been several studies, such as the Human Phenotype Ontology, attempting to provide a standardized description of the disease phenotypes. In the present article, we outline recent advances in the classification of the major types of CVD to retrospectively review the current progresses of phenotypic studies in the cardiovascular field and provide a reference for future cardiovascular research.
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Affiliation(s)
- Hang Zhang
- grid.506261.60000 0001 0706 7839The Cardiomyopathy Research Group, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037 China
| | - Xiumeng Hua
- grid.506261.60000 0001 0706 7839The Cardiomyopathy Research Group, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037 China
| | - Jiangping Song
- grid.506261.60000 0001 0706 7839The Cardiomyopathy Research Group, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037 China
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21
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Greulich S, Seitz A, Herter D, Günther F, Probst S, Bekeredjian R, Gawaz M, Sechtem U, Mahrholdt H. Long-term risk of sudden cardiac death in hypertrophic cardiomyopathy: a cardiac magnetic resonance outcome study. Eur Heart J Cardiovasc Imaging 2021; 22:732-741. [PMID: 33458753 PMCID: PMC8219365 DOI: 10.1093/ehjci/jeaa423] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Sudden cardiac death (SCD) is an appalling complication of hypertrophic cardiomyopathy (HCM). There is an ongoing discussion about the optimal SCD risk stratification strategy since established SCD risk models have suboptimal discriminative power. The aim of this study was to evaluate the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for SCD risk stratification compared to the European Society of Cardiology (ESC) SCD risk score and traditional risk factors in an >10-year follow-up. METHODS AND RESULTS Two hundred and twenty consecutive patients with HCM and LGE-CMR were enrolled. Follow-up data were available in 203 patients (median age 58 years, 61% male) after a median follow-up period of 10.4 years. LGE was present in 70% of patients with a median LGE amount of 1.6%, the median ESC 5-year SCD risk score was 1.84. In the overall cohort, SCD rates were 2.3% at 5 years, 4.8% at 10 years, and 15.7% at 15 years, independent from established risk models. An LGE amount of >5% left ventricular (LV) mass portends the highest risk for SCD with SCD prevalences of 5.5% at 5 years, 13.0% at 10 years, and 33.3% at 15 years. Conversely, patients with no or ≤5% LGE of LV mass have favourable prognosis. CONCLUSIONS LGE-CMR in HCM patients allows effective 10-year SCD risk stratification beyond established risk factors. LGE amount might be added to established risk models to improve its discriminatory power. Specifically, patients with >5% LGE should be carefully monitored and might be adequate candidates for primary prevention implantable cardioverter-defibrillator during the clinical long-term course.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology and Angiology, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany
| | - Andreas Seitz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Diana Herter
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Fabian Günther
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Sabine Probst
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
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22
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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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23
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Rodríguez-Capitán J, Fernández-Meseguer A, Márquez-Camas P, García-Pinilla JM, Calvo-Bonacho E, García-Margallo T, Cabrera-Bueno F, Gómez-Doblas JJ, Jiménez-Navarro MF, de Teresa-Galván E. Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population. Rev Clin Esp 2021; 221:315-322. [PMID: 32709302 DOI: 10.1016/j.rce.2020.01.014] [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: 08/18/2019] [Revised: 12/27/2019] [Accepted: 01/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. MATERIALS AND METHODS The study included 13,179 workers (73% men; mean age, 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. RESULTS A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. CONCLUSIONS In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19%.
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Affiliation(s)
- J Rodríguez-Capitán
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España
| | | | - P Márquez-Camas
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España
| | - J M García-Pinilla
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España
| | | | | | - F Cabrera-Bueno
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España
| | - J J Gómez-Doblas
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Universidad de Málaga, Málaga, España
| | - M F Jiménez-Navarro
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Universidad de Málaga, Málaga, España.
| | - E de Teresa-Galván
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto Biosanitario de Málaga (IBIMA), Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Universidad de Málaga, Málaga, España
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24
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Fahmy AS, Rowin EJ, Manning WJ, Maron MS, Nezafat R. Machine Learning for Predicting Heart Failure Progression in Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2021; 8:647857. [PMID: 34055932 PMCID: PMC8155292 DOI: 10.3389/fcvm.2021.647857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Development of advanced heart failure (HF) symptoms is the most common adverse pathway in hypertrophic cardiomyopathy (HCM) patients. Currently, there is a limited ability to identify HCM patients at risk of HF. Objectives: In this study, we present a machine learning (ML)-based model to identify individual HCM patients who are at high risk of developing advanced HF symptoms. Methods: From a consecutive cohort of HCM patients evaluated at the Tufts HCM Institute from 2001 to 2018, we extracted a set of 64 potential risk factors measured at baseline. Only patients with New York Heart Association (NYHA) functional class I/II and LV ejection fraction (LVEF) by echocardiography >35% were included. The study cohort (n = 1,427 patients) was split into three disjoint subsets: development (50%), model selection (10%), and independent validation (40%). The least absolute shrinkage and selection operator was used to select the most influential clinical variables. An ensemble of ML classifiers, including logistic regression, was used to identify patients with high risk of developing a HF outcome. Study outcomes were defined as progression to NYHA class III/IV, drop in LVEF below 35%, septal reduction procedure, and/or heart transplantation. Results: During a mean follow-up of 4.7 ± 3.7 years, advanced HF occurred in 283 (20% out of 1,427) patients. The model features included patients' sex, NYHA class (I or II), HCM type (i.e., obstructive or not), LV wall thickness, LVEF, presence of HF symptoms (e.g., dyspnea, presyncope), comorbidities (atrial fibrillation, hypertension, mitral regurgitation, and systolic anterior motion), and type of cardiac medications. The developed risk stratification model showed strong differentiation power to identify patients at advanced HF risk in the testing dataset (c-statistics = 0.81; 95% confidence interval [CI]: 0.76, 0.86). The model allowed correct identification of high-risk patients with accuracy 74% (CI: 0.70, 0.78), sensitivity 80% (CI: 0.77, 0.83), and specificity 72% (CI: 0.68, 0.76). The model performance was comparable among different sex and age groups. Conclusions: A 5-year risk prediction of progressive HF in HCM patients can be accurately estimated using ML analysis of patients' clinical and imaging parameters. A set of 17 clinical and imaging variables were identified as the most important predictors of progressive HF in HCM.
