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Hollowell M, Banno J, Marsy D, Shrestha N, Tan J, McNamara R, Decker J, Albano A, Franey L, Abdallah W, Loyaga-Rendon R, Chalfoun N, Fermin D. Ventricular late gadolinium enhancement by cardiac MRI as a predictor of atrial fibrillation in hypertrophic cardiomyopathy. Int J Cardiol 2024; 411:132263. [PMID: 38878873 DOI: 10.1016/j.ijcard.2024.132263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/07/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) increases stroke and mortality in patients with hypertrophic cardiomyopathy (HCM). Cardiac MRI (CMR) is increasingly used to detect late gadolinium enhancement (LGE) as a reliable indicator of left ventricular fibrosis, a potential predisposing factor of AF. Our research explored the correlation between left ventricular LGE and AF prevalence in HCM. METHODS This retrospective study involved 351 HCM patients who underwent CMR. LGE percentages (0%, 1-5%, 6-14%, ≥15%) on CMR were compared with AF prevalence in HCM patients. Demographic, comorbidity, and imaging data were analyzed using appropriate univariate and multivariate analyses assessing for significant differences in AF prevalence. The predetermined significance level was p < 0.05. RESULTS CMR demonstrated increased LGE in those with AF (p = 0.004). Increased LGE correlated with increased AF rates: 27.6% (0% LGE), 38.5% (1-5% LGE), 44.4% (6-14% LGE), and 54.7% (≥15% LGE) (p = 0.101, p = 0.043, p = 0.002, respectively, vs. 0% LGE). Adjusted for age, differences persisted and were most evident for LGE >15% (p = 0.001). Multivariate analysis, factoring age, gender, BMI, RVSP, and LVEF, supported LGE (odds ratio of 1.20, p = 0.036) and LAVI (odds ratio 1.05, 1.02-1.07, p < 0.001) as predictive markers for AF prevalence. CONCLUSIONS Our study suggests a correlation between ventricular LGE and AF in patients with HCM. LGE exceeding 15% was associated with a significant increase in AF prevalence. These patients may require more frequent AF monitoring.
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Affiliation(s)
- Matthew Hollowell
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Joseph Banno
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Dana Marsy
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Nabin Shrestha
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Jose Tan
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Richard McNamara
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Jeffrey Decker
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Alfred Albano
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Laura Franey
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Wissam Abdallah
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Renzo Loyaga-Rendon
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Nagib Chalfoun
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - David Fermin
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA.
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Crean AM, Adler A, Arbour L, Chan J, Christian S, Cooper RM, Garceau P, Giraldeau G, Heydari B, Laksman Z, Mital S, Ong K, Overgaard C, Ruel M, Seifer CM, Ward MR, Tadros R. Canadian Cardiovascular Society Clinical Practice Update on Contemporary Management of the Patient With Hypertrophic Cardiomyopathy. Can J Cardiol 2024:S0828-282X(24)00438-0. [PMID: 38880398 DOI: 10.1016/j.cjca.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024] Open
Abstract
Numerous guidelines on the diagnosis and management of hypertrophic cardiomyopathy (HCM) have been published, by learned societies, over the past decade. Although helpful they are often long and less adapted to nonexperts. This writing panel was challenged to produce a document that grew as much from years of practical experience as it did from the peer-reviewed literature. As such, rather than produce yet another set of guidelines, we aim herein to deliver a concentrate of our own experiential learning and distill for the reader the essence of effective and appropriate HCM care. This Clinical Practice Update on HCM is therefore aimed at general cardiologists and other cardiovascular practitioners rather than for HCM specialists. We set the stage with a description of the condition and its clinical presentation, discuss the central importance of "obstruction" and how to look for it, review the role of cardiac magnetic resonance imaging, reflect on the appropriate use of genetic testing, review the treatment options for symptomatic HCM-crucially including cardiac myosin inhibitors, and deal concisely with practical issues surrounding risk assessment for sudden cardiac death, and management of the end-stage HCM patient. Uniquely, we have captured the pediatric experience on our panel to discuss appropriate differences in the management of younger patients with HCM. We ask the reader to remember that this document represents expert consensus opinion rather than dogma and to use their best judgement when dealing with the HCM patient in front of them.
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Affiliation(s)
- Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; University of Manchester Heart Center, Manchester, United Kingdom.
| | - Arnon Adler
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Laura Arbour
- University of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Joyce Chan
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Robert M Cooper
- Liverpool Heart and Chest Hospital, Centre for Cardiovascular Science Liverpool John Moores University, Liverpool, United Kingdom
| | - Patrick Garceau
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Genevieve Giraldeau
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Bobak Heydari
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary Laksman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Seema Mital
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Ong
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marc Ruel
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Colette M Seifer
- St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael R Ward
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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3
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Aglan A, Fath AR, Maron BJ, Maron MS, Prasad A, Almomani A, Hammadah M, Reynolds MR, Rowin EJ. Percutaneous left atrial appendage closure for stroke prevention in hypertrophic cardiomyopathy patients with atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)02632-8. [PMID: 38797308 DOI: 10.1016/j.hrthm.2024.05.038] [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: 03/05/2024] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Percutaneous left atrial appendage closure (LAAC) is an effective alternative strategy for stroke prevention in patients with atrial fibrillation (AF) at high risk for bleeding with anticoagulation (AC). Efficacy of this strategy in hypertrophic cardiomyopathy (HCM) remains uncertain. OBJECTIVE The study aimed to compare risk of stroke in HCM-AF patients treated with LAAC with those treated with AC. METHODS By use of the TriNetX Global Research Network, HCM-AF patients from 2015 to 2024 were assigned to categories of treatment with LAAC and treatment solely with AC and observed for 3 years for ischemic stroke, systemic embolism, and all-cause mortality. Propensity score matching was used to limit confounders. RESULTS Of 14,867 HCM-AF patients identified, 364 (2.5%) were treated with LAAC vs 14,503 (97.5%) treated with AC. HCM LAAC patients were older (72 vs 67 years; P < .001) and had more comorbidities and more prior bleeding events, including higher rate of prior gastrointestinal bleeding (68% vs 18%; P < .001), compared with HCM patients treated solely with AC. After propensity score matching, there was no baseline difference between groups including prior bleeding events (P > .05). During follow-up, HCM patients treated with LAAC had higher rates of ischemic stroke (13% vs 8%; hazard ratio, 1.9; P = .006) and systemic embolism (14% vs 9%; hazard ratio, 1.8; P = .006) but no difference in mortality compared with matched HCM patients receiving AC. CONCLUSION These real-world data do not support percutaneous LAAC in HCM-AF patients as the primary treatment strategy during long-term AC to reduce stroke risk. However, LAAC may remain a reasonable option for HCM-AF patients who are unable to tolerate AC because of prohibitive bleeding risk.
