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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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Wang S, Wang Q, Zhai N, Wang X, Li Z, Gan L, Cui Y. Progression of Danon disease with medical imaging: two case reports. J Int Med Res 2021; 49:300060520986676. [PMID: 33530800 PMCID: PMC7871080 DOI: 10.1177/0300060520986676] [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] [Indexed: 11/16/2022] Open
Abstract
Danon disease is a rare X-linked dominant genetic disorder caused by loss-of-function mutations in the lysosome-associated membrane protein 2 gene. Progression of Danon disease is unknown because of its rare incidence in a diverse ethnic population. We report longitudinal data from two patients who were diagnosed with Danon disease by a genetic test. The evaluation protocol included electrocardiographic monitoring, echocardiography, and magnetic resonance imaging. Progression of hypertrophic cardiomyopathy to dilated cardiomyopathy was observed in the first patient. He died from sudden cardiac arrest. The second patient is currently suffering from hypertrophic cardiomyopathy. Development of the hypertrophic phase progressing into the dilated phase in Danon disease may provide useful information for early identification and clinical decisions in patients with this disease.
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Affiliation(s)
- Shuai Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Qinglei Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Ning Zhai
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Xin Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Zhihua Li
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Lijun Gan
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yinghua Cui
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
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D'souza RS, Mestroni L, Taylor MRG. Danon disease for the cardiologist: case report and review of the literature. J Community Hosp Intern Med Perspect 2017. [PMID: 28638575 PMCID: PMC5473185 DOI: 10.1080/20009666.2017.1324239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Danon disease is a rare, X-linked dominant genetic disorder that is caused by defects in the lysosome-associated membrane protein 2 (LAMP2) gene. It manifests predominantly in young males with a classic triad of cardiomyopathy, skeletal myopathy, and intellectual disability. Death from cardiac disease is the ultimate cause of demise in many patients if left untreated. Given the rarity of the condition, the natural history is poorly understood. Here, we present a case report on a 14-year-old Hispanic boy with Danon disease, highlighting major clinical events and diagnostic study findings over a six-year period from age of symptom onset to age of death. He had significant hypertrophic cardiomyopathy (ventricular septal thickness 65 mm) and experienced various arrhythmias during his clinical course including Wolf-Parkinson-White syndrome, non-sustained ventricular tachycardia, and pre-excited atrial fibrillation with a fasciculoventricular anomalous accessory pathway. He had sudden cardiac death from ventricular fibrillation at age 14 and his heart had a weight of 1425 grams at autopsy. We also provide a review of the cardiac Danon disease literature related to diagnostic and management approaches to aid cardiologists in evaluating and treating cardiac manifestations in Danon disease patients.
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Affiliation(s)
- Ryan S D'souza
- Adult Medical Genetics Program and Division of Cardiology, University of Colorado Denver, Denver, CO, USA.,Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Luisa Mestroni
- Adult Medical Genetics Program and Division of Cardiology, University of Colorado Denver, Denver, CO, USA
| | - Matthew R G Taylor
- Adult Medical Genetics Program and Division of Cardiology, University of Colorado Denver, Denver, CO, USA
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Ren CW, Liu JJ, Li JH, Li JW, Dai J, Lai YQ. RNA‑seq profiling of mRNA associated with hypertrophic cardiomyopathy. Mol Med Rep 2016; 14:5573-5586. [PMID: 27840985 DOI: 10.3892/mmr.2016.5931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/20/2016] [Indexed: 11/06/2022] Open
Abstract
The mechanisms of hypertrophic cardiomyopathy (HCM) pathogenesis can be investigated by determining the differences between healthy and disease states at the molecular level. In the present study, large‑scale transcriptome sequencing was performed to compare mRNA expression in patients with HCM and control groups using an Illumina sequencing platform. Compared with the genome background, 257 differentially expressed genes (DEGs) were identified in which 62 genes were downregulated and 195 genes were upregulated. Reverse transcription‑quantitative polymerase chain reaction was performed to validate the expression pattern of certain mRNAs. Gene ontology enrichment and KEGG analysis of mRNAs was conducted to identify the biological modules and pathological pathways associated with the DEGs. To the best of our knowledge, this is the first time study to investigate the differences in mRNA between patients with HCM and normal controls at the transcriptome level. The results of the study will contributed to the understanding of the important molecular mechanisms involved in HCM and aid the selection of key genes to investigate in the future.
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Affiliation(s)
- Chang-Wei Ren
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jia-Ji Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jin-Hua Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jing-Wei Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jiang Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Yong-Qiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Lee DD, Veith RL, Dimmock DP, Samyn MM. Hypertrophic cardiomyopathy: a new mutation illustrates the need for family-centered care. Pediatr Cardiol 2014; 35:1474-7. [PMID: 25182012 DOI: 10.1007/s00246-014-1002-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
This is a case series of a family positive for a previously undescribed mutation in the myofilament gene MYH7, causing hypertrophic cardiomyopathy (HCM), a potentially lethal cardiac disease with strong hereditability. The family's significant disease became strikingly apparent with the unanticipated diagnosis of their newborn infant shortly after her birth. This led to the discovery of the MYH7 mutation in the infant, as well as her father and two siblings, all of whom had varying degrees of disease severity. Despite prior diagnosis of HCM for the paternal grandmother and great uncles, this family's situation points to the need for continued education of healthcare providers, when heritable diseases are encountered. Genetics consult should occur early and has been shown to be helpful in making an accurate diagnosis and identifying relatives at risk of developing the condition. It may, as in this case series, lead to the discovery of a novel mutation and contribute to the growing genetic database for familial HCM.