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Affiliation(s)
- Ahmed S Fahmy
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Ethan J Rowin
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA, United States
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Martin S Maron
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA, United States
| | - Reza Nezafat
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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25
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Abstract
PURPOSE OF REVIEW The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed. RECENT FINDINGS Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particularly concerning in pediatric patients' where weight gain and linear growth is likely to lead to more significant hemodynamic changes in shorter periods of time. Some studies have even shown that risk factors concerning in adults may actually be protective in pediatric patients. Additionally, large gaps still remain between genotype and phenotype expression in HCM. SUMMARY A better understanding of the relationship between cause, phenotype, and outcomes is needed to truly be able to determine risk for SCD in childhood HCM. Larger studies, including newer technologies and quantitative models, similar to the European HCM Risk-SCD model, which allows for a quantitative risk diagnosis, are needed as well.
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26
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Rodríguez-Capitán J, Fernández-Meseguer A, Márquez-Camas P, García-Pinilla JM, Calvo-Bonacho E, García-Margallo T, Cabrera-Bueno F, Gómez-Doblas JJ, Jiménez-Navarro MF, de Teresa-Galván E. Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population. Rev Clin Esp 2021; 221:315-322. [PMID: 34059228 DOI: 10.1016/j.rceng.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. MATERIALS AND METHODS The study included 13,179 workers (73% men; mean age: 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. RESULTS A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. CONCLUSIONS In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19%.
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Affiliation(s)
- J Rodríguez-Capitán
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | | | - P Márquez-Camas
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - J M García-Pinilla
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - F Cabrera-Bueno
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - J J Gómez-Doblas
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Universidad de Málaga, Málaga, Spain
| | - M F Jiménez-Navarro
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Universidad de Málaga, Málaga, Spain.
| | - E de Teresa-Galván
- UGC Área del Corazón, Servicio de Cirugía Cardiovascular y Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Instituto Biosanitario de Málaga (IBIMA), Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Universidad de Málaga, Málaga, Spain
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Concomitant Cox-Maze IV and Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy. Ann Thorac Surg 2021; 113:109-117. [PMID: 33662312 DOI: 10.1016/j.athoracsur.2020.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In patients with hypertrophic obstructive cardiomyopathy, atrial fibrillation is associated with heart failure and increased late mortality. However, the role of surgical ablation in these patients is not well defined. The aim of this study was to evaluate the efficacy of the concomitant Cox-Maze IV procedure in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy. METHODS Between 2005 and 2019, 347 patients who underwent septal myectomy at a single institution (Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO) were retrospectively reviewed. For patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent a concomitant Cox-Maze IV procedure, freedom from atrial tachyarrhythmias (ATAs) on or off antiarrhythmic drugs (AADs) was evaluated annually. Predictors of ATA recurrence were identified using Fine-Gray regression, with death as a competing risk. RESULTS A total of 42 patients underwent concomitant septal myectomy and Cox-Maze IV procedures. The majority of patients, 69% (29 of 42), had paroxysmal atrial fibrillation with a 2.5-year median duration. Operative mortality was 7% (3 of 42). New York Heart Association functional class was reduced after surgery (P < .01). Rates of freedom from recurrent ATAs at 1- and 5-year intervals were 93% (27 of 29) and 100% (14 of 14), respectively. Rates of freedom from ATAs and AADs were 83% (24 of 29) and 100% (14 of 14) at the same time points, respectively. Increased left atrial diameter predicted first ATA recurrence (P < .01). Cerebrovascular accident risk was lower in patients with atrial fibrillation who underwent concomitant Cox-Maze IV and septal myectomy relative to myectomy only (P = .02). CONCLUSIONS Late freedom from ATAs on or off AADs was excellent after Cox-Maze IV and septal myectomy. Although there was a higher than expected rate of perioperative complications, the study results suggest that concomitant surgical ablation should be considered in selected patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.
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Rowin EJ, Burrows A, Madias C, Estes NM, Link MS, Maron MS, Maron BJ. Long-Term Outcome in High-Risk Patients With Hypertrophic Cardiomyopathy After Primary Prevention Defibrillator Implants. Circ Arrhythm Electrophysiol 2020; 13:e008123. [DOI: 10.1161/circep.119.008123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The implantable cardioverter-defibrillator (ICD) is effective for preventing sudden death in patients with hypertrophic cardiomyopathy. However, data on performance and complications of implanted ICDs over particularly long time periods to inform clinical practice is presently incomplete.
Methods:
The study cohort comprises 217 consecutive hypertrophic cardiomyopathy patients with primary prevention ICDs implanted before 2008 and followed for ≥10 years (mean 12±4; range to 31).
Results:
Patients were 38±17 years at implant and 45 (21%) experienced appropriate interventions terminating ventricular tachycardia/ventricular fibrillation. The majority of ICD discharges occurred ≥5 years after implant (29 patients; 64%), including ≥10 years in 16 patients (36%). Initial device therapy increased in frequency from 2.3% of patients at <1 year to 8.5% of patients at ≥10-years after implant (
P
=0.005). Inappropriate ICD shocks in 39 patients occurred most commonly <5 years after implant (54%) and decreased in frequency with increasing time from implant (from 9.7% of patients at <5 years to 3.8% at ≥10 years,
P
=0.02). Other major device complications including infection and lead fractures and dislodgement occurred in 27 patients (12%) but did not increase in frequency over follow-up after implant (
P
=0.47). There were no arrhythmic sudden death events among the 217 patients with ICD.
Conclusions:
In hypertrophic cardiomyopathy, after a primary prevention implant, ICD therapy often followed prolonged periods of device dormancy and increased progressively in frequency over time, including one-third of patients with initial therapy after 5 to 9 years, and an additional one-third of patients at ≥10 years. Frequency of inappropriate shocks decreased over follow-up, likely reflecting standard changes in device programming, while occurrence of device complications, such as lead fractures/infection, did not increase during follow-up.
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Affiliation(s)
- Ethan J. Rowin
- Hypertrophic Cardiomyopathy Institute (E.J.R., M.S.M., B.J.M.), Tufts Medical Center, Boston, MA
| | - Austin Burrows
- Cardiac Arrhythmia Center (A.B., C.M.), Tufts Medical Center, Boston, MA
| | - Christopher Madias
- Cardiac Arrhythmia Center (A.B., C.M.), Tufts Medical Center, Boston, MA
| | - N.A. Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (N.A.M.E.)
| | - Mark S. Link
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas TX (M.S.L.)