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Affiliation(s)
- Amro Aglan
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Ayman R Fath
- Division of Cardiology, University of Texas Health Science Center at San Antonio, Texas
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Anand Prasad
- Division of Cardiology, University of Texas Health Science Center at San Antonio, Texas
| | - Ahmed Almomani
- Division of Cardiology, University of Texas Health Science Center at San Antonio, Texas
| | - Muhammad Hammadah
- Division of Cardiology, University of Texas Health Science Center at San Antonio, Texas
| | - Matthew R Reynolds
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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4
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Marine JE, Vasquez N. Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Caveat Ablator. JACC. ADVANCES 2024; 3:100900. [PMID: 38939643 PMCID: PMC11198182 DOI: 10.1016/j.jacadv.2024.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Joseph E. Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nestor Vasquez
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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5
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Yang Y, Lu M, Guan X, Zhao S, Long L. Left Atrial Dysfunction in Apical Hypertrophic Cardiomyopathy: Assessed by Cardiovascular Magnetic Resonance Feature-tracking. J Thorac Imaging 2024; 39:157-164. [PMID: 37341629 PMCID: PMC11027970 DOI: 10.1097/rti.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE To evaluate the left atrial (LA) function in participants with apical hypertrophic cardiomyopathy (AHCM) by cardiovascular magnetic resonance feature tracking (CMR-FT). MATERIALS AND METHODS Thirty typical AHCM (TAHCM) patients, 23 subclinical AHCM (SAHCM) patients and 32 normal healthy volunteers who underwent CMR exam were retrospectively analyzed. LA reservoir, conduit, and contractile function were quantified by volumetric and CMR-FT derived strain and strain rate (SR) parameters from 2-chamber and 4-chamber cine imaging. RESULTS Compared with healthy participants, both TAHCM and SAHCM patients had impaired LA reservoir function (total strain [%]: TAHCM 31.3±12.2, SAHCM 31.8±12.3, controls 40.4±10.7, P <0.01; total SR [/s]: TAHCM 1.1±0.4, SAHCM 1.1±0.5, controls 1.4 ± 0.4, P <0.01) and conduit function (passive strain [%]: TAHCM 14.4±7.6, SAHCM 16.4±8.8, controls 23.3±8.1, P <0.01; passive SR [/s]: TAHCM -0.5±0.3, SAHCM -0.6±0.3, controls -1.0±0.4, P <0.01). Regarding contraction function, although TAHCM and SAHCM patients had preserved active emptying fraction and strain (all P >0.05), patients with TAHCM had the lowest active SR value among the 3 groups ( P= 0.03). LA reservoir and conduit strain were both significantly associated with left ventricular mass index and maximal wall thickness (all P <0.05). A moderate correlation between LA passive SR and left ventricular cardiac index ( P <0.01). CONCLUSIONS The LA reservoir and conduit function are predominately impaired and appeared in both SAHCM and TAHCM patients.
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Affiliation(s)
- Yingxia Yang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University
- Department of Radiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Xuechun Guan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University
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Fumagalli C, Zocchi C, Ciabatti M, Milazzo A, Cappelli F, Fumagalli S, Pieroni M, Olivotto I. From Atrial Fibrillation Management to Atrial Myopathy Assessment: The Evolving Concept of Left Atrium Disease in Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:876-886. [PMID: 38286174 DOI: 10.1016/j.cjca.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most prevalent genetically inherited cardiovascular disorder in adults and a significant cause of heart failure and sudden cardiac death. Historically, atrial fibrillation (AF) has been considered as a critical aspect in HCM patients as it is considered to be a marker of disease progression, escalates the frequency of heart failure hospitalisations, increases the risk of thromboembolic events, and worsens quality of life and outcome. Increasing evidence suggests that AF is the result of a subtle long-standing process that starts early in the history of HCM. The process of left atrial dilation accompanied by morphologic and functional remodelling is the quintessential prerequisite for the onset of AF. This review aims to describe the current understanding of AF pathophysiology in HCM, emphasising the role of left atrial myopathy in its development. In addition, we discuss risk factors and management strategies specific to AF in the context of HCM, providing insights into the complexities and challenges of treating this specific patient population.
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Affiliation(s)
- Carlo Fumagalli
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Chiara Zocchi
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | | | - Alessandra Milazzo
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Fumagalli
- Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Florence, Italy
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7
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Zhao Y, Song Y, Mu X. Application of left atrial strain derived from cardiac magnetic resonance feature tracking to predict cardiovascular disease: A comprehensive review. Heliyon 2024; 10:e27911. [PMID: 38560271 PMCID: PMC10979159 DOI: 10.1016/j.heliyon.2024.e27911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
The structural and functional changes of the left atrium (LA)are important for maintaining the filling of the left ventricle (LV), whether the hemodynamics is stable or not, and are valuable for evaluating LV diastolic dysfunction and grading the severity. Studies over the past decade have shown that LA structural alterations are linked to several cardiovascular disorders, and LA enlargement has been identified as a strong predictor of several cardiovascular diseases. However, LA structural or volumetric abnormalities are commonly seen in the advanced stages of disease and do not adequately represent functional changes throughout the cardiac cycle. In recent years, LA strain obtained using cardiac magnetic resonance feature tracking (CMR-FT)technology has been shown to provide early monitoring of LA tension damage while also comprehensively reflecting LA functional changes in three phases, providing deeper insights into cardiovascular disease risk, prognosis of cardiovascular disease, and evaluation of therapeutic efficacy. When compared to the ultrasound speckle tracking approach, the CMR-FT technique provides improved spatial resolution, repeatability, and reproducibility. We report a comprehensive review of the most recent studies on CMR-LA strain in the past five years, including normal reference values, early detection of disease, incremental diagnosis, improvement of risk stratification, assessment of the value of atrial-ventricular hemodynamics and coupled injury, major adverse cardiovascular events and prognostic value, as well as future research perspectives and current limitations, aiming at providing an objective reference for the further exploration of the value of the application of CMR-LA strain in various cardiac disorders.
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Affiliation(s)
- Yetong Zhao
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
- Department of Graduate School, Dalian Medical University, Dalian, 116000, PR China
| | - Yang Song
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
| | - Xiaolin Mu
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
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8
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Huang T, Huang X, Cui X, Dong Q. Predictive nomogram models for atrial fibrillation in COPD patients: A comprehensive analysis of risk factors and prognosis. Exp Ther Med 2024; 27:171. [PMID: 38476891 PMCID: PMC10928814 DOI: 10.3892/etm.2024.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
The aim of the present study was to identify the independent risk factors and prognostic indicators for atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) and to develop predictive nomogram models. This retrospective study included a total of 286 patients with COPD who were admitted to the Second Affiliated Hospital of Guilin Medical College between January 2020 and May 2022. The average age of the patients was 77.11±8.67 years. Based on the presence or absence of AF, the patients were divided into two groups: The AF group (n=87) and the non-AF group (n=199). Logistic regression analysis was conducted to identify variables with significant differences between the two groups. Nomogram models were constructed to predict the occurrence of AF in COPD patients and to assess prognosis. Survival analysis was performed using the Kaplan-Meier method. The follow-up period for the present study extended until April 31, 2023. Survival time was defined as the duration from the date of the interview to the date the participant succumbed or the end of the follow-up period. In the present study, age, uric acid (UA) and left atrial diameter (LAD) were found to be independent risk factors for the development of AF in patients diagnosed with COPD. The stepwise logistic regression analysis revealed that age had an odds ratio (OR) of 1.072 [95% confidence interval (CI): 1.019-1.128; P=0.007], UA had an OR of 1.004 (95% CI: 1.001-1.008; P=0.010) and LAD had an OR of 1.195 (95% CI: 1.098-1.301; P<0.001). Univariate and multivariate Cox regression analysis revealed that LAD and UA were independent prognostic factors for long-term mortality in COPD patients with AF. LAD had a hazard ratio (HR) of 1.104 (95% CI: 1.046-1.165; P<0.001) and UA had an HR of 1.004 (95% CI: 1.000-1.008; P=0.042). Based on these findings, predictive nomogram models were developed for AF in COPD patients, which demonstrated good discrimination ability with an area under the curve of 0.886. The prognostic nomogram for COPD patients with AF also showed good predictive accuracy with a concordance index of 0.886 (95% CI: 0.842-0.930). These models can provide valuable information for risk assessment and prognosis evaluation in clinical practice. Age, UA and LAD are independent risk factors for AF in COPD patients. The developed nomogram models provide a reliable tool for predicting AF in COPD patients and for prognosis assessment.