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Affiliation(s)
- Daniel D Lee
- Medical College of Wisconsin, Milwaukee, WI, USA,
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Todiere G, Pisciella L, Barison A, Del Franco A, Zachara E, Piaggi P, Re F, Pingitore A, Emdin M, Lombardi M, Aquaro GD. Abnormal T2-STIR magnetic resonance in hypertrophic cardiomyopathy: a marker of advanced disease and electrical myocardial instability. PLoS One 2014; 9:e111366. [PMID: 25356653 PMCID: PMC4214734 DOI: 10.1371/journal.pone.0111366] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/01/2014] [Indexed: 01/27/2023] Open
Abstract
Background Myocardial hyperintensity on T2-weighted short-tau inversion recovery (STIR) (HyT2) cardiac magnetic resonance (CMR) images has been demonstrated in patients with hypertrophic cardiomyopathy (HCM) and is considered a sign of acute damage. The aim of the current study was to evaluate the relationship between HyT2 and both a) markers of ventricular electrical instability and b) clinical and CMR parameters. Methods Sixty-five patients underwent a thorough clinical examination, consisting of 24-h ECG recording and CMR examination including functional evaluation, T2-STIR images and late gadolinium enhancement (LGE). Results HyT2 was detected in 27 patients (42%), and subjects with HyT2 showed a greater left ventricle (LV) mass index (p<0.001), lower LV ejection fraction (p = 0.05) and greater extent of LGE (p<0.001) compared to those without HyT2. Twenty-two subjects (34%) presented non-sustained ventricular tachycardia (NSVT) on the 24-h ECG recording, 21 (95%) of whom exhibited HyT2. Based on the logistic regression analysis, HyT2 (odds ratio [OR]: 165, 95% CI 11–2455, p<0.001) and LGE extent (1.1, 1.0–1.3, p<0.001) served as independent predictors of NSVT, while the presence of LGE was not associated with NSVT occurrence (p = 0.49). The presence of HyT2 was associated with lower heart rate variability (p = 0.006) and a higher number of arrhythmic risk factors (p<0.001). Conclusions In HCM patients, HyT2 upon CMR examination is associated with more advanced disease and increased arrhythmic burden.
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Affiliation(s)
- Giancarlo Todiere
- Fondazione G. Monasterio Regione Toscana-National Research Council, Pisa, Italy
- * E-mail:
| | - Lorena Pisciella
- Cardiologia 2 Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Andrea Barison
- Fondazione G. Monasterio Regione Toscana-National Research Council, Pisa, Italy
| | | | | | - Paolo Piaggi
- Endocrinology Unit, University Hospital, Pisa, Italy
| | - Federica Re
- Cardiologia 2 Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | | | - Michele Emdin
- Fondazione G. Monasterio Regione Toscana-National Research Council, Pisa, Italy
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Soliman EZ, Shah AJ, Boerkircher A, Li Y, Rautaharju PM. Inter-relationship between electrocardiographic left ventricular hypertrophy and QT prolongation as predictors of increased risk of mortality in the general population. Circ Arrhythm Electrophysiol 2014; 7:400-6. [PMID: 24762807 DOI: 10.1161/circep.113.001396] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prolonged-QT commonly coexists in the ECG with left ventricular hypertrophy (ECG-LVH). However, it is unclear whether to what extent QT prolongation coexisting with ECG-LVH can explain the prognostic significance of ECG-LVH, and whether prolonged-QT coexisting with ECG-LVH should be considered as an innocent consequence of ECG-LVH. METHODS AND RESULTS The study population consisted of 7506 participants (mean age, 59.4±13.3 years; 49% whites; and 47% men) from the US Third National Health and Nutrition Examination Survey. ECG-LVH was defined by Cornell voltage criteria. Prolonged heart-rate-adjusted QT (prolonged-QTa) was defined as QTa≥460 ms in women or 450 ms in men. Cox proportional hazards analysis was used to calculate the hazard ratios with 95% confidence intervals for the risk of all-cause mortality for various combinations of ECG-LVH and prolonged-QTa. ECG-LVH was present in 4.2% (N=312) of the participants, of whom 16.4% had prolonged-QTa. In a multivariable-adjusted model and compared with the group without ECG-LVH or prolonged-QTa, mortality risk was highest in the group with concomitant ECG-LVH and prolonged-QTa (hazard ratio, 1.63; 95% confidence interval, 1.12-2.36), followed by isolated ECG-LVH (1.48; 1.24-1.77), and then isolated prolonged-QTa (1.27; 1.12-1.46). In models with similar adjustment where ECG-LVH and prolonged-QTa were entered as 2 separate variables and subsequently additionally adjusted for each other, the mortality risk was essentially unchanged for both variables. CONCLUSIONS Although prolonged-QT commonly coexists with LVH, both are independent markers of poor prognosis. Concomitant presence of prolonged-QT and ECG-LVH carries a higher risk than either predictor alone.