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Institute (E.J.R., M.S.M., B.J.M.), Tufts Medical Center, Boston, MA
| | - Barry J. Maron
- Hypertrophic Cardiomyopathy Institute (E.J.R., M.S.M., B.J.M.), Tufts Medical Center, Boston, MA
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29
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Mahfouz Badran H, Soltan G, Eltahan E, Yacoub MH, Faheem N. Relation of atrial electromechanical delay to P-wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2020; 26:e12801. [PMID: 32969115 PMCID: PMC7816806 DOI: 10.1111/anec.12801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives Heterogeneity of structural and electrophysiologic properties of atrial myocardium is common characteristic in hypertrophic cardiomyopathy (HCM). We assessed the dispersion of atrial refractoriness on surface ECG using P‐wave dispersion (PWD) and its relation to atrial electromechanical functions using vector velocity imaging (VVI) in HCM population. Methods Seventy‐nine HCM patients (mean age: 43.7 ± 13 years, 67% male) were compared with 25 healthy individuals as control. P‐wave durations, Pmax and Pmin, P‐wave dispersion (PWD), and P terminal force (PTF) were measured from 12‐lead ECG. LA segmental delay (TTP‐d) and dispersion (TTP‐SD) of electromechanical activation were derived from atrial strain rate curves. Results HCM patients had longer PR interval, PW duration, higher PWD, PTF, QTc compared to control (p < .001). HCM patients were classified according to presence of PWD into two groups, group I with PWD > 46 ms (n = 25) and group II PWD ≤ 46 ms (n = 54). Group I showed higher prevalence of female gender, higher PTF, QTc interval, left ventricular outflow tract (LVOT) obstruction, p < .01, LVOT gradient (p < .001), LV mass index (p < .01), E/E' (p < .01), and severe mitral regurgitation (p < .001). Moreover, PWD was associated with increased atrial electromechanical delay (TTP‐d) and LA mechanical dyssynchrony (TTP‐SD), p < .001. LA segmental delay and dispersion of electromechanical activation were distinctly higher among HCM patient. Conclusion PWD is simple ECG criterion, and it is associated with more severe HCM phenotype and LA electromechanical delay while PTF is linked only to atrial remodeling.
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Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department Menofia University, Shebin Elkom, Egypt.,The BAHCM National Program, Aswan, Egypt
| | - Ghada Soltan
- Cardiology Department Menofia University, Shebin Elkom, Egypt
| | - Eslam Eltahan
- Cardiology Department Menofia University, Shebin Elkom, Egypt
| | - Magdi H Yacoub
- The BAHCM National Program, Aswan, Egypt.,Imperial College, London, UK
| | - Naglaa Faheem
- Cardiology Department Menofia University, Shebin Elkom, Egypt.,The BAHCM National Program, Aswan, Egypt
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30
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Yeung C, Enriquez A, Suarez-Fuster L, Baranchuk A. Atrial fibrillation in patients with inherited cardiomyopathies. Europace 2020; 21:22-32. [PMID: 29684120 DOI: 10.1093/europace/euy064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) often complicates the course of inherited cardiomyopathies and, in some cases, may be the presenting feature. Each inherited cardiomyopathy has its own peculiar pathogenetic characteristics that can contribute to the development and maintenance of AF. Atrial fibrillation may occur as a consequence of disease-specific defects, non-specific cardiac chamber changes secondary to the primary illness, or a combination thereof. The presence of AF can denote a turning point in the progression of the disease, promoting clinical deterioration and increasing morbidity and mortality. Furthermore, the management of AF can be particularly challenging in patients with inherited cardiomyopathies. In this article, we review the current information on the prevalence, pathophysiology, risk factors, and treatment of AF in three different inherited cardiomyopathies: hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia/cardiomyopathy, familial dilated cardiomyopathy, and left ventricular non-compaction cardiomyopathy.
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Affiliation(s)
- Cynthia Yeung
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Andres Enriquez
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | | | - Adrian Baranchuk
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
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31
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Liu L, Liu S, Shen L, Tu B, Hu Z, Hu F, Zheng L, Ding L, Fan X, Yao Y. Correlations between cardiac troponin I and nonsustained ventricular tachycardia in hypertrophic obstructive cardiomyopathy. Clin Cardiol 2020; 43:1150-1159. [PMID: 32810305 PMCID: PMC7534013 DOI: 10.1002/clc.23425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Nonsustained ventricular tachycardia (NSVT) is an independent risk factor for sudden cardiac death (SCD) in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, data concerning the correlations of cardiac biomarkers and NSVT in HOCM are rather limited. HYPOTHESIS Our study aimed to investigate the associations between the occurrence of NSVT and circulating biomarkers representing myocardial injury (cardiac troponin I, cTnI), cardiac function (N-terminal pro-brain natriuretic peptide, NT-pro BNP), and inflammation (high-sensitivity C-reactive protein) in a large Chinese HOCM cohort. METHODS A total of 755 consecutive HOCM patients were recruited. Systematic cardiac evaluations and circulating biomarkers were examined routinely in all subjects under the clinically stable status. According to the results of 24-hour Holter monitoring, patients were divided into the NSVT group (n = 138) and the nonventricular tachycardia (non-VT) group (n = 617). RESULTS Compared with the non-VT group, circulating levels of both cTnI and NT-pro BNP elevated significantly in patients with positive NSVT episodes (P < .001). Multivariable analyses demonstrated that cTnI was independently associated with the presence of NSVT (OR = 1.675, 95% CI: 1.406-1.994, P < .001). Concentrations of cTnI increased progressively not only with the aggravation of ventricular arrhythmic events (P < .001), but also with the growing risk of SCD in HOCM patients (P < .001). Serum cTnI ≥ 0.0265 ng/mL indicated predictive value for the occurrence of NSVT in the HOCM cohort (area under the curve = 0.707, 95% CI: 0.660-0.754, P < .001). CONCLUSIONS Elevated cTnI was an independent determinant of NSVT, and it seemed to be valuable for assessing the clinical status of ventricular arrhythmias and the risk of SCD in patients with HOCM.
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Affiliation(s)
- Limin Liu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shangyu Liu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lishui Shen
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Tu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhicheng Hu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Hu
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihui Zheng
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ligang Ding
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kubo T, Baba Y, Ochi Y, Takahashi A, Hirota T, Yamasaki N, Hamashige N, Yamamoto K, Kondo F, Bando K, Yamada E, Furuno T, Yabe T, Doi YL, Kitaoka H. Sudden Cardiac Death-Relevant Events of Hypertrophic Cardiomyopathy in a Regional Japanese Cohort ― Results From the Kochi RYOMA Study ―. Circ Rep 2020; 2:433-439. [PMID: 33693265 PMCID: PMC7819656 DOI: 10.1253/circrep.cr-20-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background:
Sudden cardiac death (SCD) is a most devastating complication of hypertrophic cardiomyopathy (HCM). The aim of this study was to clarify the clinical features of HCM in patients who experienced SCD-relevant events in an aged Japanese community. Methods and Results:
In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, and herein report on 293 patients with HCM who are followed as part of the registry. The mean (±SD) age at registration and diagnosis was 63±14 and 56±16 years, respectively. SCD-relevant events occurred in 19 patients during a mean follow-up period of 6.1±3.2 years (incidence rate 1.0%/year): sudden death in 9 patients, successful recovery from cardiopulmonary arrest in 4 patients, and appropriate implantable cardioverter–defibrillator discharge in 6 patients. At registration, 13 patients were in the dilated phase of HCM (D-HCM). During the follow-up period, HCM developed to D-HCM in 21 patients; thus, 34 patients in total had D-HCM. Multivariate analysis revealed that D-HCM at registration or during follow-up and detection of non-sustained ventricular tachycardia (NSVT) during follow-up were significant predictors of SCD-relevant events. Conclusions:
In this HCM population in an aged Japanese community, the annual rate of SCD-relevant events was 1.0%. HCM developed to D-HCM in a considerable number of patients, and D-HCM and NSVT were shown to be independently associated with an increased risk of SCD-relevant events.