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Affiliation(s)
- Tao Huang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region 541100, P.R. China
| | - Xingjie Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region 541100, P.R. China
| | - Xueying Cui
- Department of Reproductive Medical Center, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region 541004, P.R. China
| | - Qinghua Dong
- Department of Critical Care Medicine, Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin, Guangxi Zhuang Autonomous Region 541000, P.R. China
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9
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Hussain K, Nso N, Tsourdinis G, Haider S, Mian R, Sanagala T, Erwin JP, Pursnani A. A systematic review and meta-analysis of left atrial strain in hypertrophic cardiomyopathy and its prognostic utility. Curr Probl Cardiol 2024; 49:102146. [PMID: 37863460 DOI: 10.1016/j.cpcardiol.2023.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Despite advances in noninvasive imaging modalities to identify atrial fibrillation (AF) risk in Hypertrophic Cardiomyopathy (HCM), there is a paucity of evidence concerning the impact of low Left Atrial strain (LAS) on AF and major adverse cardiac events (MACE) incidence in these patients. This study investigated the diagnostic and prognostic significance of LAS in predicting AF and MACE in HCM. Findings revealed lower LA reservoir (MD: -11.79, 95% CI -14.83, -8.74; p<0.00001), booster (MD: -4.10, 95% CI -6.29, -1.91; p=0.0002), and conduit (MD: -7.52, 95% CI -9.39, -5.65; p<0.00001) strains in HCM patients versus healthy controls, and also indicated a significant association between low LA reservoir/conduit/booster strain and the development of new AF as well as MACE prevalence in HCM patients. The results from this study suggest the valuable role of LA strain in HCM and its utility in predicting the development of new AF and cardiac events in HCM patients.
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Affiliation(s)
- Kifah Hussain
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States.
| | - Nso Nso
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - George Tsourdinis
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Suha Haider
- University of Sussex, Brighton, United Kingdom
| | - Raza Mian
- Loyola University, Chicago, IL, United States
| | - Thriveni Sanagala
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - John P Erwin
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Amit Pursnani
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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10
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Moroni A, Tondi L, Milani V, Pieroni M, Pieruzzi F, Bevilacqua F, Pasqualin G, Chow K, Pica S, Lombardi M, Camporeale A. Left atrial remodeling in hypertrophic cardiomyopathy and Fabry disease: A CMR-based head-to-head comparison and outcome analysis. Int J Cardiol 2023; 393:131357. [PMID: 37696360 DOI: 10.1016/j.ijcard.2023.131357] [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: 05/23/2023] [Revised: 08/19/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and Fabry disease cardiomyopathy (FD) are phenocopies, as they show left ventricular hypertrophy (LVH). The left atrium (LA) is emerging as a potential marker of disease severity in both cardiomyopathies. The present study compares HCM and FD cardiomyopathy with similar degree of LVH, exploring LA morpho-functional parameters and the correlates of clinical outcome. METHODS We performed a comprehensive CMR-based comparison between 30 HCM and 30 FD patients matched on age, sex, BSA, LV mass and major cardiovascular risk factors affecting LA remodeling (arterial hypertension and diabetes). 30 healthy controls were also included. CMR feature tracking (CMR-FT) analysis, T1 mapping and conventional parameters were evaluated. Patients also underwent transthoracic echocardiography for LV diastolic function assessment. Clinical events at follow-up were collected (atrial and ventricular events, bradyarrhythmia, heart failure (HF) hospitalization and death). RESULTS HCM patients showed greater LA remodeling compared to FD patients, namely higher LA end-systolic volume index (LAVi max), lower LA-ejection fraction (LA-EF) and worse reservoir (εs) and booster function (εa) (all p < 0.05). Accordingly, these parameters have demonstrated good potential for distinguishing between FD and HCM (AUC 0.68-0.73, all p < 0.05), with LAVi max being an independent predictor for HCM diagnosis (OR 1.07, 95%CI 1.011-1.132, p 0.02). Moreover, in HCM patients a significant association between εs and HF occurrence was observed at 2-year follow-up (OR 0.85, 95%CI 0.72-0.99, p 0.04). CONCLUSIONS In HCM, LA remodeling is greater than in FD cardiomyopathy with similar LVH, and reservoir strain is associated with HF at follow-up.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Federico Pieruzzi
- Department of Medicine and Surgery, University of Milano Bicocca, Nephrology and Dialysis Unit, ASST-Monza San Gerardo Hospital, Monza, Italy
| | - Francesca Bevilacqua
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giulia Pasqualin
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, United States
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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11
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Place F, Carpenter H, Morrison BN, Chester N, Cooper R, Stansfield BN, George KP, Oxborough D. The impact of image and performance enhancing drugs on atrial structure and function in resistance trained individuals. Echo Res Pract 2023; 10:19. [PMID: 38053157 DOI: 10.1186/s44156-023-00031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Image and performance enhancing drugs (IPEDs) are commonly used in resistance trained (RT) individuals and negatively impact left ventricular (LV) structure and function. Few studies have investigated the impact of IPEDs on atrial structure and function with no previous studies investigating bi-atrial strain. Additionally, the impact of current use vs. past use of IPEDs is unclear. METHODS Utilising a cross-sectional design, male (n = 81) and female (n = 15) RT individuals were grouped based on IPED user status: current (n = 57), past (n = 19) and non-users (n = 20). Participants completed IPED questionnaires, anthropometrical measurements, electrocardiography, and transthoracic echocardiography with strain imaging. Structural cardiac data was allometrically scaled to body surface area (BSA) according to laws of geometric similarity. RESULTS Body mass and BSA were greater in current users than past and non-users of IPEDs (p < 0.01). Absolute left atrial (LA) volume (60 ± 17 vs 46 ± 12, p = 0.001) and right atrial (RA) area (19 ± 4 vs 15 ± 3, p < 0.001) were greater in current users than non-users but this difference was lost following scaling (p > 0.05). Left atrial reservoir (p = 0.008, p < 0.001) and conduit (p < 0.001, p < 0.001) strain were lower in current users than past and non-users (conduit: current = 22 ± 6, past = 29 ± 9 and non-users = 31 ± 7 and reservoir: current = 33 ± 8, past = 39 ± 8, non-users = 42 ± 8). Right atrial reservoir (p = 0.015) and conduit (p = 0.007) strain were lower in current than non-users (conduit: current = 25 ± 8, non-users = 33 ± 10 and reservoir: current = 36 ± 10, non-users = 44 ± 13). Current users showed reduced LV diastolic function (A wave: p = 0.022, p = 0.049 and E/A ratio: p = 0.039, p < 0.001) and higher LA stiffness (p = 0.001, p < 0.001) than past and non-users (A wave: current = 0.54 ± 0.1, past = 0.46 ± 0.1, non-users = 0.47 ± 0.09 and E/A ratio: current = 1.5 ± 0.5, past = 1.8 ± 0.4, non-users = 1.9 ± 0.4, LA stiffness: current = 0.21 ± 0.7, past = 0.15 ± 0.04, non-users = 0.15 ± 0.07). CONCLUSION Resistance trained individuals using IPEDs have bi-atrial enlargement that normalises with allometric scaling, suggesting that increased size is, in part, associated with increased body size. The lower LA and RA reservoir and conduit strain and greater absolute bi-atrial structural parameters in current than non-users of IPEDs suggests pathological adaptation with IPED use, although the similarity in these parameters between past and non-users suggests reversibility of pathological changes with withdrawal.