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Affiliation(s)
- Elsayed Z Soliman
- From the Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S., Y.L., P.M.R.) and Section on Cardiology, Department of Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston Salem, NC; Department of Epidemiology, Emory University, Atlanta, GA (A.J.S.); and Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC (A.B.).
| | - Amit J Shah
- From the Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S., Y.L., P.M.R.) and Section on Cardiology, Department of Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston Salem, NC; Department of Epidemiology, Emory University, Atlanta, GA (A.J.S.); and Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC (A.B.)
| | - Andrew Boerkircher
- From the Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S., Y.L., P.M.R.) and Section on Cardiology, Department of Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston Salem, NC; Department of Epidemiology, Emory University, Atlanta, GA (A.J.S.); and Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC (A.B.)
| | - Yabing Li
- From the Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S., Y.L., P.M.R.) and Section on Cardiology, Department of Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston Salem, NC; Department of Epidemiology, Emory University, Atlanta, GA (A.J.S.); and Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC (A.B.)
| | - Pentti M Rautaharju
- From the Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S., Y.L., P.M.R.) and Section on Cardiology, Department of Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston Salem, NC; Department of Epidemiology, Emory University, Atlanta, GA (A.J.S.); and Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC (A.B.)
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Pacileo G, Salerno G, Gravino R, Calabrò R, Elliott PM. Risk stratification in hypertrophic cardiomyopathy: time for renewal? J Cardiovasc Med (Hagerstown) 2014; 14:319-25. [PMID: 22885536 DOI: 10.2459/jcm.0b013e328357739e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Systematic clinical assessment and careful monitoring of patients with hypertrophic cardiomyopathy (HCM) can be used to identify a cohort of patients that benefit from medical intervention and almost certainly improve long-term outcomes. One of the major limitations of the current approach is a lack of predictive power of individual risk factors, which means that many patients receive therapy. The aim of this review is to highlight other aspects of the disease, assessed using old and new medical technologies, that appear to provide new prognostic information. The hope for the future is that their incorporation in new risk algorithms will improve treatment for all HCM patients with the disease, irrespective of their vulnerability to adverse complications.
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Affiliation(s)
- Giuseppe Pacileo
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
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Charron P, Komajda M. Molecular genetics in hypertrophic cardiomyopathy: towards individualized management of the disease. Expert Rev Mol Diagn 2014; 6:65-78. [PMID: 16359268 DOI: 10.1586/14737159.6.1.65] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hypertrophic cardiomyopathy is a relatively common genetic disease, affecting one person per 500 in the general population, and is clinically defined by the presence of unexplained left ventricular hypertrophy. Although recognized as the most common cause of sudden death in the young (especially in athletes), the cardiac expression of the disease is highly variable with respect to age at onset, degree of symptoms and risk of cardiac death. As a consequence, therapeutic strategies are diverse and must be adapted to the specific features of an individual. Recently, the molecular bases of the disease have been unraveled with the identification of a large number of mutations in genes encoding sarcomeric proteins. This review focuses on the impact of the molecular data on the understanding of the disease, and considers the emerging issues regarding the impact of molecular testing on the management of patients (or relatives) in clinical practice.
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Affiliation(s)
- Philippe Charron
- Centre of Reference for Cardiac Hereditary Diseases, Département de Génétique, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France.
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Kawasaki T, Sakai C, Harimoto K, Yamano M, Miki S, Kamitani T, Sugihara H. Holter Monitoring and Long-Term Prognosis in Hypertrophic Cardiomyopathy. Cardiology 2012; 122:44-54. [DOI: 10.1159/000338156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 02/28/2012] [Indexed: 01/12/2023]
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Moak JP, Leifer ES, Tripodi D, Mohiddin SA, Fananapazir L. Long-term follow-up of children and adolescents diagnosed with hypertrophic cardiomyopathy: risk factors for adverse arrhythmic events. Pediatr Cardiol 2011; 32:1096-105. [PMID: 21487794 DOI: 10.1007/s00246-011-9967-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 03/20/2011] [Indexed: 11/30/2022]
Abstract
Our aim was to identify prognostic factors for an arrhythmic event (AE) in children with hypertrophic cardiomyopathy (HCM) without a previous AE. One hundred thirty-one nonconsecutive patients (≤ 20 years) with HCM but no previous AE were evaluated at the NIH Clinical Center from 1980 to 2001. At a median follow-up of 6.4 years, 22 patients experienced an AE [sudden death (SD) (n = 12), resuscitated cardiac arrest (n = 3), clinical sustained ventricular tachycardia (VT) (n = 2), and implantable cardiac defibrillator discharge (n = 5)], resulting in a 2% annual AE rate. Baseline factors that were most predictive in univariate risk analysis included ventricular septal thickness (ST) (P = 0.01), VT induction by programmed ventricular stimulation (PVS) (P = 0.01), age (P = 0.05), and presyncope/syncope (P = 0.05). In multivariate analysis, ST, age, presyncope/syncope, and PVS were not independently predictive of risk for an AE. However, the 5-year event rates for AE was 15% (95% CI: 5-23%) if ST ≥ 20 mm, 19% (95% CI: 6-31%) when age ≥ 13 years and ST ≥ 20 mm were combined together, and 23% (95% CI: 3-39%) when PVS and ST ≥ 20 mm were combined together. Of the various risk factors that were considered in our pediatric HCM cohort, ST and inducible VT were the most significant univariate predictors of risk for an AE. More traditional risk factors identified in older patients (family history of SD, VT on Holter, and exercise-induced hypotension) were not predictive of an AE in patients age under 21 years.