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Affiliation(s)
- Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Asa Takahashi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | | | - Fumiaki Kondo
- Department of Cardiology, Japanese Red Cross Kochi Hospital
| | - Kanji Bando
- Department of Cardiology, Tosa Municipal Hospital
| | | | - Takashi Furuno
- Department of Cardiology, Kochi Prefectural Aki General Hospital
| | - Toshikazu Yabe
- Department of Cardiology, Kochi Prefectural Hata Kenmin Hospital
| | - Yoshinori L. Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
- Department of Cardiology, Chikamori Hospital
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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Chen Y, O'Mahony C. The price and value of implantable cardioverter defibrillators in hypertrophic cardiomyopathy. Int J Cardiol 2020; 311:52-53. [DOI: 10.1016/j.ijcard.2020.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
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34
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D'Arcy JL, Manen O, Davenport ED, Syburra T, Rienks R, Guettler N, Bron D, Gray G, Nicol ED. Heart muscle disease management in aircrew. Heart 2020; 105:s50-s56. [PMID: 30425086 PMCID: PMC6256300 DOI: 10.1136/heartjnl-2018-313058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/17/2018] [Accepted: 09/30/2018] [Indexed: 01/01/2023] Open
Abstract
This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with suspected or confirmed heart muscle disease (both pilots and non-pilot aviation professionals). ECG abnormalities on aircrew periodic medical examination or presentation of a family member with a confirmed cardiomyopathy are the most common reason for investigation of heart muscle disease in aircrew. Holter monitoring and imaging, including cardiac MRI is recommended to confirm or exclude the presence of heart muscle disease and, if confirmed, management should be led by a subspecialist. Confirmed heart muscle disease often requires restriction toflying duties due to concerns regarding arrhythmia. Pericarditis and myocarditis usually require temporary restriction and return to flying duties is usually dependent on a lack of recurrent symptoms and acceptable imaging and electrophysiological investigations.
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Affiliation(s)
- Joanna L D'Arcy
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, Oxfordshire, UK
| | - Olivier Manen
- Aviation Medicine Department, AeMC, Percy Military Hospital, Clamart, Île-de-France, France
| | - Eddie D Davenport
- Aeromedical Consult Service, United States Air Force School of Aerospace Medicine, Wright-Patterson AFB, Ohio, USA
| | - Thomas Syburra
- Cardiac Surgery Department, Luzerner Kantonsspital, Luzern, Switzerland
| | - Rienk Rienks
- Department of Cardiology, University Medical Center Utrecht and Central Military Hospital, Utrecht, The Netherlands
| | - Norbert Guettler
- German Air Force Center for Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - Dennis Bron
- Aeromedical Centre, Swiss Air Force, Duebendorf, Switzerland
| | - Gary Gray
- Canadian Forces Environmental Medical Establishment, Toronto, Ontario, Canada
| | - Edward D Nicol
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, Oxfordshire, UK
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Liu J, Wu G, Zhang C, Ruan J, Wang D, Zhang M, Wang L, Yang Y, Li X, Wang Y, Hui R, Zou Y, Kang L, Wang J, Song L. Improvement in sudden cardiac death risk prediction by the enhanced American College of Cardiology/American Heart Association strategy in Chinese patients with hypertrophic cardiomyopathy. Heart Rhythm 2020; 17:1658-1663. [PMID: 32311532 DOI: 10.1016/j.hrthm.2020.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/21/2020] [Accepted: 04/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The lack of validated and effective sudden cardiac death (SCD) risk prediction methods is the biggest barrier to perform the lifesaving treatment with a prophylactic implantable cardioverter-defibrillator in Chinese patients with hypertrophic cardiomyopathy (HCM). OBJECTIVE This study aimed to evaluate the efficacy of 3 existing SCD risk prediction methods recommended by the 2011 American College of Cardiology Foundation and American Heart Association (ACCF/AHA) guideline, the 2014 European Society of Cardiology (ESC) guideline, and the 2019 enhanced American College of Cardiology (ACC)/AHA strategy in Chinese patients with HCM. METHODS The present study consisted of 1369 consecutive adult patients with HCM without a history of SCD events. The primary end point was a composite of SCD and equivalent events, namely, resuscitation from cardiac arrest and appropriate implantable cardioverter-defibrillator shock therapy for ventricular tachycardia or fibrillation. RESULTS During follow-up of 3.2 ± 2.4 years, 39 patients reached SCD end points, of whom 26 (66.7%) were correctly predicted as those at a high risk of SCD by using methods recommended by the 2019 enhanced ACC/AHA strategy, 20 (51.3%) by the 2011 ACCF/AHA guideline, but only 5 (12.8%) by the 2014 ESC guideline. The 2019 enhanced ACC/AHA strategy showed a higher C-statistic (0.647) for SCD prediction than did the 2011 ACCF/AHA guideline (0.598) and 2014 ESC guideline (0.605) and resulted in the correct reclassification of SCD risk when compared with the 2011 ACCF/AHA guideline (net reclassification index 0.113; P = .074) and 2014 ESC guideline (net reclassification index 0.245; P = .038). CONCLUSION The 2019 enhanced ACC/AHA strategy showed better predictive performance for SCD risk stratification in Chinese patients with HCM, with a notably high sensitivity.