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Affiliation(s)
- Florence Place
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Harry Carpenter
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Barbara N Morrison
- School of Human Kinetics, Trinity Western University, Langley, BC, Canada
| | - Neil Chester
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Ben N Stansfield
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Arizona, USA
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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12
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Rowin EJ, Link MS, Maron MS, Maron BJ. Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Circulation 2023; 148:1797-1811. [PMID: 38011245 DOI: 10.1161/circulationaha.123.065037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with clinical and subclinical episodes occurring in nearly one-half of patients. AF in HCM historically has been characterized as a decisive disease complication associated with substantial risk for thromboembolic stroke and increased morbidity and mortality. However, there have been many advances in treatment strategy resulting in improved outcomes for this patient group. For example, stroke risk in HCM has been greatly reduced by using systemic oral anticoagulation initiated after the first clinical (symptomatic) AF episode, usually with preference given to direct anticoagulants over warfarin. In contrast, stroke risk scoring systems (such as CHA2DS2-VASc score) are not informative in HCM given the substantial potential for stroke events in patients with low scores, and therefore should not be used for anticoagulation decisions in this disease. A novel risk score specifically designed for HCM (HCM-AF score) can reliably identify most patients with HCM at risk for future AF. Although a strategy focused on controlling ventricular rate is effective in asymptomatic (or minimally symptomatic) patients with AF, restoring and maintaining sinus rhythm is required for most patients with marked AF symptom burden and impaired quality of life. Several antiarrhythmic drugs such as sotalol, disopyramide, and amiodarone, can be effective in suppressing AF episodes; albeit safe, long-term efficacy is supported by only limited data. Catheter AF ablation has emerged as an important treatment option for some patients, although freedom from AF after a single ablation is relatively low (35% at 3 years), multiple ablations and the concomitant use of antiarrhythmic drugs can control AF with more than two-thirds of patients maintaining sinus rhythm at 5 years. Surgical AF ablation with biatrial Cox-Maze IV performed as an adjunctive procedure during myectomy can reduce symptomatic AF episodes (70% of patients free from AF at 5 years). For the vast majority of patients who have HCM with AF, the implementation of contemporary therapies has allowed for improved quality of life and low HCM-related mortality.
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Affiliation(s)
- Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, MA (E.J.R., M.S.M., B.J.M.)
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas (M.S.L.)
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, MA (E.J.R., M.S.M., B.J.M.)
| | - Barry J Maron
- Lahey Hospital and Medical Center, Burlington, MA (E.J.R., M.S.M., B.J.M.)
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13
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Zuo K, Fang C, Gao Y, Fu Y, Wang H, Li J, Zhong J, Yang X, Xu L. Suppression of the gut microbiota-bile acid-FGF19 axis in patients with atrial fibrillation. Cell Prolif 2023; 56:e13488. [PMID: 37186335 PMCID: PMC10623955 DOI: 10.1111/cpr.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
This study aimed to investigate the role of the gut microbiota (GM)-bile acid (BA)-fibroblast growth factor (FGF) 19 axis in patients with atrial fibrillation (AF). Gut bacterial metabolisms of BAs were determined in an AF metagenomic dataset. The composition of faecal BAs pools was characterized by targeted metabolomics in an independent AF cross-sectional cohort. Circulating levels of FGF19 were measured by ELISA. In vitro cell experiments were conducted to validate the regulatory role of FGF19 in atrial cardiomyocytes stimulated with palmitic acid. First, metagenomic profiling revealed that gut microbial biotransformation from primary to secondary BAs was dysregulated in AF patients. Second, the proportion of secondary BAs decreased in the faeces of patients with AF. Also, eight BAs were identified as AF-associated BAs, including seven AF-enriched BAs (ursodeoxycholic acid, chenodeoxycholic acid, etc.), and AF-decreased dehydrolithocholic acid. Third, reduced levels of circulating FGF19 were observed in patients with AF. Subsequently, FGF19 was found to protect against palmitic acid-induced lipid accumulation and dysregulated signalling in atrial cardiomyocytes, including attenuated phosphorylation of YAP and Ca2+ /calmodulin-dependent protein kinases II and secretion of interleukin-1β, mediated via peroxisome proliferator-activated receptor α. Our data found decreased levels of secondary BAs and circulating FGF19, resulting in the impaired protective function of FGF19 against lipid accumulation in atrial cardiomyocytes.
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Affiliation(s)
- Kun Zuo
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Chen Fang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Yuanfeng Gao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Yuan Fu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Hongjiang Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Jing Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Jiuchang Zhong
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Li Xu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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14
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 290] [Impact Index Per Article: 290.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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15
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Chung H, Choi EY. Multimodality Imaging in Patients with Hypertrophic Cardiomyopathy and Atrial Fibrillation. Diagnostics (Basel) 2023; 13:3049. [PMID: 37835790 PMCID: PMC10572439 DOI: 10.3390/diagnostics13193049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Ventricular hypertrophy is associated with diastolic dysfunction, resulting in increased left atrial (LA) pressure, enlargement, fibrosis, and decreased LA function. Hypertrophic cardiomyopathy (HCM) is characterized by myocyte disarray, myocardial fibrosis, and hypertrophy. Notably, a thickened and noncompliant LV results in the impairment of diastolic function. These conditions promote LA remodeling and enlargement, which contribute to developing and maintaining atrial fibrillation (AF). AF is an atrial arrhythmia that occurs frequently in HCM, and evaluating the morphology and physiology of the atrium and ventricle is important for treatment and prognosis determination in HCM patients with AF. In addition, it provides a clue that can predict the possibility of new AF, even in patients not previously diagnosed with AF. Cardiac magnetic resonance (CMR), which can overcome the limitations of transthoracic echocardiography (TTE), has been widely used traditionally and even enables tissue characterization; moreover, it has emerged as an essential imaging modality for patients with HCM. Here, we review the role of multimodal imaging in patients with HCM and AF.
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Affiliation(s)
- Hyemoon Chung
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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16
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Li H, Wang H, Wang T, Jin C, Lu M, Liu B. Different phenotype of left atrial function impairment in patients with hypertrophic cardiomyopathy and hypertension: comparison of healthy controls. Front Cardiovasc Med 2023; 10:1027665. [PMID: 37234371 PMCID: PMC10206117 DOI: 10.3389/fcvm.2023.1027665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Background The impairment of atrial function and atrial-ventricular coupling in diseases with left ventricular (LV) hypertrophy has been increasingly recognized. This study compares left atrium (LA) and right atrium (RA) function, as well as LA-LV coupling, in patients with hypertrophic cardiomyopathy (HCM) and hypertension (HTN) with preserved LV ejection fraction (EF), using cardiovascular magnetic resonance feature tracking (CMR-FT). Methods Fifty-eight HCM patients, 44 HTN patients, and 25 healthy controls were retrospectively enrolled. LA and RA functions were compared among the three groups. LA-LV correlations were evaluated in the HCM and HTN groups. Results LA reservoir (LA total EF, ɛs, and SRs), conduit (LA passive EF, ɛe, SRe), and booster pump (LA booster EF, ɛa, SRa) functions were significantly impaired in HCM and HTN patients compared to healthy controls (HCM vs. HTN vs. healthy controls: ɛs, 24.8 ± 9.8% vs. 31.3 ± 9.3% vs. 25.2 ± 7.2%; ɛe, 11.7 ± 6.7% vs. 16.8 ± 6.9% vs. 25.5 ± 7.5%; ɛa, 13.1 ± 5.8% vs. 14.6 ± 5.5% vs. 16.5 ± 4.5%, p < 0.05). Reservoir and conduit functions were more impaired in HCM patients compared to HTN patients (p < 0.05). LA strains demonstrated significant correlations with LV EF, LV mass index, LV MWT, global longitudinal strain parameters, and native T1 in HCM patients (p < 0.05). The only correlations in HTN were observed between LA reservoir strain (ɛs) and booster pump strain (ɛa) with LV GLS (p < 0.05). RA reservoir function (RA ɛs, SRs) and conduit function (RA ɛe, SRe) were significantly impaired in HCM and HTN patients (p < 0.05), while RA booster pump function (RA ɛa, SRa) was preserved. Conclusions LA functions were impaired in HCM and HTN patients with preserved LV EF, with reservoir and conduit functions more affected in HCM patients. Moreover, different LA-LV couplings were apparent in two different diseases, and abnormal LA-LV coupling was emphasized in HTN. Decreased RA reservoir and conduit strains were evident in both HCM and HTN, while booster pump strain was preserved.