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Affiliation(s)
- Jeffrey P Moak
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA.
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Abstract
Hypertrophic cardiomyopathy is a myocardial disease characterized by myocardial hypertrophy, disorganization of cardiac myocytes, and fibrosis. Twenty-five percent of patients have a dynamic left ventricular outflow tract gradient caused by the combined effects of rapid ventricular ejection, a narrowed outflow tract, and systolic anterior motion of the mitral valve. Most cases are caused by mutations in genes that encode cardiac sarcomeric proteins. Patients present at all ages with chest pain, dyspnea, palpitations, and syncope. The most important complications of the disease are sudden cardiac death, heart failure, and thromboembolism. The principal aims of management are the alleviation of symptoms and the prevention of sudden death. In patients with substantial left ventricular outflow tract obstruction, interventions that reduce the magnitude of the outflow tract gradient (disopyramide, verapamil, β-blockade, alcohol ablation of the interventricular septum, dual-chamber pacing, and surgery) often improve symptoms. Therapeutic options in patients without left ventricular outflow tract obstruction are more limited. Clinical risk stratification is used to estimate the risk of sudden death and to target effective prophylactic treatment with an implantable cardioverter defibrillator.
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Peña JR, Szkudlarek AC, Warren CM, Heinrich LS, Gaffin RD, Jagatheesan G, del Monte F, Hajjar RJ, Goldspink PH, Solaro RJ, Wieczorek DF, Wolska BM. Neonatal gene transfer of Serca2a delays onset of hypertrophic remodeling and improves function in familial hypertrophic cardiomyopathy. J Mol Cell Cardiol 2010; 49:993-1002. [PMID: 20854827 DOI: 10.1016/j.yjmcc.2010.09.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 08/25/2010] [Accepted: 09/10/2010] [Indexed: 10/19/2022]
Abstract
Familial hypertrophic cardiomyopathy (FHC) is an autosomal dominant genetic disorder linked to numerous mutations in the sarcomeric proteins. The clinical presentation of FHC is highly variable, but it is a major cause of sudden cardiac death in young adults with no specific treatments. We tested the hypothesis that early intervention in Ca(2+) regulation may prevent pathological hypertrophy and improve cardiac function in a FHC displaying increased myofilament sensitivity to Ca(2+) and diastolic dysfunction. A transgenic (TG) mouse model of FHC with a mutation in tropomyosin at position 180 was employed. Adenoviral-Serca2a (Ad.Ser) was injected into the left ventricle of 1-day-old non-transgenic (NTG) and TG mice. Ad.LacZ was injected as a control. Serca2a protein expression was significantly increased in NTG and TG hearts injected with Ad.Ser for up to 6 weeks. Compared to TG-Ad.LacZ hearts, the TG-Ad.Ser hearts showed improved whole heart morphology. Moreover, there was a significant decline in ANF and β-MHC expression. Developed force in isolated papillary muscle from 2- to 3-week-old TG-Ad.Ser hearts was higher and the response to isoproterenol (ISO) improved compared to TG-Ad.LacZ muscles. In situ hemodynamic measurements showed that by 3 months the TG-Ad.Ser hearts also had a significantly improved response to ISO compared to TG-Ad.LacZ hearts. The present study strongly suggests that Serca2a expression should be considered as a potential target for gene therapy in FHC. Moreover, our data imply that development of FHC can be successfully delayed if therapies are started shortly after birth.
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Affiliation(s)
- James R Peña
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA
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Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the prototypic form of pathological cardiac hypertrophy. HCM is an important cause of sudden cardiac death in the young and a major cause of morbidity in the elderly. DESIGN We discuss the clinical implications of recent advances in the molecular genetics of HCM. RESULTS The current diagnosis of HCM is neither adequately sensitive nor specific. Partial elucidation of the molecular genetic basis of HCM has raised interest in genetic-based diagnosis and management. Over a dozen causal genes have been identified. MYH7 and MYBPC3 mutations account for about 50% of cases. The remaining known causal genes are uncommon and some are rare. Advances in DNA sequencing techniques have made genetic screening practical. The difficulty, particularly in the sporadic cases and in small families, is to discern the causal from the non-causal variants. Overall, the causal mutations alone have limited implications in risk stratification and prognostication, as the clinical phenotype arises from complex and often non-linear interactions between various determinants. CONCLUSIONS The clinical phenotype of 'HCM' results from mutations in sarcomeric proteins and subsequent activation of multiple cellular constituents including signal transducers. We advocate that HCM, despite its current recognition and management as a single disease entity, involves multiple partially independent mechanisms, despite similarity in the ensuing phenotype. To treat HCM effectively, it is necessary to delineate the underlying fundamental mechanisms that govern the pathogenesis of the phenotype and apply these principles to the treatment of each subset of clinically recognized HCM.