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Affiliation(s)
- Jie Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guixin Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ce Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jieyun Ruan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mo Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Limei Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yaoyao Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinrong Li
- The National Engineering Research Centre for Miniaturized Detection Systems, Shaanxi Lifegen Co. Ltd, Shaanxi, China
| | - Yilu Wang
- Intensive Care Unit, Emergency General Hospital, Beijing, China
| | - Rutai Hui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lianming Kang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Jizheng Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lei Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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36
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The SHIFT model combines clinical, electrocardiographic and echocardiographic parameters to predict sudden cardiac death in hypertrophic cardiomyopathy. Rev Port Cardiol 2019; 38:847-853. [DOI: 10.1016/j.repc.2019.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 04/15/2019] [Accepted: 05/05/2019] [Indexed: 12/28/2022] Open
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37
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Ruivo C, Montenegro Sá F, Correia J, Belo A, Loureiro MF, Morais J. The SHIFT model combines clinical, electrocardiographic and echocardiographic parameters to predict sudden cardiac death in hypertrophic cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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38
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Zhu J, Hou W, Xu Y, Ji F, Wang G, Chen C, Lin C, Lin X, Li J, Zhuo C, Shao M. Antipsychotic drugs and sudden cardiac death: A literature review of the challenges in the prediction, management, and future steps. Psychiatry Res 2019; 281:112598. [PMID: 31622875 DOI: 10.1016/j.psychres.2019.112598] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
Abstract
Sudden cardiac death (SCD) is relatively uncommon, yet it is a deadly consequence of some antipsychotic medications in patients with psychiatric disorders. The widespread concerns about the adverse cardiac effects associated with antipsychotics and their unpredictable nature have led to a restriction on the use of some antipsychotic medications. Recent progress has been made in the identification of important genetic factors that may contribute to the adverse complication of antipsychotic drugs, suggesting that high-risk individuals can be identified prior to initiating therapy. In addition, some high-tech smart wearable medical devices have recently been developed, allowing users to record and analyze the electrocardiogram (ECG) in couple with artificial intelligence (AI) technologies, and notifying of irregular heart rhythms or arrhythmias, a medical condition well documented in most SCD cases. In this literature review, we summarize recent advances in understanding the link between SCD and antipsychotic drug usage, as well as in utilizing wearable medical devices for monitoring of cardiac arrhythmias. New strategies for improving the care of patients receiving antipsychotic medications are proposed. As it is now possible to evaluate the risk of SCD in patients on antipsychotic medications, preventative measures and close monitoring may be used to detect the early signs of adverse cardiac events and SCD.
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Affiliation(s)
- Jingjing Zhu
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Weihong Hou
- Department of Biochemistry and Molecular Biology, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China,; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China; National Key Disciplines, Key Laboratory for Cellular Physiology, Ministry of Education, Department of Neurobiology, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining, Shandong, 272191, China
| | - Guowei Wang
- Department of Psychiatry, Linyi Mental Health Center, Linyi, Shandong, 271000, China
| | - Ce Chen
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Chongguang Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Xiodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Jie Li
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China
| | - Chuanjun Zhuo
- Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining, Shandong, 272191, China; Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China; Department of Biochemistry and Molecular Biology, Zhengzhou University, Zhengzhou, Henan, 450001, China; Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China; Department of China-Canada Biological Psychiatry Lab, Xiamen Xianyue Hospital, Xiamen, Fujian, 361000, China
| | - Mingjng Shao
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, 100029, China
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Kaltenecker E, Schleihauf J, Meierhofer C, Shehu N, Mkrtchyan N, Hager A, Kühn A, Cleuziou J, Klingel K, Seidel H, Zenker M, Ewert P, Hessling G, Wolf CM. Long-term outcomes of childhood onset Noonan compared to sarcomere hypertrophic cardiomyopathy. Cardiovasc Diagn Ther 2019; 9:S299-S309. [PMID: 31737538 DOI: 10.21037/cdt.2019.05.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background To compare outcome and cardiac pathology between patients with Noonan syndrome (N-HCM) and sarcomere protein-associated (S-HCM) childhood onset hypertrophic cardiomyopathy (HCM). Methods Clinical data were recorded from medical charts. Primary endpoint was survival. Secondary endpoints were survival without hospitalization, without intervention or without arrhythmic events. Functional clinical status and results from genetic testing, imaging, electrocardiographic (ECG) studies, cardiopulmonary exercise testing (CPET) and histopathology were compared between groups. Results Childhood HCM was diagnosed in 29 N-HCM and 34 S-HCM patients. Follow-up time was greater than 10 years in more than half of all patients. Mortality was below 7% and not different between groups. Children with N-HCM presented at a younger age and there was less time of survival without hospitalization for heart failure or intervention in N-HCM compared to S-HCM patients. Clinical functional status improved over time in N-HCM patients. On long-term follow-up, left ventricular posterior wall thickness indexed to body surface area decreased in N-HCM and increased in S-HCM patients. There was a trend to lower risk for severe arrhythmic events in N-HCM patients and only S-HCM individuals received an implantable cardioverter-defibrillator. There were no differences between groups in ventricular function, ECG and CPET parameters. Myocardial fibrosis as assessed by histopathology of myocardial specimens and cardiovascular magnetic resonance with late gadolinium enhancement or T1 mapping was present in both groups. Conclusions When compared to S-HCM patients, children with N-HCM have increased morbidity during early disease course, but favorable long-term outcome with low mortality, stagnation of myocardial hypertrophy, and low risk for malignant arrhythmias.
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Affiliation(s)
- Emanuel Kaltenecker
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Julia Schleihauf
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Naira Mkrtchyan
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Andreas Kühn
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany.,(INSURE) Institute for Translational Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Heide Seidel
- Institute of Human Genetics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Cordula M Wolf
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and defined by unexplained isolated progressive myocardial hypertrophy, systolic and diastolic ventricular dysfunction, arrhythmias, sudden cardiac death and histopathologic changes, such as myocyte disarray and myocardial fibrosis. Mutations in genes encoding for proteins of the contractile apparatus of the cardiomyocyte, such as β-myosin heavy chain and myosin binding protein C, have been identified as cause of the disease. Disease is caused by altered biophysical properties of the cardiomyocyte, disturbed calcium handling, and abnormal cellular metabolism. Mutations in sarcomere genes can also activate other signaling pathways via transcriptional activation and can influence non-cardiac cells, such as fibroblasts. Additional environmental, genetic and epigenetic factors result in heterogeneous disease expression. The clinical course of the disease varies greatly with some patients presenting during childhood while others remain asymptomatic until late in life. Patients can present with either heart failure symptoms or the first symptom can be sudden death due to malignant ventricular arrhythmias. The morphological and pathological heterogeneity results in prognosis uncertainty and makes patient management challenging. Current standard therapeutic measures include the prevention of sudden death by prohibition of competitive sport participation and the implantation of cardioverter-defibrillators if indicated, as well as symptomatic heart failure therapies or cardiac transplantation. There exists no causal therapy for this monogenic autosomal-dominant inherited disorder, so that the focus of current management is on early identification of asymptomatic patients at risk through molecular diagnostic and clinical cascade screening of family members, optimal sudden death risk stratification, and timely initiation of preventative therapies to avoid disease progression to the irreversible adverse myocardial remodeling stage. Genetic diagnosis allowing identification of asymptomatic affected patients prior to clinical disease onset, new imaging technologies, and the establishment of international guidelines have optimized treatment and sudden death risk stratification lowering mortality dramatically within the last decade. However, a thorough understanding of underlying disease pathogenesis, regular clinical follow-up, family counseling, and preventative treatment is required to minimize morbidity and mortality of affected patients. This review summarizes current knowledge about molecular genetics and pathogenesis of HCM secondary to mutations in the sarcomere and provides an overview about current evidence and guidelines in clinical patient management. The overview will focus on clinical staging based on disease mechanism allowing timely initiation of preventative measures. An outlook about so far experimental treatments and potential for future therapies will be provided.