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Affiliation(s)
- Hongwen Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haibao Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingting Wang
- Cardiac Imaging Center, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaolong Jin
- Cardiac Imaging Center, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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17
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López-Galvez R, Rivera-Caravaca JM, Roldán V, Orenes-Piñero E, Esteve-Pastor MA, López-García C, Saura D, González J, Lip GYH, Marín F. Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making. Am Heart J 2023; 258:1-16. [PMID: 36526006 DOI: 10.1016/j.ahj.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.
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Affiliation(s)
- Raquel López-Galvez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; School of Nursing, University of Murcia, Murcia, Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Biochemistry and Molecular Biology, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Cecilia López-García
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Daniel Saura
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Josefa González
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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18
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Ezeani M, Prabhu S. PI3K(p110α) as a determinant and gene therapy for atrial enlargement in atrial fibrillation. Mol Cell Biochem 2023; 478:471-490. [PMID: 35900667 PMCID: PMC9938077 DOI: 10.1007/s11010-022-04526-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is an irregular heart rhythm, characterised by chaotic atrial activation, which is promoted by remodelling. Once initiated, AF can also propagate the progression of itself in the so-called ''AF begets AF''. Several lines of investigation have shown that signalling molecules, including reactive oxygen species, angiotensin II, and phosphoinositide 3-kinases (PI3Ks), in presence or absence of cardiovascular disease risk factors, stabilise and promote AF maintenance. In particular, reduced cardiac-specific PI3K activity that is not associated with oncology is cardiotoxic and increases susceptibility to AF. Atrial-specific PI3K(p110α) transgene can cause pathological atrial enlargement. Highlighting the crucial importance of the p110α protein in a clinical problem that currently challenges the professional health care practice, in over forty (40) transgenic mouse models of AF (Table1), currently existing, of which some of the models are models of human genetic disorders, including PI3K(p110α) transgenic mouse model, over 70% of them reporting atrial size showed enlarged, greater atrial size. Individuals with minimal to severely dilated atria develop AF more likely. Left atrial diameter and volume stratification are an assessment for follow-up surveillance to detect AF. Gene therapy to reduce atrial size will be associated with a reduction in AF burden. In this overview, PI3K(p110α), a master regulator of organ size, was investigated in atrial enlargement and in physiological determinants that promote AF.
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Affiliation(s)
- Martin Ezeani
- NanoBiotechnology Laboratory, Central Clinical School, Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, 3004, Australia.
| | - Sandeep Prabhu
- The Alfred, and Baker Heart and Diabetes Institute, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
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19
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Ozden O, Unlu S, Kilic DI, Sherif SA, Opan S, Kemal HS, Ozmen E, Tuner H, Bingol G, Barutcu A, Nasifov M, Bakan S, Goktekin O. [The association between cardiac mr feature tracking strain and myocardial late gadolinium enhancement in patients with hypertrophic cardiomyopathy]. KARDIOLOGIIA 2023; 63:52-58. [PMID: 36880144 DOI: 10.18087/cardio.2023.2.n2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 03/08/2023]
Abstract
Aim Hypertrophic cardiomyopathy (HCM) is a relatively common, heritable cardiomyopathy, and cardiac magnetic resonance (CMR) studies have been performed previously to evaluate different aspects of the disease. However, a comprehensive study, including all four cardiac chambers and analysis of left atrial (LA) function, is missing in the literature. The aim of this retrospective study was to analyze CMR-feature tracking (CMR-FT) strain parameters and atrial function of HCM patients and to investigate the association of these parameters with the amount of myocardial late gadolinium enhancement (LGE).Material and Methods In this retrospective, cross-sectional study, we analyzed the CMR images (CMRI) of 58 consecutive patients, who from February 2020 to September 2022 were diagnosed with HCM at our tertiary cardiovascular center. Patients who were younger than 18 yrs or who had moderate or severe valvular heart disease, significant coronary artery disease, previous myocardial infarction, suboptimal image quality, or with contraindication to CMR were excluded. CMRI was performed at 1.5 T with a scanner, and all scans were assessed by an experienced cardiologist and then re-assessed by an experienced radiologist. SSFP 2-, 3- and 4‑chamber, short axis views were obtained and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were measured. LGE images were obtained using a PSIR sequence. Native T1 and T2 mapping and post-contrast T1 map sequences were performed and each patient's myocardial extracellular volume (ECV) was calculated. LA volume index (LAVI), LA ejection fraction (LAEF), LA coupling index (LACI) were calculated. The complete CMR analysis of each patient was performed with CVI 42 software (Circle CVi, Calgary, Canada), off-line.Results The patients were divided into two groups, HCM with LGE (n=37, 64 %) and HCM without LGE (n=21, 36 %). The average patient age in the HCM patients with LGE was 50.8±14 yrs and 47±12.9 yrs in the HCM patients without LGE. Maximum LV wall thickness and basal antero-septum thickness were significantly higher in the HCM with LGE group compared to the HCM without LGE group (14.8±3.5 mm vs 20.3±6.5 mm (p<0.001), 14.2±3.2 mm vs 17.3±6.1 mm (p=0.015), respectively). LGE was 21.9±31.7 g and 15.7±13.4 % in the HCM with LGE group. LA area (22.2±6.1 vs 28.8±11.2 cm2; p=0.015) and LAVI (28.9±10.2 vs 45.6±23.1; p-0.004) were significantly higher in the HCM with LGE group. LACI was doubled in the HCM with LGE group (0.2±0.1 vs 0.4±0.2; p<0.001). LA strain (30.4±13.2 vs 21.3±16.2; p-0.04) and LV strain (15.2±3 vs 12.2±4.5; p=0.012) were significantly decreased in the HCM with LGE group.Conclusion This study sheds light on the CMR-FT differences between HCM with and without LGE. We found a greater burden of LA volume but significantly lower LA and LV strain in the LGE patients. These findings highlight further the LA and LV remodeling in HCM. Impaired LA function appears to have physiological significance, being associated with greater LGE. While our CMR-FT findings support the progressive nature of HCM, beginning with sarcomere dysfunction to eventual fibrosis, further studies are needed to validate these results in larger cohorts and to evaluate their clinical relevance.
