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Captur G, Lopes LR, Mohun TJ, Patel V, Li C, Bassett P, Finocchiaro G, Ferreira VM, Esteban MT, Muthurangu V, Sherrid MV, Day SM, Canter CE, McKenna WJ, Seidman CE, Bluemke DA, Elliott PM, Ho CY, Moon JC. Prediction of sarcomere mutations in subclinical hypertrophic cardiomyopathy. Circ Cardiovasc Imaging 2014; 7:863-71. [PMID: 25228707 DOI: 10.1161/circimaging.114.002411] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sarcomere protein mutations in hypertrophic cardiomyopathy induce subtle cardiac structural changes before the development of left ventricular hypertrophy (LVH). We have proposed that myocardial crypts are part of this phenotype and independently associated with the presence of sarcomere gene mutations. We tested this hypothesis in genetic hypertrophic cardiomyopathy pre-LVH (genotype positive, LVH negative [G+LVH-]). METHODS AND RESULTS A multicenter case-control study investigated crypts and 22 other cardiovascular magnetic resonance parameters in subclinical hypertrophic cardiomyopathy to determine their strength of association with sarcomere gene mutation carriage. The G+LVH- sample (n=73) was 29 ± 13 years old and 51% were men. Crypts were related to the presence of sarcomere mutations (for ≥1 crypt, β=2.5; 95% confidence interval [CI], 0.5-4.4; P=0.014 and for ≥2 crypts, β=3.0; 95% CI, 0.8-7.9; P=0.004). In combination with 3 other parameters: anterior mitral valve leaflet elongation (β=2.1; 95% CI, 1.7-3.1; P<0.001), abnormal LV apical trabeculae (β=1.6; 95% CI, 0.8-2.5; P<0.001), and smaller LV end-systolic volumes (β=1.4; 95% CI, 0.5-2.3; P=0.001), multiple crypts indicated the presence of sarcomere gene mutations with 80% accuracy and an area under the curve of 0.85 (95% CI, 0.8-0.9). In this G+LVH- population, cardiac myosin-binding protein C mutation carriers had twice the prevalence of crypts when compared with the other combined mutations (47 versus 23%; odds ratio, 2.9; 95% CI, 1.1-7.9; P=0.045). CONCLUSIONS The subclinical hypertrophic cardiomyopathy phenotype measured by cardiovascular magnetic resonance in a multicenter environment and consisting of crypts (particularly multiple), anterior mitral valve leaflet elongation, abnormal trabeculae, and smaller LV systolic cavity is indicative of the presence of sarcomere gene mutations and highlights the need for further study.
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Affiliation(s)
- Gabriella Captur
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Luis R Lopes
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Timothy J Mohun
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Vimal Patel
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Chunming Li
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Paul Bassett
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Gherardo Finocchiaro
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Vanessa M Ferreira
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Maite Tome Esteban
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Vivek Muthurangu
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Mark V Sherrid
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Sharlene M Day
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Charles E Canter
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - William J McKenna
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Christine E Seidman
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - David A Bluemke
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Perry M Elliott
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Carolyn Y Ho
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - James C Moon
- From the Department of Cardiovascular Science (G.C., L.R.L., V.P., V.M., W.J.M., P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Inherited Cardiovascular Diseases (G.C., L.R.L., V.P., M.T.E., W.J.M., P.M.E., J.C.M.) and Cardiac Imaging Department (G.C., G.F., M.T.E., W.J.M., J.C.M.), Barts Heart Centre, London, United Kingdom; Department of Developmental Biology, MRC National Institutes for Medical Research, Mill Hill, United Kingdom (T.J.M.); Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Center for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom (V.M.F.); UCL Department for Cardiovascular Imaging, Great Ormond Street Hospital for Children, London, United Kingdom (V.M.); Department of Cardiology, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (M.V.S.); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (S.M.D.); Pediatric Cardiology Department, Washington University School of Medicine, St Louis, MO (C.E.C.); Department of Genetics, Harvard Medical School, Boston, MA (C.E.S.); Radiology and Imaging Sciences Department, National Institutes of Health/Clinical Center, Bethesda, MD (D.A.B.); and Cardiovascular Department, Brigham and Women's Hospital, Boston, MA (C.Y.H.).