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Affiliation(s)
- Cordula Maria Wolf
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
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Kresin N, Stücker S, Krämer E, Flenner F, Mearini G, Münch J, Patten M, Redwood C, Carrier L, Friedrich FW. Analysis of Contractile Function of Permeabilized Human Hypertrophic Cardiomyopathy Multicellular Heart Tissue. Front Physiol 2019; 10:239. [PMID: 30984009 PMCID: PMC6447666 DOI: 10.3389/fphys.2019.00239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/22/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nico Kresin
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sabrina Stücker
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Elisabeth Krämer
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Frederik Flenner
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Giulia Mearini
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Julia Münch
- University Heart Center Hamburg, Hamburg, Germany
| | | | - Charles Redwood
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Lucie Carrier
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Felix W Friedrich
- Institute of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Rigopoulos AG, Ali M, Abate E, Matiakis M, Melnyk H, Mavrogeni S, Leftheriotis D, Bigalke B, Noutsias M. Review on sudden death risk reduction after septal reduction therapies in hypertrophic obstructive cardiomyopathy. Heart Fail Rev 2019; 24:359-366. [DOI: 10.1007/s10741-018-09767-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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43
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Burns J, Jean-Pierre P. Disparities in the Diagnosis of Hypertrophic Obstructive Cardiomyopathy: A Narrative Review of Current Literature. Cardiol Res Pract 2018; 2018:3750879. [PMID: 30370151 PMCID: PMC6189670 DOI: 10.1155/2018/3750879] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022] Open
Abstract
Hypertrophic obstructive cardiomyopathy (HOCM) is a disorder of abnormal thickening of the myocardium that affects 0.2% of the population. HOCM is a frequently implicated cause of sudden cardiac death (SCD) in young athletes. In this manner, this condition has the capacity for tremendous emotional, social, financial, and medical burdens for families and communities across the country. Multiple factors including genetics and hormonal elements are believed to play a role in the development of this cardiomyopathy. HOCM is an autosomal dominant trait with variable expressivity. It is associated with several genetic changes in the myosin heavy chain genes. Current treatment includes optimization of cardiac risk factors and medical management with beta-adrenergic blockade with definitive treatment of surgical intervention to reduce cardiac workload. The demographic most likely to be diagnosed with HOCM based upon clinical registry data is Caucasian boys and men. However, a growing body of data supports increased prevalence in African American populations and percentages equal to, if not higher than, Caucasian males in Hispanic populations. Similarly, males of African American ethnicity that participate in basketball are the most likely demographic to be affected by HOCM based on the data available from the National Collegiate Athletic Association (NCAA). Further, though rates of diagnosis may be up to 1.5 times higher in males than in females, an increasing number of studies demonstrate an increased prevalence of HOCM in females, often presenting with worse symptoms and an increased incidence of disease progression. Similarly, data suggest that age of diagnosis is associated with various prognostic factors including annual mortality. In addition, consideration of the social determinants of health undoubtedly impacts the rate of diagnosis, access to care, and HOCM-related complications in underserved populations. Effective screening including auscultation and electrocardiography (EKG) with confirmatory echocardiography in these communities supports equitable surveillance and management of HOCM.
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Affiliation(s)
- Joseph Burns
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
| | - Philippe Jean-Pierre
- Florida International University, Department of Biological Sciences, Miami, FL 33199, USA
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Mirabel M, Damy T, Donal E, Huttin O, Labombarda F, Eicher JC, Cervino C, Laurito M, Offredo L, Tafflet M, Jouven X, Giura G, Desnos M, Jeunemaître X, Empana JP, Charron P, Habib G, Réant P, Hagège A. Influence of centre expertise on the diagnosis and management of hypertrophic cardiomyopathy: A study from the French register of hypertrophic cardiomyopathy (REMY). Int J Cardiol 2018; 275:107-113. [PMID: 30316646 DOI: 10.1016/j.ijcard.2018.09.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our knowledge of hypertrophic cardiomyopathy (HCM) mainly originates from quarternary centres. The objective is to assess the current management of HCM patients in a large multicentre French register according to the level of expertise. METHODS AND RESULTS A total of 1431 HCM patients were recruited across 26 (11 expert and 15 non-expert) centres in REMY, a prospective hospital-based register of adult HCM patients. A sarcomeric origin was suspected in 1284 (89.7%) patients [261 (20.3%) with a reported gene mutation, 242 (18.8%) genotype-negative], while 107 (7.5%) had a diagnosis of non-sarcomeric HCM. Patients managed in non-expert centres were older (P < 0.01) and presented more often with NYHA III/IV class dyspnoea (P < 0.01), congestive heart failure (P < 0.01), low LEVF (P < 0.01), less often with a syncope history (P < 0.01) and lower LV obstruction (P < 0.01) than patients in expert centres. Genotype positive sarcomeric aetiologies were less frequent in non-expert centres (P < 0.01). The use of diagnostic and prognostic tests as cardiac MRI (P < 0.001), genetic (P < 0.001) and alpha-galactosidase A enzyme level testing (P < 0.001), Holter ECG (P < 0.001), and exercise test (P < 0.001), was lower in non-expert centres. Septal ablation procedures using alcohol (P < 0.001) or myectomy (P < 0.001) were more frequent in expert centres. CONCLUSION In real life practice, only a minority of HCM patients are identified as sarcomere positive as per genetic testing. The management of HCM patients varies according to the centre's level of expertise, with less access to diagnostic and prognostic tests in non-expert centres. Non-sarcomeric HCM may therefore be overlooked despite specific treatment in some aetiologies.
