1
|
Kim EK, Hwang JW, Chang SA, Park SJ, Kim JH, Park SW, Kim SM, Choe YH, Lee SC. Different characteristics of apical aneurysm in hypertrophic cardiomyopathy are related to difference in long-term prognosis. Int J Cardiol 2023; 370:287-293. [PMID: 36174829 DOI: 10.1016/j.ijcard.2022.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data regarding long-term cardiac and cerebrovascular adverse events in patients with hypertrophic cardiomyopathy (HCM) and apical aneurysm (AAn) are scarce and specific treatment strategies that include the use of anticoagulants have not yet been established. We aimed to evaluate the prevalence and long-term prognostic implication based on characteristics of AAn in patients with HCM. METHODS A total of 458 consecutive patients diagnosed with HCM underwent cardiovascular magnetic resonance imaging and echocardiography from August 1, 2008 to December 31, 2015. AAn was classified into Grade 1 and Grade 2 based on size and morphology. The patients were followed up for a median duration of 6.3 years (range, 4.2-8.7 years) for major adverse cardiac and cerebral events (MACCEs); a composite of cardiac death, HCM-related hospitalization, cerebrovascular accident (CVA), heart transplantation, myocardial infarction, and implantable cardiac defibrillator/cardiac resynchronization therapy. RESULTS AAn was detected in 9.2%. MACCEs developed more frequently in patients with AAn than in those without AAn (30.1% vs. 20.7%, P = 0.015), with the rate of CVA as the main difference (9.7% vs. 5.3%, P = 0.011). Grade 2 AAn group showed significantly higher MACCE than Grade 1 AAn group (41.8% vs. 21.9%, P < 0.001). In multivariate analysis, the presence of AAn was independently associated with increased risk of MACCEs (adjusted hazard ratio: 1.95; 95% confidence interval, CI: 1.16-3.28; P = 0.012). CONCLUSIONS AAn is independently associated with increased risk of HCM-related adverse events, especially cerebral infarction, with significant relationship between aneurysm size and adverse events.
Collapse
Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Mok Kim
- Division of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hyeon Choe
- Division of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Bazoukis G, Garcia-Zamora S, Çinier G, Lee S, Elvin Gul E, Álvarez-García J, Miana G, Hayıroğlu Mİ, Tse G, Liu T, Baranchuk A. Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings. World J Cardiol 2022; 14:483-495. [PMID: 36187429 PMCID: PMC9523270 DOI: 10.4330/wjc.v14.i9.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is a unique tool for non-invasive tissue characterization, especially for identifying fibrosis.
AIM To present the existing data regarding the association of electrocardiographic (ECG) markers with myocardial fibrosis identified by CMR - late gadolinium enhancement (LGE).
METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com).
RESULTS A total of 32 studies were included. In hypertrophic cardiomyopathy (HCM), fragmented QRS (fQRS) is related to the presence and extent of myocardial fibrosis. fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients, while fQRS has also been related to fibrosis in myocarditis. Selvester score, abnormal Q waves, and notched QRS have also been associated with LGE. Repolarization abnormalities as reflected by increased Tp-Te, negative T-waves, and higher QT dispersion are related to myocardial fibrosis in HCM patients. In patients with Duchenne muscular dystrophy, a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed. In atrial fibrillation patients, advanced inter-atrial block is defined as P-wave duration ≥ 120 ms, and biphasic morphology in inferior leads is related to left atrial fibrosis.
CONCLUSION Myocardial fibrosis, a reliable marker of prognosis in a broad spectrum of cardiovascular diseases, can be easily understood with an easily applicable ECG. However, more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.
Collapse
Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6036, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2414, Cyprus
| | | | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong 999077, China
| | - Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia
| | - Jesús Álvarez-García
- Department of Cardiology, Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Gabi Miana
- Telehealth Center of Hospital das Clínicas, Hong Kong 999077, China
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Canterbury CT2 7FS, United Kingdom
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin, Tianjin Medical University, Tianjin 300211, China
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Department of Cardiology, Queen's University, Ontario K7L 3N6, Canada
| |
Collapse
|
3
|
Gossios T, Savvatis K, Zegkos T, Ntelios D, Rouskas P, Parcharidou D, Karvounis H, Efthimiadis GK. Deciphering hypertrophic cardiomyopathy with electrocardiography. Heart Fail Rev 2021; 27:1313-1323. [PMID: 34286451 DOI: 10.1007/s10741-021-10147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
The comprehensive assessment of patients with hypertrophic cardiomyopathy is a complex process, with each step concurrently focusing on confirmation of the diagnosis, differentiation between sarcomeric and non-sarcomeric disease (phenocopy), and prognostication. Novel modalities such as genetic testing and advanced imaging have allowed for substantial advancements in the understanding of this condition and facilitate patient management. However, their availability is at present not universal, and interpretation requires a high level of expertise. In this setting, electrocardiography, a fast and widely available method, still retains a significant role in everyday clinical assessment of this population. In our review, we follow a stepwise approach for the interpretation of each electrocardiographic segment, discussing clinical implications of electrocardiographic patterns in sarcomeric disease, their value in the differential diagnosis from phenocopies, and impact on patient management. Outlining the substantial amount of information to be obtained from a simple tracing, we exhibit how electrocardiography is likely to remain an integral diagnostic tool in the future as well.