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Affiliation(s)
- Ali J Marian
- Center for Cardiovascular Genetics, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center and Texas Heart Institute at St. Luke's Episcopal Hospital, 6770 Bertner Street, Suite C900A, Houston, TX 77030, USA.
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SYSKA PAWEŁ, PRZYBYLSKI ANDRZEJ, CHOJNOWSKA LIDIA, LEWANDOWSKI MICHAŁ, STERLIŃSKI MACIEJ, MACIĄG ALEKSANDER, GEPNER KATARZYNA, PYTKOWSKI MARIUSZ, KOWALIK ILONA, MĄCZYŃSKA-MAZURUK RENATA, RUZYŁŁO WITOLD, SZWED HANNA. Implantable Cardioverter-Defibrillator in Patients With Hypertrophic Cardiomyopathy: Efficacy and Complications of the Therapy in Long-Term Follow-up. J Cardiovasc Electrophysiol 2010; 21:883-9. [DOI: 10.1111/j.1540-8167.2009.01716.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Genetic counseling and testing for hypertrophic cardiomyopathy: an adult perspective. J Cardiovasc Transl Res 2009; 2:493-9. [PMID: 20560007 DOI: 10.1007/s12265-009-9127-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 09/08/2009] [Indexed: 10/20/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is considered to be a genetic disease. As such, multidisciplinary approach is needed to evaluate and treat this condition. We present several patient vignettes to illustrate the complementary skills of cardiologists and genetic counselors in providing comprehensive care. Translational application of research will continue to expand as more genetic causes of HCM will be recognized and more genetic tests will become available. Now is the opportunity to build a strong collaboration between the two disciplines to be prepared for the era of personalized medicine.
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20
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TOWBIN JEFFREYA. Hypertrophic Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 2:S23-31. [DOI: 10.1111/j.1540-8159.2009.02381.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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O'Mahony C, Elliott P. The quest for perfection: the contribution of the electrocardiogram to the prevention of sudden death in hypertrophic cardiomyopathy. Europace 2009; 11:548-9. [DOI: 10.1093/europace/eup063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Elliott P, McKenna W. The science of uncertainty and the art of probability: syncope and its consequences in hypertrophic cardiomyopathy. Circulation 2009; 119:1697-9. [PMID: 19349332 DOI: 10.1161/circulationaha.109.851287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Marian AJ. Contemporary treatment of hypertrophic cardiomyopathy. Tex Heart Inst J 2009; 36:194-204. [PMID: 19568388 PMCID: PMC2696493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Cardiac Pacing, Artificial
- Cardiac Surgical Procedures
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/therapy
- Cardiovascular Agents/therapeutic use
- Catheter Ablation
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Endocarditis/etiology
- Endocarditis/prevention & control
- Humans
- Treatment Outcome
- Ventricular Outflow Obstruction/etiology
- Ventricular Outflow Obstruction/therapy
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Affiliation(s)
- Ali J Marian
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, and Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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24
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Abstract
Sudden cardiac death in athletes is an uncommon but extremely visible event because of the high profile of amateur and professional athletes and the expected excellent health of these athletes. However, paradoxically, athletic performance may immediately increase the risk of ventricular arrhythmias and sudden cardiac death while run reducing atherosclerosis, which thus improves cardiovascular health and longevity. In athletes younger than 30 years, the most common underlying causes are due to inherited heart disease. In the older athletes, sudden death is generally due to arrhythmias in the context of coronary artery disease. Many athletes with aborted sudden death, arrhythmia-related syncope, or high-risk genetic disorders benefit from therapy with implanted cardioverter/defibrillators (ICDs) . Although ICD therapy can effectively abort sudden death, implantation of an ICD generally prohibits an individual from all competitive athletics except low-intensity sports. The screening of athletes has been notoriously inadequate; however, the optimal screening strategies have yet to be determined. Recommendations for participation in competitive athletics generally follow the recently published 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.
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Affiliation(s)
- Mark S Link
- Division of Cardiology, Cardiac Arrhythmia Service, Tufts-New England Medical Center, Boston, MA 02111, USA.
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25
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26
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Amano Y, Takayama M, Kumita S, Kumazaki T. MR imaging evaluation of regional, remote, and global effects of percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy. J Comput Assist Tomogr 2007; 31:600-4. [PMID: 17882040 DOI: 10.1097/rct.0b013e31803151fd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate regional, remote, and global effects of percutaneous transluminal septal myocardial ablation (PTSMA) in hypertrophic obstructive cardiomyopathy (HOCM) using magnetic resonance (MR) imaging. METHODS Twenty-one patients with HOCM underwent cine and delayed contrast-enhanced MR imaging. The regional effects of ablated myocardium as well as remote and global effects of PTSMA were assessed. RESULTS The ablated interventricular septal myocardium was hyperenhanced and thinned after successful PTSMA. Decreases in posterior wall thickness and myocardial mass were observed more than 12 weeks after PTSMA. Decreases in posterior wall thickness, myocardial mass, and left atrial diameter were observed in patients without myocardial hyperenhancement before PTSMA. Neither reduction nor increase in hyperenhancing myocardium, except for the ablated myocardium, was observed after PTSMA. CONCLUSIONS Cardiac MR imaging showed regional, remote, and global effects of PTSMA on the myocardium in HOCM and might indicate patients with a good global response to PTSMA.