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Affiliation(s)
- Mariana Mirabel
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM CMR970, Paris Cardiovascular Research Center - PARCC, Paris, France
| | - Thibaud Damy
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, GRC Amyloid Research Institute, IMRB and Cardiology Department, 94000 Créteil, France
| | - Erwan Donal
- Centre Hospitalo-Universitaire de Rennes, Hôpital Pontchaillou, Cardiology Department,- CIC-IT 1414 and LTSI Inserm U 1099 Université Rennes -1, Rennes, France
| | - Olivier Huttin
- Centre Hospitalo-Universitaire de Nancy, Hôpitaux de Brabois, Cardiology Department, Nancy, France
| | - Fabien Labombarda
- Centre Hospitalo-Universitaire de Caen, Hôpital Côte de Nacre, Cardiology Department, Caen, France
| | - Jean-Christophe Eicher
- Centre Hospitalo-Universitaire de Dijon, Dijon, Hôpital du Bocage, Cardiology Department, France
| | - Claudio Cervino
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France
| | - Marianna Laurito
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France
| | - Lucile Offredo
- INSERM CMR970, Paris Cardiovascular Research Center - PARCC, Paris, France
| | - Muriel Tafflet
- INSERM CMR970, Paris Cardiovascular Research Center - PARCC, Paris, France
| | - Xavier Jouven
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM CMR970, Paris Cardiovascular Research Center - PARCC, Paris, France
| | - Geltrude Giura
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Michel Desnos
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Xavier Jeunemaître
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Genetics, Paris, France
| | | | - Philippe Charron
- Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Cardiology Department & ICAN, Paris, France
| | - Gilbert Habib
- Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Cardiology Department, Marseille, France
| | - Patricia Réant
- Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut Levêque, Cardiology Department, Université de Bordeaux, INSERM 1045, IHU Lyric, Pessac, CIC1401 Bordeaux, France
| | - Albert Hagège
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM CMR970, Paris Cardiovascular Research Center - PARCC, Paris, France.
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Montag J, Petersen B, Flögel AK, Becker E, Lucas-Hahn A, Cost GJ, Mühlfeld C, Kraft T, Niemann H, Brenner B. Successful knock-in of Hypertrophic Cardiomyopathy-mutation R723G into the MYH7 gene mimics HCM pathology in pigs. Sci Rep 2018; 8:4786. [PMID: 29555974 PMCID: PMC5859159 DOI: 10.1038/s41598-018-22936-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/01/2018] [Indexed: 11/09/2022] Open
Abstract
Familial Hypertrophic Cardiomyopathy (HCM) is the most common inherited cardiac disease. About 30% of the patients are heterozygous for mutations in the MYH7 gene encoding the ß-myosin heavy chain (MyHC). Hallmarks of HCM are cardiomyocyte disarray and hypertrophy of the left ventricle, the symptoms range from slight arrhythmias to sudden cardiac death or heart failure. To gain insight into the underlying mechanisms of the diseases' etiology we aimed to generate genome edited pigs with an HCM-mutation. We used TALEN-mediated genome editing and successfully introduced the HCM-point mutation R723G into the MYH7 gene of porcine fibroblasts and subsequently cloned pigs that were heterozygous for the HCM-mutation R723G. No off-target effects were determined in the R723G-pigs. Surprisingly, the animals died within 24 h post partem, probably due to heart failure as indicated by a shift in the a/ß-MyHC ratio in the left ventricle. Most interestingly, the neonatal pigs displayed features of HCM, including mild myocyte disarray, malformed nuclei, and MYH7-overexpression. The finding of HCM-specific pathology in neonatal R723G-piglets suggests a very early onset of the disease and highlights the importance of novel large animal models for studying causative mechanisms and long-term progression of human cardiac diseases.
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Affiliation(s)
- J Montag
- Institute for Molecular and Cell Physiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - B Petersen
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystrasse 10, Mariensee, 31535, Neustadt, Germany.,REBIRTH, Cluster of Excellence, Hannover Medical School, Hannover, 30625, Germany
| | - A K Flögel
- Institute for Molecular and Cell Physiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - E Becker
- Institute for Molecular and Cell Physiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Lucas-Hahn
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystrasse 10, Mariensee, 31535, Neustadt, Germany
| | - G J Cost
- Sangamo Therapeutics, 501 Canal Boulevard, CA, 94804, Richmond, USA.,Casebia Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - C Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - T Kraft
- Institute for Molecular and Cell Physiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,REBIRTH, Cluster of Excellence, Hannover Medical School, Hannover, 30625, Germany
| | - H Niemann
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystrasse 10, Mariensee, 31535, Neustadt, Germany.,REBIRTH, Cluster of Excellence, Hannover Medical School, Hannover, 30625, Germany
| | - B Brenner
- Institute for Molecular and Cell Physiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,REBIRTH, Cluster of Excellence, Hannover Medical School, Hannover, 30625, Germany
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Gatzoulis KA, Georgopoulos S, Antoniou CK, Anastasakis A, Dilaveris P, Arsenos P, Sideris S, Tsiachris D, Archontakis S, Sotiropoulos E, Theopistou A, Skiadas I, Kallikazaros I, Stefanadis C, Tousoulis D. Programmed ventricular stimulation predicts arrhythmic events and survival in hypertrophic cardiomyopathy. Int J Cardiol 2018; 254:175-181. [DOI: 10.1016/j.ijcard.2017.10.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/16/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022]
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Hmaid AAAA, Markelic M, Otasevic V, Masovic S, Jankovic A, Korac B, Korac A. Structural alterations in rat myocardium induced by chronic l-arginine and l-NAME supplementation. Saudi J Biol Sci 2018; 25:537-544. [PMID: 29686516 PMCID: PMC5910630 DOI: 10.1016/j.sjbs.2016.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/09/2015] [Accepted: 01/12/2016] [Indexed: 02/07/2023] Open
Abstract
Structural changes affecting cardiomyocyte function may contribute to the pathophysiological remodeling underlying cardiac function impairment. Recent reports have shown that endogenous nitric oxide (NO) plays an important role in this process. In order to examine the role of NO in cardiomyocyte remodeling, male rats were acclimated to room temperature (22 ± 1 °C) or cold (4 ± 1 °C) and treated with 2.25% l-arginine·HCl or 0.01% l-NAME (Nω-nitro-l-arginine methyl ester)·HCl for 45 days. Untreated groups served as controls. Right heart ventricles were routinely prepared for light microscopic examination. Stereological estimations of volume densities of cardiomyocytes, surrounding blood vessels and connective tissue, as well as the morphometric measurements of cardiomyocyte diameters were performed. Tissue sections were also analyzed for structural alterations. We observed that both l-arginine and l-NAME supplementation induced cardiomyocyte hypertrophy, regardless of ambient temperature. However, cardiomyocyte hypertrophy was associated with fibrosis and extra collagen deposition only in the l-NAME treated group. Taken together, our results suggest that NO has a modulatory role in right heart ventricle remodeling by coordinating hypertrophy of cardiomyocytes and fibrous tissue preventing cardiac fibrosis.