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Captur G, Lopes LR, Patel V, Li C, Bassett P, Syrris P, Sado DM, Maestrini V, Mohun TJ, McKenna WJ, Muthurangu V, Elliott PM, Moon JC. Abnormal cardiac formation in hypertrophic cardiomyopathy: fractal analysis of trabeculae and preclinical gene expression. ACTA ACUST UNITED AC 2014; 7:241-8. [PMID: 24704860 DOI: 10.1161/circgenetics.113.000362] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Mutations in genes coding for sarcomeric proteins cause hypertrophic cardiomyopathy. Subtle abnormalities of the myocardium may be present in mutation carriers without left ventricular hypertrophy (G+LVH-) but are difficult to quantify. Fractal analysis has been used to define trabeculae in left ventricular noncompaction and to identify normal racial variations. We hypothesized that trabeculae measured by fractal analysis of cardiovascular magnetic resonance images are abnormal in G+LVH- patients, providing a preclinical marker of disease in hypertrophic cardiomyopathy. METHODS AND RESULTS Cardiovascular magnetic resonance was performed on 40 G+LVH- patients (33±15 years, 38% men), 67 patients with a clinical diagnosis of hypertrophic cardiomyopathy (53±15 years, 76% men; 31 with a pathogenic mutation [G+LVH+]), and 69 matched healthy volunteers (44±15 years, 57% men). Trabeculae were quantified by fractal analysis of cine slices to calculate the fractal dimension, a unitless index of endocardial complexity calculated from endocardial contours after segmentation. In G+LVH- patients, apical left ventricular trabeculation was increased compared with controls (maximal apical fractal dimension, 1.249±0.07 versus 1.199±0.05; P=0.001). In G+LVH+ and G-LVH+ cohorts, maximal apical fractal dimension was greater than in controls (P<0.0001) irrespective of gene status (G+LVH+: 1.370±0.08; G-LVH+: 1.380±0.09). Compared with controls, G+LVH- patients also had a higher frequency of clefts (28% versus 8%; P=0.02), longer anterior mitral valve leaflets (23.5±3.0 versus 19.7±3.1 mm; P<0.0001), greater septal systolic wall thickness (12.6±3.2 versus 11.2±2.1 mm; P=0.03), higher ejection fraction (71±4% versus 69±4%; P=0.03), and smaller end-systolic volumes (38±9 versus 43±12 mL; P=0.03). CONCLUSIONS Increased myocardial trabecular complexity is one of several preclinical abnormalities in hypertrophic cardiomyopathy sarcomere gene mutation carriers without LVH.
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Affiliation(s)
- Gabriella Captur
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Luis R Lopes
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Vimal Patel
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Chunming Li
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Paul Bassett
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Petros Syrris
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Daniel M Sado
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Viviana Maestrini
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Timothy J Mohun
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - William J McKenna
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Vivek Muthurangu
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - Perry M Elliott
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu)
| | - James C Moon
- From Division of Cardiovascular Imaging and Inherited Cardiovascular Disease Unit, The Heart Hospital, part of University College London NHS Foundation Trust, London, United Kingdom (G.C., L.L., V.P., P.S., D.M.S., V. Maestrini, W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science (G.C., L.L., V.P., P.B., P.S., D.M.S., V. Maestrini, W.J.M., V. Muthurangu, P.M.E., J.C.M.) and Biostatistics Joint Research Office (P.B.), University College London, London, United Kingdom; Department of Radiology, University of Pennsylvania, Philadelphia (C.L.); Developmental Biology Division, MRC National Institute for Medical Research, London, United Kingdom (T.J.M.); and UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, United Kingdom (V. Muthurangu).
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