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Affiliation(s)
- Yasuo Amano
- Department of Radiology, Nippon Medical School, Tokyo, Japan.
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27
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Alcalai R, Seidman JG, Seidman CE. Genetic basis of hypertrophic cardiomyopathy: from bench to the clinics. J Cardiovasc Electrophysiol 2007; 19:104-10. [PMID: 17916152 DOI: 10.1111/j.1540-8167.2007.00965.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder that characterized by marked thickening of the left ventricular wall that occurs in the absence of increased external load. HCM is the most common cause of sudden cardiac death under 35 years and in addition causes heart failure. HCM is usually inherited as an autosomal dominant mutation in genes that encode protein constituents of the sarcomere. To date, more than 450 different mutations have been identified within 13 myofilament-related genes. This review focuses current research involved in the discovery of other causative genes, investigation of the mechanisms by which sarcomere genes mutations produce hypertrophy and arrhythmia, and identification of modifying factors that influence clinical expression in HCM patients. The clinical implications of molecular advances in HCM are discussed.
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Affiliation(s)
- Ronny Alcalai
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
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28
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Dovgalyuk J, Holstege C, Mattu A, Brady WJ. The electrocardiogram in the patient with syncope. Am J Emerg Med 2007; 25:688-701. [PMID: 17606095 DOI: 10.1016/j.ajem.2006.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 12/04/2006] [Indexed: 11/20/2022] Open
Abstract
Syncope is a common and challenging presentation for the emergency physician. Various investigators have developed clinical risk score and clinical decision rules which are designed to identify the population at highest risk for adverse events. In each of these clinical decision tools, the electrocardiogram (ECG) is one of the key clinical variables used to evaluate the patient. Certain electrocardiographic presentations in the patient with syncope will not only provide a reason for the loss of consciousness but also guide early therapy and disposition in this individual. Bradycardia, atrioventricular block, intraventricular conduction abnormality, and tachydysrhythmia in the appropriate clinical setting provide an answer to the clinician for the syncopal event. Morphologic findings suggesting the range of cardiovascular malady are also encountered; these entities are far ranging, including the various ST-segment and T-wave abnormalities of acute coronary syndrome, ventricular preexcitation as seen in the Wolff-Parkinson-White syndrome, Brugada syndrome with the associated tendency for sudden death, prolonged QT interval common in the diverse long QT interval presentations, and right ventricular hypertrophy suggestive of hypertrophic cardiomyopathy. This review discusses the ECG in the patient with syncope. The general use of the 12-lead ECG in this patient population is discussed. Furthermore, specific electrocardiographic presentations seen in the patient with syncope are also reviewed.
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Affiliation(s)
- Jacqueline Dovgalyuk
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
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29
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Venckunas T, Mazutaitiene B. The role of echocardiography in the differential diagnosis between training induced myocardial hypertrophy versus cardiomyopathy. J Sports Sci Med 2007; 6:166-171. [PMID: 24149325 PMCID: PMC3786236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 03/15/2007] [Indexed: 06/02/2023]
Abstract
Increased myocardial mass due to regular high-volume intense exercise training (so-called athlete's heart) is not uncommon. Although directly correlated with the extent of training loads, myocardial hypertrophy is not present exclusively in well-trained or elite athletes. Athlete's heart is considered a physiological phenomenon with no known harmful consequences. However, extreme forms of myocardial hypertrophy due to endurance training resemble a structural heart disease such as hypertrophic cardiomyopathy, a condition associated with substantially increased risk of cardiac event. Endurance sports such as rowing and road cycling, rather than strength/power training, are most commonly associated with left ventricular (LV) wall thickness compatible with hypertrophic cardiomyopathy. The differentiation between physiological and maladaptive cardiac hypertrophy in athletes is undoubtedly important, since untreated cardiac abnormality often possesses a real threat of premature death due to heart failure during intense physical exertion. Luckily, the distinction from pathological hypertrophy is usually straightforward using transthoracic echocardiography, as endurance athletes, in addition to moderately and proportionally thickened LV walls with normal acoustic density, tend to possess increased LV diameter. In more uncertain cases, a detailed evaluation of myocardial function using (tissue) Doppler and contrast echocardiography is effective. When a doubt still remains, knowledge of an athlete's working capacity may be useful in evaluating whether the insidious cardiac pathology is absent. In such cases cardiopulmonary exercise testing typically resolves the dilemma: indices of aerobic capacity are markedly higher in healthy endurance athletes compared to patients. Other characteristics such as a decrease of LV mass due to training cessation are also discussed in the article. Key pointsTransthoracic echocardiography is still the most common relevant differentiation technique applied to distinguish athlete's heart from the cardiomyopathy.Conventional echocardiographic criteria such as left ventricular chamber size and diastolic function parameters are to be regarded first when making differential diagnosis between substantially increased wall thickness in athlete's heart (i.e. physiological adaptation) versus a disease (usually hypertrophic cardiomyopathy).When conventional echocardiographic parameters fail to diagnose the nature of myocardial hypertrophy, other differentiation criteria such as aerobic fitness, cardiac performance in response to physical exertion, and changes in echocardiographic parameters due to detraining, must be taken into consideration.Tissue Doppler, contrast and three-dimensional imaging are state-of-the-art echocardiographic techniques which have recently appeared in the differential diagnostics.