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Affiliation(s)
| | | | | | - Sara Abu Sherif
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust
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20
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Hosokawa T, Kawakami H, Tanabe Y, Fukuyama N, Yoshida K, Ohara K, Kitamura T, Kawaguchi N, Kido T, Nagai T, Inoue K, Yamaguchi O, Kido T. Left atrial strain assessment using cardiac computed tomography in patients with hypertrophic cardiomyopathy. Jpn J Radiol 2023:10.1007/s11604-023-01401-6. [PMID: 36811719 PMCID: PMC10366261 DOI: 10.1007/s11604-023-01401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate left atrial (LA) function in patients with hypertrophic cardiomyopathy (HCM) by LA strain assessment using cardiac computed tomography (CT-derived LA strain). MATERIALS AND METHODS This was a retrospective study of 34 patients with HCM and 31 non-HCM patients who underwent cardiac computed tomography (CT) using retrospective electrocardiogram-gated mode. CT images were reconstructed every 5% (0-95%) of the RR intervals. CT-derived LA strain (reservoir [LASr], conduit [LASc], and booster pump strain [LASp]) were semi-automatically analyzed using a dedicated workstation. We also measured the left atrial volume index (LAVI) and left ventricular longitudinal strain (LVLS) for the left atrial and ventricular functional parameters to assess the relationship with CT-derived LA strain. RESULTS CT-derived LA strain significantly correlated with LAVI: r = - 0.69, p < 0.001 for LASr; r = - 0.70, p < 0.001 for LASp; and r = - 0.35, p = 0.004 for LASc. CT-derived LA strain also significantly correlated with LVLS: r = - 0.62, p < 0.001 for LASr; r = - 0.67, p < 0.001 for LASc; and r = - 0.42, p = 0.013 for LASp. CT-derived LA strain in patients with HCM was significantly lower than that in non-HCM patients: LASr (20.8 ± 7.6 vs. 31.7 ± 6.1%, p < 0.001); LASc (7.9 ± 3.4 vs. 14.2 ± 5.3%, p < 0.001); and LASp (12.8 ± 5.7 vs. 17.6 ± 4.3%, p < 0.001). Additionally, CT-derived LA strain showed high reproducibility; inter-observer correlation coefficients were 0.94, 0.90, and 0.89 for LASr, LASc, and LASp, respectively. CONCLUSION CT-derived LA strain is feasible for quantitative assessment of left atrial function in patients with HCM.
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Affiliation(s)
- Takaaki Hosokawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Naoki Fukuyama
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kentaro Ohara
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takuya Kitamura
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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21
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Zegkos T, Kamperidis V, Ntelios D, Gossios T, Parcharidou D, Tziomalos G, Papanastasiou CA, Boutou AΚ, Katranas S, Rouskas P, Karamitsos T, Giannakoulas G, Karvounis H, Efthimiadis G. Left Atrial Myopathy is Associated With Exercise Incapacity and Ventilatory Inefficiency in Hypertrophic Cardiomyopathy. Heart Lung Circ 2023; 32:215-223. [PMID: 36404220 DOI: 10.1016/j.hlc.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/03/2022] [Accepted: 10/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left atrial (LA) myopathy is an established component of hypertrophic cardiomyopathy (HCM); however, the data about its association with exercise incapacity or ventilatory inefficiency that may be seen in HCM patients are limited. This study aimed to explore the association between LA myopathy, evaluated by echocardiography LA strain, and exercise capacity and ventilatory efficiency, evaluated by cardiopulmonary exercise testing (CPET), in HCM patients. METHODS This study included 241 consecutive HCM patients (aged 51.2±15.7 years 67.2% male) in sinus rhythm who underwent CPET and transthoracic echocardiography at the same visit. Exercise incapacity (maximal/predicted oxygen consumption [%peakVO2] <80%) and ventilatory inefficiency (ventilation/carbon dioxide output [VE/VCO2] slope >34) were assessed by CPET. Left atrial myopathy was examined by speckle-tracking myocardial deformation parameters: LA reservoir, conduit and booster strain. RESULTS All three LA strain values were univariate predictors of exercise capacity and ventilatory efficiency. Among them, LA reservoir strain had the higher r correlation coefficient for predicting both %peakVO2 and VE/VCO2 slope. Left atrial reservoir strain, presence of angina and family history of HCM were independent predictors of exercise capacity. Left atrial reservoir strain, male gender and non-sustained ventricular tachycardia were independent predictors of ventilatory efficiency. Left atrial reservoir strain was a significant predictor of %peakVO2<80% with an optimal cut-off value of 27% (sensitivity 87% and specificity 31%) and VE/VCO2>34 with an optimal cut-off value of 18% (sensitivity 71% and specificity 83%). CONCLUSION Left atrial myopathy, as reflected by the LA strain values, was associated with exercise incapacity and ventilatory inefficiency in HCM individuals. Left atrial reservoir strain was the only common independent predictor of %peakVO2 and VE/VCO2 slope.
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Affiliation(s)
- Thomas Zegkos
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Vasileios Kamperidis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece.
| | - Dimitris Ntelios
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Thomas Gossios
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Despoina Parcharidou
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Tziomalos
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Afroditi Κ Boutou
- Respiratory Medicine Department, Hippokration Hospital, Thessaloniki, Greece
| | - Sotirios Katranas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Pavlos Rouskas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Theodoros Karamitsos
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Haralampos Karvounis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Efthimiadis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
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22
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Yao B, Wu R, Chen BH, Wesemann LD, Xu JR, Zhou Y, Wu LM. Cardiovascular magnetic resonance myocardial feature tracking for the determination of left atrial strain in hypertensive left ventricular hypertrophy and hypertrophic cardiomyopathy. Clin Radiol 2023; 78:e409-e416. [PMID: 36746719 DOI: 10.1016/j.crad.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/23/2023]
Abstract
AIM To measure the left atrial (LA) function in patients with hypertrophic cardiomyopathy (HCM; with [OHCM] and without obstruction [NOHCM]) and hypertension-related left ventricular hypertrophy (H-LVH) using cardiovascular magnetic resonance imaging feature tracking (CMR-FT). MATERIALS AND METHODS Patients who met the criteria for HCM (n=68), H-LVH (n=46), and 30 healthy controls participated. Left atrial strain was analysed using CMR-FT in cine images with two and four chambers. RESULTS The strain rate and LA strain measurements showed that patients with HCM, and H-LVH had impaired conduit and reservoir functions (versus controls). These capacities were more severely impaired in OHCM than those seen in NOHCM and H-LVH. The LA volume parameters (LAVIpac, LAVImin and LAVImax) from the OHCM group were higher than both the NOHCM and H-LVH groups (all p<0.05). There were differences between the OHCM and H-LVH groups in terms of the parameters for LA reservoir function (εs), booster pump function (SRa), and conduit function (SRe, LA passive EF, εe; p<0.05). The strongest correlations included the associations between LA total EF and εs, εe and LA passive EF, and SRe and LA passive EF. CONCLUSION CMR-FT can reliably identify LA dysfunction and deformation in the early stages of HCM and H-LVH.