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Affiliation(s)
- Amal Abdussalam Ali A. Hmaid
- Chair of Cell and Tissue Biology, Faculty of Biology, University of Belgrade, Studentski trg 16, 11000 Belgrade, Serbia
| | - Milica Markelic
- Chair of Cell and Tissue Biology, Faculty of Biology, University of Belgrade, Studentski trg 16, 11000 Belgrade, Serbia
| | - Vesna Otasevic
- Department of Physiology, Institute for Biological Research “Sinisa Stankovic”, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia
| | - Sava Masovic
- Department of Physiology, Institute for Biological Research “Sinisa Stankovic”, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia
| | - Aleksandra Jankovic
- Department of Physiology, Institute for Biological Research “Sinisa Stankovic”, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia
| | - Bato Korac
- Department of Physiology, Institute for Biological Research “Sinisa Stankovic”, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia
| | - Aleksandra Korac
- Chair of Cell and Tissue Biology, Faculty of Biology, University of Belgrade, Studentski trg 16, 11000 Belgrade, Serbia
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Betancourt Cuellar SL, Palacio D, Benveniste MF, Carter BW, Gladish G. Pitfalls and Misinterpretations of Cardiac Findings on PET/CT Imaging: A Careful Look at the Heart in Oncology Patients. Curr Probl Diagn Radiol 2018; 48:172-183. [PMID: 29549978 DOI: 10.1067/j.cpradiol.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
Abstract
Positron emission tomography (PET) computed tomography (CT) with 2-[fluorine-18] fluoro-2-deoxy-d-glucose (FDG) has been established as an effective modality for evaluation of cancer. Interpretations of patterns of physiologic 18F-FDG uptake by the heart is particularly difficult given the wide normal variations of 18F-FDG metabolic activity observed. Atypical patterns of focal or diffuse physiologic cardiac 18F-FDG uptake and post-therapeutic effects after radiation therapy, systemic diseases, or cardiomyopathy may also be confused with malignant disease on 18F-FDG PET/CT. In this article, we review the variations of normal cardiac 18F-FDG uptake observed in oncology patients and the appearances of other patterns of pathologic metabolic activity, related or not related to the malignancy being investigated, that may lead to false-negative and false-positive results.
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Affiliation(s)
| | - Diana Palacio
- Department of Medical Imaging, The University of Arizona, Banner Medical Center, Tucson, AZ
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory Gladish
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Leong KM, Chow JJ, Ng FS, Falaschetti E, Qureshi N, Koa-Wing M, Linton NW, Whinnett ZI, Lefroy DC, Davies DW, Lim PB, Peters NS, Kanagaratnam P, Varnava AM. Comparison of the Prognostic Usefulness of the European Society of Cardiology and American Heart Association/American College of Cardiology Foundation Risk Stratification Systems for Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 121:349-355. [PMID: 29203036 PMCID: PMC5812921 DOI: 10.1016/j.amjcard.2017.10.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 10/31/2022]
Abstract
Implantable cardiodefibrillators (ICDs) have proven benefit in preventing sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HC), making risk stratification essential. Data on the predictive accuracy on the European Society of Cardiology (ESC) risk scoring system have been conflicting. We independently evaluated the ESC risk scoring system in our cohort of patients with HC from a large tertiary center and compared this with previous guidance by the American College of Cardiology Foundation and Heart Association (ACCF/AHA). Risk factor profiles, 5-year SCD risk estimates, and ICD recommendations, as defined by the ACCF/AHA and ESC guidelines, were retrospectively ascertained for 288 HC patients with and without SCD or equivalent events at our center. In the SCD group (n = 14), a significantly higher proportion of patients would not have met the criteria for an ICD implant using the ESC scoring algorithm compared with ACCF/AHA guidance (43% vs 7%, p = 0.029). In those without SCD events (n = 274), a larger proportion of individuals not requiring an ICD was identified using the ESC risk score model compared with the ACCF/AHA model (82% vs 57%; p < 0.0001). Based on risk stratification criteria alone, 5 more individuals with a previously aborted SCD event would not have received an ICD with the ESC risk model compared with the ACCF/AHA risk model. In conclusion, we found that the current ESC scoring system potentially leaves more high-risk patients unprotected from sudden death in our cohort of patients.
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Sarr SA, Dodo B, Babaka K, Aw F, Bodian M, Ndiaye MB, Kane A, Diao M, Ba SA. Risk assessment of the occurrence of sudden death related to hypertrophic cardiomyopathy in Dakar. Cardiovasc J Afr 2018; 29:e1-e5. [PMID: 29582881 PMCID: PMC6002797 DOI: 10.5830/cvja-2017-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/12/2017] [Indexed: 11/06/2022] Open
Abstract
Objectifs La cardiomyopathie hypertrophique (CMH) est l’une des principales causes de mort subite (MS) du sujet jeune, notamment chez le sportif de moins de 35 ans. Le niveau de risque est variable et nécessite d’être évalué afin d’adopter une stratégie préventive adaptée. Nous avons entrepris ce travail dans le but d’évaluer le risque de survenue de mort subite dans une population de CMH à Dakar. Méthode Il s’agissait d’une étude transversale et descriptive menée à la clinique cardiologique de l’hôpital Aristide Le Dantec de Dakar du 1er Janvier 2014 au 30 Juin 2015. Nous avions évalué sur le plan clinique et paraclinique les facteurs de risque de mort subite et utilisé le score en ligne de l’European Society of Cardiology (ESC) pour le calcul de ce risque. La population étudiée était constituée de patients porteurs de CMH diagnostiquée, suivis dans ledit service. Résultats Nous avions retrouvé un âge moyen des patients de 53.25 ans et il y avait une prédominance masculine (sexratio de 1.66). La syncope inexpliquée était retrouvée chez 2 patients et 2 autres avaient des antécédents de survenue de mort subite dans leurs familles à des âges de 50 ans et 55 ans. L’hypertrophie septale maximale était en moyenne de 20.9 mm. Quatorze patients présentaient une dilatation auriculaire gauche. Sept patients présentaient une obstruction intra-ventriculaire gauche. Selon le score ESC, 1 patient avait un haut risque de survenue de mort subite dans les 5 ans, 3 un risque intermédiaire et 13 un risque faible. Le sport de compétition était proscrit, 13 patients étaient sous traitement médical, 1 avait eu un défibrillateur automatique implantable (DAI) et 2 n’étaient sous aucun traitement. Conclusion Notre travail a mis en exergue une prédominance de risque faible et intermédiaire de mort subite à 5 ans. Le haut risque existait dans un cas.
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Affiliation(s)
- Simon Antoine Sarr
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Boubacar Dodo
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Kana Babaka
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Fatou Aw
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Malick Bodian
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | | | - Adama Kane
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal.
| | - Maboury Diao
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
| | - Serigne Abdou Ba
- Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal
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