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31
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Ashrafian H, Watkins H. Reviews of Translational Medicine and Genomics in Cardiovascular Disease: New Disease Taxonomy and Therapeutic Implications. J Am Coll Cardiol 2007; 49:1251-64. [PMID: 17394955 DOI: 10.1016/j.jacc.2006.10.073] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 10/24/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
The enduring subdivision of cardiomyopathies into hypertrophic (HCM), dilated (DCM), and restrictive (RCM) categories reflects the emphasis of traditional classifications on morphology. Rapid advances in the genetic interrogation of these disorders have redefined their taxonomy and revealed potential conflicts between the old and new classifications. Hypertrophic cardiomyopathy has been redefined as a disease of perturbed sarcomere function. Dilated cardiomyopathy is a disease that results from more varied perturbations, including, but not limited to, defects of the cytoskeleton. Positional cloning and candidate gene approaches have been successful in identifying >40 disease loci, many of which have led to disease genes in HCM, DCM, RCM, and arrhythmogenic right ventricular cardiomyopathy. These findings provide mechanistic insights, permit genetic screening, and to a limited extent, facilitate prognostication. Although single gene analyses rapidly focus down to the underlying mechanistic pathways, they do not take account of all relevant variation in the human genome. Correspondingly, advances in genomics, through microarrays, have facilitated characterization of these broader downstream elements. As well as refining the taxonomic reclassification of cardiomyopathies, these genomic approaches, coupled with functional studies, have identified novel potential therapeutic targets, such as cardiac energetics, calcium handling, and apoptosis. We review the successes and pitfalls of genetic and genomic approaches to cardiomyopathy and their impact on current and future clinical care.
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Affiliation(s)
- Houman Ashrafian
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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32
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Abstract
The completion of the Human Genome Project in 2003 is shifting the focus of modern health care from disease management based on clinical signs to genomic-based treatment and prevention. Nurses at all levels of practice are going to increasingly come under pressure to deliver evidence-based, competent care to families undergoing genetic testing for hereditary conditions (Skirton and Barnes, 2005). A new chapter added to the National Service Framework for Coronary Heart Disease in 2005 raised awareness of the genetic basis of up to 400 sudden cardiac deaths that occur every year in the UK (Department of Health, 2005). This article addresses some of the clinical and ethical implications for nurses caring for families who may be at risk of an inherited sudden cardiac death syndrome. Nursing practice implications are discussed, concluding that more research is needed to explore how family members cope with genetic information which will shape the provision of future genetic healthcare.
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Kelly BS, Mattu A, Brady WJ. Hypertrophic cardiomyopathy: electrocardiographic manifestations and other important considerations for the emergency physician. Am J Emerg Med 2007; 25:72-9. [PMID: 17157688 DOI: 10.1016/j.ajem.2006.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Accepted: 04/17/2006] [Indexed: 11/16/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the most common inherited primary cardiac disorders and the most common cause of sudden cardiac death in young athletes. With advances in technology, it is now recognized that HCM affects individuals of all ages. Many patients with HCM will have a benign course with few symptoms. Some patients, however, possess risk factors that greatly increase the likelihood of sudden death if their disease remains undiagnosed. Therefore, it is imperative that emergency physicians be familiar with the symptoms and typical electrocardiogram manifestations of HCM. Three illustrative cases are presented with a review of the disease.
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Affiliation(s)
- Brian S Kelly
- Department of Emergency Medicine, Mount Carmel Health System, Columbus, OH 43123, USA
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34
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernández X, Peteiro J, Bouzas B, Piñón P, Castro-Beiras A. Significado clínico del realce tardío de gadolinio con resonancia magnética en pacientes con miocardiopatía hipertrófica. Rev Esp Cardiol 2007. [DOI: 10.1157/13097921] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Shah AM, Estes NAM, Weinstock J, Homoud MK, Link MS. Treatment of athletes with cardiac disease or arrhythmias. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:353-61. [PMID: 16939673 DOI: 10.1007/s11936-006-0039-1] [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: 11/29/2022]
Abstract
Ventricular arrhythmias and sudden cardiac death in the athlete are uncommon but extremely visible because of the high profile of amateur and professional athletes. In athletes under the age of 30 years, the incidence of sudden death is low and in most cases occurs in individuals with inherited heart disease. In the older athlete, sudden death is more common and is generally due to arrhythmias in the context of coronary artery disease. Many athletes with aborted sudden death, arrhythmia-related syncope, or high-risk genetic disorders benefit from therapy with implantable cardioverter-defibrillators (ICDs). Although ICD therapy can effectively abort sudden death, implantation of an ICD generally prohibits an individual from all competitive athletics except low-intensity sports. Recommendations for participation in competitive athletics generally follow the recently published 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.