Collapse
Affiliation(s)
- Thomas Gossios
- Cardiology Department, NHS Foundation Trust, Guy's and St Thomas Westminster Bridge Road, London, SE1 7EH, UK. .,Inherited Cardiac Conditions Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK. .,Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
| | - Konstantinos Savvatis
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Thomas Zegkos
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Ntelios
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Pavlos Rouskas
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Despoina Parcharidou
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Haralambos Karvounis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgios K Efthimiadis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|
4
|
Captur G, Manisty C, Moon JC. Cardiac MRI evaluation of myocardial disease. Heart 2016; 102:1429-35. [PMID: 27354273 DOI: 10.1136/heartjnl-2015-309077] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/28/2016] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a key imaging technique for cardiac phenotyping with a major clinical role. It can assess advanced aspects of cardiac structure and function, scar burden and other myocardial tissue characteristics but there is new information that can now be derived. This can fill many of the gaps in our knowledge with the potential to change thinking, disease classifications and definitions as well as patient care. Established techniques such as the late gadolinium enhancement technique are now embedded in clinical care. New techniques are coming through. Myocardial tissue characterisation techniques, particularly myocardial mapping can precisely measure tissue magnetisation-T1, T2, T2* and also the extracellular volume. These change in disease. Key biological pathways are now open for scrutiny including focal fibrosis (scar) and diffuse fibrosis, inflammation, metabolism and infiltration. Other new areas to engage in where major insights are growing include detailed assessments of myocardial mechanics and performance, spectroscopy and hyperpolarised CMR. In spite of the advances, challenges remain, particularly surrounding utilisation, technical development to improve accuracy, reproducibility and deliverability, and the role of multidisciplinary research to understand the detailed pathological basis of the MR signal changes. Collectively, these new developments are galvanising CMR uptake and having a major translational impact on healthcare globally and it is steadily becoming key imaging tool.
Collapse
Affiliation(s)
- Gabriella Captur
- UCL Biological Mass Spectrometry Laboratory, Institute of Child Health and Great Ormond Street Hospital, London, UK NIHR University College London Hospitals Biomedical Research Centre, Maple House Suite A, 149 Tottenham Court Road, London, UK
| | - Charlotte Manisty
- UCL Institute of Cardiovascular Science, University College London, London, UK The Cardiovascular Magnetic Resonance Imaging Unit and The Center for Rare Cardiovascular Diseases Unit, Barts Heart Center, St Bartholomew's Hospital, London, UK
| | - James C Moon
- NIHR University College London Hospitals Biomedical Research Centre, Maple House Suite A, 149 Tottenham Court Road, London, UK UCL Institute of Cardiovascular Science, University College London, London, UK The Cardiovascular Magnetic Resonance Imaging Unit and The Center for Rare Cardiovascular Diseases Unit, Barts Heart Center, St Bartholomew's Hospital, London, UK
| |
Collapse
|
5
|
Baysal E, Yaylak B, Altıntaş B. Fragmented QRS is associated with ventricular tachycardia in patients with apical aneurysm with hypertrophic cardiomyopathy. Indian Heart J 2016; 68:199. [PMID: 27133337 DOI: 10.1016/j.ihj.2015.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 12/18/2022] Open
Affiliation(s)
- Erkan Baysal
- Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
| | - Barış Yaylak
- Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Bernas Altıntaş
- Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| |
Collapse
|
6
|
KONNO TETSUO, HAYASHI KENSHI, FUJINO NOBORU, OKA RIE, NOMURA AKIHIRO, NAGATA YOJI, HODATSU AKIHIKO, SAKATA KENJI, FURUSHO HIROSHI, TAKAMURA MASAYUKI, NAKAMURA HIROYUKI, KAWASHIRI MASAAKI, YAMAGISHI MASAKAZU. Electrocardiographic QRS Fragmentation as a Marker for Myocardial Fibrosis in Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2015; 26:1081-7. [DOI: 10.1111/jce.12742] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 12/13/2022]
Affiliation(s)
- TETSUO KONNO
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
- Research and Education Center for Innovative and Preventive Medicine; Kanazawa University; Kanazawa Japan
| | - KENSHI HAYASHI
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - NOBORU FUJINO
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - RIE OKA
- Department of Internal Medicine; Hokuriku Central Hospital; Oyabe Japan
| | - AKIHIRO NOMURA
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - YOJI NAGATA
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - AKIHIKO HODATSU
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - KENJI SAKATA
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - HIROSHI FURUSHO
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - MASAYUKI TAKAMURA
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - HIROYUKI NAKAMURA
- Research and Education Center for Innovative and Preventive Medicine; Kanazawa University; Kanazawa Japan
- Department of Public Health; Graduate School of Medical Science Kanazawa University; Kanazawa Japan
| | - MASA-AKI KAWASHIRI
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - MASAKAZU YAMAGISHI
- Division of Cardiovascular Medicine; Kanazawa University Graduate School of Medicine; Kanazawa Japan
- Research and Education Center for Innovative and Preventive Medicine; Kanazawa University; Kanazawa Japan
| |
Collapse
|
7
|
Kim EK, Lee SC, Hwang JW, Chang SA, Park SJ, On YK, Park KM, Choe YH, Kim SM, Park SW, Oh JK. Differences in apical and non-apical types of hypertrophic cardiomyopathy: a prospective analysis of clinical, echocardiographic, and cardiac magnetic resonance findings and outcome from 350 patients. Eur Heart J Cardiovasc Imaging 2015; 17:678-86. [DOI: 10.1093/ehjci/jev192] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/08/2015] [Indexed: 12/14/2022] Open
|