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Affiliation(s)
- B Yao
- Department of Radiology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215000, China
| | - R Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - B-H Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - L D Wesemann
- Department of Radiology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - J-R Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Y Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - L-M Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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23
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Choi YJ, Kim D, Rhee TM, Lee HJ, Park JB, Lee SP, Chang SA, Kim YJ, Jeon ES, Oh JK, Choi JO, Kim HK. Left atrial reservoir strain as a novel predictor of new-onset atrial fibrillation in light-chain-type cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2023; 24:751-758. [PMID: 36637873 DOI: 10.1093/ehjci/jeac269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS To investigate whether left arterial reservoir strain (LASr) could predict new-onset atrial fibrillation (NOAF) in patients with light-chain-type cardiac amyloidosis (ALCA). METHODS AND RESULTS This study enrolled 427 patients with CA from two tertiary centres between 2005 and 2019. LASr was measured using a vendor-independent analysis programme. The primary outcome was NOAF. A total of 287 patients with ALCA were included [median age 63.0 (56.0-70.0) years, 53.3% male]. The median LASr was 13.9% (10.5-20.8%). During the median follow-up of 0.85 years, AF occurred in 34 patients (11.8%). In the receiver operating characteristics curve analysis, the optimal cut-off of LASr for predicting NOAF was 14.4%. Patients with LASr ≤14.4% had a higher risk of NOAF than those with LASr >14.4% (18.1% vs. 5.1%, P < 0.010). In the multivariate analysis adjusting for confounding factors, including left arterial volume index and left ventricular global longitudinal strain (LV-GLS), higher LASr (%) was independently associated with lower risk for NOAF [adjusted hazard ratio (aHR): 0.936, 95% confidence interval (95% CI): 0.879-0.997, P = 0.039]. Furthermore, LASr ≤14.4% was an independent predictor for NOAF (aHR: 3.370, 95% CI: 1.337-8.492, P = 0.010). This remained true after accounting for all-cause death as a competing risk. Compared with Model 1 (LV-GLS) and Model 2 (LV-GLS plus LAVI), Model 3, including LASr showed a better reclassification ability for predicting NOAF (net reclassification index = 0.735, P < 0.001 compared with Model 1; net reclassification index = 0.514, P = 0.003 compared with Model 2). CONCLUSION LASr was an independent predictor of NOAF in patients with ALCA.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-dong, Guro-gu Seoul 08308, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Tea-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jae K Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea.,Department of Cardiovascular Medicine, Mayo Clinic, 201 W. Center St., Rochester, MN 55902, USA
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
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24
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Ziaka M, Exadaktylos A. The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy-A Review. J Stroke 2023; 25:39-54. [PMID: 36592971 PMCID: PMC9911836 DOI: 10.5853/jos.2022.02173] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023] Open
Abstract
In recent years, it has been convincingly demonstrated that acute brain injury may cause severe cardiac complications-such as neurogenic stress cardiomyopathy (NSC), a specific form of takotsubo cardiomyopathy. The pathophysiology of these brain-heart interactions is complex and involves sympathetic hyperactivity, activation of the hypothalamic-pituitary-adrenal axis, as well as immune and inflammatory pathways. There have been great strides in our understanding of the axis from the brain to the heart in patients with isolated acute brain injury and more specifically in patients with stroke. On the other hand, in patients with NSC, research has mainly focused on hemodynamic dysfunction due to arrhythmias, regional wall motion abnormality, or left ventricular hypokinesia that leads to impaired cerebral perfusion pressure. Comparatively little is known about the underlying secondary and delayed cerebral complications. The aim of the present review is to describe the stroke-heart-brain axis and highlight the main pathophysiological mechanisms leading to secondary and delayed cerebral injury in patients with concurrent hemorrhagic or ischemic stroke and NSC as well as to identify further areas of research that could potentially improve outcomes in this specific patient population.
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Affiliation(s)
- Mairi Ziaka
- Department of Internal Medicine, Thun General Hospital, Thun, Switzerland,Correspondence: Mairi Ziaka Department of Internal Medicine, Thun General Hospital, Krankenhausstrasse 12, 3600, Thun, Switzerland Tel: +0041636582967 E-mail:
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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25
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Cremer PC, Geske JB, Owens A, Jaber WA, Harb SC, Saberi S, Wang A, Sherrid M, Naidu SS, Schaff H, Smedira NG, Wang Q, Wolski K, Lampl KL, Sehnert AJ, Nissen SE, Desai MY. Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study. Circ Cardiovasc Imaging 2022; 15:e014986. [PMID: 36335645 DOI: 10.1161/circimaging.122.014986] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the randomized phase 3 VALOR-HCM study (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) of patients with obstructive hypertrophic cardiomyopathy, mavacamten reduced the need for septal reduction therapy. Because mavacamten improves ventricular compliance, this sub-study examined the effects of treatment with this cardiac myosin inhibitor on diastolic function. METHODS Symptomatic obstructive hypertrophic cardiomyopathy patients on maximally tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. At baseline and week 16, a resting and stress echocardiogram was performed with interpretation by a core laboratory. In this exploratory substudy, the principal end point was the change in parameters used to define the grade of diastolic function in patients treated with mavacamten and placebo. A related objective was to assess the proportion of patients with an improvement in diastolic function grade. A secondary aim was to assess for correlation between diastolic function parameters and the secondary end points from VALOR-HCM: New York Heart Association class, quality of life, and cardiac biomarkers. RESULTS Diastolic dysfunction grade was evaluable in 98 patients at baseline and week 16. Among patients treated with mavacamten, 29.4% (15 of 51) demonstrated improvement in diastolic function grade compared with 12.8% (6 of 47) patients with placebo (P=0.05). Average E/e' ratio decreased significantly in patients treated with mavacamten (-3.4±5.3) compared with placebo (0.57±3.5; P<0.001). Indexed left atrial volumes (mL/m2) also decreased significantly in patients who received mavacamten (-5.2±7.8) compared with placebo (-0.51±8.1; P=0.005). After adjustment for change in left ventricular outflow tract gradient and mitral regurgitation, mavacamten was significantly associated with a decrease in average E/e' ratio and indexed left atrial volumes. Change in average E/e' ratio was significantly correlated with the secondary end points from VALOR-HCM. CONCLUSIONS In this exploratory substudy, after 16 weeks of therapy, mavacamten improved diastolic function, and this change correlated with improvement in clinical and biomarker end points. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04349072.
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Affiliation(s)
- Paul C Cremer
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.B.G.)
| | - Anjali Owens
- Division of Cardiology, University of Pennsylvania (A.O.)
| | - Wael A Jaber
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Serge C Harb
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.S.)
| | - Andrew Wang
- Department of Cardiology, Duke University, Durham, NC (A.W.)
| | - Mark Sherrid
- Department of Cardiology, New York University (M.S.)
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, NY (S.S.N.)
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (H.S.)
| | - Nicholas G Smedira
- Department of Cardiothoracic Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, OH (N.G.S.).,Hypertrophic Cardiomyopathy Center, Cleveland Clinic, OH (N.G.S., M.Y.D.)
| | - Qiuqing Wang
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Kathy Wolski
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Kathy L Lampl
- MyoKardia, Inc, a wholly-owned subsidiary of Bristol Myers Squibb, Brisbane, CA (K.L.L., A.J.S.)
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly-owned subsidiary of Bristol Myers Squibb, Brisbane, CA (K.L.L., A.J.S.)
| | - Steven E Nissen
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH
| | - Milind Y Desai
- Department of Cardiovascular Medicine (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Cleveland Clinic Coordinating Center for Clinical Research Heart Vascular and Thoracic Institute (P.C.C., W.A.J., S.C.H., Q.W., K.W., S.E.N., M.Y.D.), Cleveland Clinic, OH.,Hypertrophic Cardiomyopathy Center, Cleveland Clinic, OH (N.G.S., M.Y.D.)
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26
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Kim M, Chung H, Kim IS, Park CH, Rim SJ, Choi EY. Effects of left atrial function on pulmonary arterial pressure in acute myocardial infarction, hypertrophic and dilated cardiomyopathy. BMC Cardiovasc Disord 2022; 22:507. [PMID: 36435744 PMCID: PMC9701432 DOI: 10.1186/s12872-022-02952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
To investigate the differential contribution of the left atrial (LA) function and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure (PASP) in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and reperfused acute myocardial infarction (AMI).