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Affiliation(s)
- Amil M Shah
- Tufts-New England Medical Center, Cardiac Arrhythmia Service, Division of Cardiology, 750 Washington Street, Box # 197, Boston, MA 02111, USA
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36
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Marín F, Gimeno JR, Payá E, García-Alberola A, Pérez-Álvarez L, Fernández X, de la Morena G, Sogorb F, Castro-Beiras A, Valdés M, Martínez JG, Monserrat L. Desfibrilador automático en la miocardiopatía hipertrófica. Experiencia de 3 centros. Rev Esp Cardiol 2006. [DOI: 10.1157/13089740] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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37
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Gori F, Pedemonte E, Nesi G. Myocardial infarction with spontaneous reperfusion in a young woman with hypertrophic cardiomyopathy. Cardiovasc Pathol 2006; 15:174-5. [PMID: 16697935 DOI: 10.1016/j.carpath.2005.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 12/23/2005] [Indexed: 12/01/2022] Open
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Abstract
Cardiac hypertrophy was viewed as a compensatory response to hemodynamic stress. However, cumulative evidence obtained from studies using more advanced technologies in human patients and animal models suggests that cardiac hypertrophy is a maladaptive process of the heart in response to intrinsic and extrinsic stimuli. Although hypertrophy can normalize wall tension, it is a risk factor for QT-prolongation and cardiac sudden death. Studies using molecular biology techniques such as transgenic and knockout mice have revealed many important molecules that are involved in the development of heart hypertrophy and have demonstrated signaling pathways leading to the pathogenesis. With the same approach, the consequence of heart hypertrophy has been examined. The significance of hypertrophy in the development of overt heart failure has been demonstrated and several critical molecular pathways involved in the process were revealed. A comprehensive understanding of the threats of heart hypertrophy to patients has helped to develop novel treatment strategies. The recognition of hypertrophy as a major risk factor for QT-prolongation and cardiac sudden death is an important advance in cardiac medicine. Cellular and molecular mechanisms of this risk aspect are currently under extensively exploring. These studies would lead to more comprehensive approaches to prevention of potential life threatening arrhythmia and cardiac sudden death. The adaptation of new approaches such as functional genomics and proteomics will further advance our knowledge of heart hypertrophy.
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Affiliation(s)
- Y James Kang
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
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Ferguson EA, Paech MJ, Veltman MG. Hypertrophic cardiomyopathy and caesarean section: intraoperative use of transthoracic echocardiography. Int J Obstet Anesth 2006; 15:311-6. [PMID: 16431102 DOI: 10.1016/j.ijoa.2005.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 08/01/2005] [Indexed: 10/25/2022]
Abstract
A pregnant woman with severe hypertrophic cardiomyopathy was monitored with transthoracic echocardiography to guide management of fluids and vasopressors during elective caesarean section. After insertion of intravenous, arterial and central venous cannulae, a transthoracic echocardiogram was performed noting left ventricular cavity size and contractility, systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction. Following combined spinal-epidural anaesthesia, serial examinations were made intraoperatively. Short-lived haemodynamic instability ensued just before the incision and with administration of oxytocin. Her postoperative course was complicated by post-partum haemorrhage requiring radiological intervention but she ultimately recovered fully. Maintaining preload to avoid worsening of left ventricular outflow tract obstruction is essential in these patients. A transthoracic echocardiogram is easily performed, of low risk and provides more useful information than a pulmonary artery catheter.
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Affiliation(s)
- E A Ferguson
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia.
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40
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Binder WD, Fifer MA, King ME, Stone JR. Case records of the Massachusetts General Hospital. Case 26-2005. A 48-year-old man with sudden loss of consciousness while jogging. N Engl J Med 2005; 353:824-32. [PMID: 16120863 DOI: 10.1056/nejmcpc059021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW As the underlying genetic basis of hypertrophic cardiomyopathy is being characterized, there has been increasing recognition of the wide spectrum and variable evolution of this disease within the pediatric age range. This review outlines recent evidence relevant to the diagnosis, management, and prognosis of hypertrophic cardiomyopathy specific to children and adolescents. RECENT FINDINGS Studies of putative causal genes are leading to the discovery of factors affecting the variability of phenotypic expression and possible avenues for new therapies. Nonetheless, the use of genetic testing currently remains for research purposes only. Echocardiography is the primary means for evaluation, with an increasing focus on diastolic performance. Useful prognostic information can be obtained from the safe performance of cardiopulmonary stress testing. Sudden death can occur in children, although the risk factors are likely different than in adults. The role and mechanisms for possible ischemia remain controversial, and likely differ between individuals. Activity restrictions are recommended, with medical therapy reserved for those who are symptomatic. For those with important left ventricular outflow obstruction, surgical myectomy may be indicated, with little current role for alcohol septal ablation. Advances in implantable defibrillators now make this therapy feasible in younger children. SUMMARY There are important differences from adults in the approach to the diagnosis and management of hypertrophic cardiomyopathy in children and adolescents. Care regarding prognostication and therapy must be taken given the potential life-long implications.
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Affiliation(s)
- Anji T Yetman
- University of Colorado Health Sciences Center, The Children's Hospital, Denver, Colorado, USA
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42
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Ashrafian H, Watkins H. Metabolic perturbations in the pathogenesis of hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ddmec.2005.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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