Methods
Data of 370 patients with HCM (n = 133), DCM (n = 114) and reperfused AMI (n = 123) who underwent both echocardiography and cardiovascular magnetic resonance (CMR) were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), LA stiffness index, defined as E/e′/LA-GLS and extracellular volume fraction (ECV) of LV were measured using CMR.
Results
E/e′ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The LA stiffness index was related to PASP in HCM (p = 0.01) and DCM (p = 0.03) independent of LA volume index and E/e′, but not in AMI. In DCM, ECV was significantly related to PASP (p < 0.001) independent of LA volume index and E/e′. When subdivided according to the linear regression between PASP and E/e′, patients in the discrepantly high PASP group had lower total emptying fraction and reservoir fraction of left atrium in HCM and DCM but not in AMI.
Conclusions
The LA function in HCM and DCM and LV fibrosis in DCM correlated with PASP independent of E/e′ and LA size, contrary to that in AMI. These results suggest the presence of LA dysfunction in non-ischemic cardiomyopathies and usefulness of ECV measurement in DCM for the comprehensive evaluation of LV diastolic function.
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27
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Teixeira KLM, Correia EDB, Tressino CG, Peçanha MM, Melchior WA, Barretto RBDM, Medeiros BGD, Le Bihan D. Echocardiographic assessment of atrial function in patients with hypertrophic cardiomyopathy with and without paroxysmal atrial fibrillation. Rev Port Cardiol 2022; 41:771-779. [DOI: 10.1016/j.repc.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/11/2021] [Accepted: 06/21/2021] [Indexed: 10/17/2022] Open
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Pu L, Diao Y, Wang J, Fang T, Xu Z, Sun J, Chen Y. The predictive value of fast semi-automated left atrial long-axis strain analysis for atrial fibrillation in hypertrophic cardiomyopathy. Eur Radiol 2022; 33:312-320. [PMID: 35907026 DOI: 10.1007/s00330-022-09020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/28/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy (HCM) patients are closely related to LA functional impairment. Left atrial (LA) strain provides more insight into LA function. The study aimed to investigate the left atrial dysfunction of HCM patients by rapid semi-automatic method and determine the predictive value of left atrial long-axis strain (LAS) for atrial fibrillation (AF). METHODS We enrolled 372 HCM patients and 100 healthy participants to assess the LA functional parameters. LAS was obtained by semi-automated tracking of the distance between the mid-posterior point of LA wall which is defined as the intersection of the LA long axis and the posterior wall, and the origins of the mitral valve. The inferior and anterior mitral valve annular insertion points on the 2-chamber view and the lateral and septal insertion points on the 4-chamber view were chosen as the origins of the mitral valve. The clinical outcome was defined as detecting the onset of AF. RESULTS The LA strain values were analyzed as 20.8 ± 7.48% for εs, 9.81 ± 5.09% for εe, and 10.91 ± 4.24% for εa in HCM patients, which decreased significantly compared with normal controls. Significant correlations were detected between LV functional parameters and LA strain. During a median follow-up of 61 months, 44 (11.8%) patients developed AF. In the Cox regression analysis, LA strain was identified as a significant predictor of the onset of AF. CONCLUSIONS HCM patients had impairment of LA strain before LA enlargement and reduced EF. LA-LAS can be used as a predictive value for predicting the occurrence of AF in HCM patients. KEY POINTS • Fast semi-automated long-axis strain analysis by CMR is feasible and effective for evaluating the LA longitudinal function. • Hypertrophic cardiomyopathy patients show significant impairment of left atrial strain before LA enlargement. • The left atrial long-axis strain was an independent predictor of atrial fibrillation in hypertrophic cardiomyopathy.
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Affiliation(s)
- Lutong Pu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yike Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Tingting Fang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China. .,Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. .,Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Hu S, Mi L, Fu J, Ma W, Ni J, Zhang Z, Li B, Guan G, Wang J, Zhao N. Model Embraced Electromechanical Coupling Time for Estimation of Heart Failure in Patients With Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2022; 9:895035. [PMID: 35800170 PMCID: PMC9254680 DOI: 10.3389/fcvm.2022.895035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to establish a model embraced electromechanical coupling time (EMC-T) and assess the value of the model for the prediction of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods Data on 82 patients with HCM at Shaanxi Provincial People’s Hospital between February 2019 and November 2021 were collected and then formed the training dataset (n = 82). Data were used to screen predictors of HF using univariate and multivariate analyses. Predictors were implemented to discover the optimal cut-off value, were incorporated into a model, and shown as a nomogram. The cumulative HF curve was calculated using the Kaplan–Meier method. Additionally, patients with HCM at other hospitals collected from March 2019 to March 2021 formed the validation dataset. The model’s performance was confirmed both in training and validation sets. Results During a median of 22.91 months, 19 (13.38%) patients experienced HF. Cox analysis showed that EMC-T courses in the lateral wall, myoglobin, PR interval, and left atrial volume index were independent predictors of HF in patients with HCM. Five factors were incorporated into the model and shown as a nomogram. Stratification of patients into two risk subgroups by applying risk score (<230.65, ≥230.65) allowed significant distinction between Kaplan–Meier curves for cumulative incidence of HF events. In training dataset, the model had an AUC of 0.948 (95% CI: 0.885–1.000, p < 0.001) and achieved a good C-index of 0.918 (95% CI: 0.867–0.969). In validation dataset, the model had an AUC of 0.991 (95% CI: 0.848–1.000, p < 0.001) and achieved a strong C-index of 0.941 (95% CI: 0.923–1.000). Calibration plots showed high agreement between predicted and observed outcomes in both two datasets. Conclusion We established and validated a novel model incorporating electromechanical coupling time courses for predicting HF in patients with HCM.
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Affiliation(s)
- Su Hu
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.,Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianli Fu
- Department of Cardiovascular Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Wangxia Ma
- Department of Cardiovascular Medicine, Zhouzhi County Hospital, Xi'an, China
| | - Jingsong Ni
- Department of Cardiovascular Medicine, Huazhou District People's Hospital, Weinan, China
| | - Zhenxia Zhang
- Department of Cardiovascular Medicine, Pucheng County Hospital, Weinan, China
| | - Botao Li
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Na Zhao
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
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Wazzan AA, Galli E, Lacout M, Paven E, L'official G, Schnell F, Oger E, Donal E. Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy? Eur Heart J Cardiovasc Imaging 2022; 24:616-624. [PMID: 35793319 DOI: 10.1093/ehjci/jeac131] [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: 01/26/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial arrhythmia (AA) is considered a turning point for prognosis in patients with hypertrophic cardiomyopathy (HCM). We sought to assess whether the occurrence of AA and stroke could be estimated by an echocardiographic evaluation. METHODS AND RESULTS A total of 216 patients with HCM (52 ± 16 years old) were analysed. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), peak left atrial strain (PLAS), and peak atrial contraction strain. The patients were followed for 2.9 years for the occurrence of a composite endpoint including AA and/or stroke and peripheral embolism. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (57.1 ± 14.4 vs. 50.3 ± 16.7 years; P = 0.0035), had a higher prevalence of arterial hypertension (62.3 vs. 42.3%; P = 0.005), and had higher NT-proBNP. The LAV (47 ± 20 vs. 37.2 ± 15.7 mL/m²; P = 0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (19.3 ± 9.54 vs. 26.6 ± 9.12%; P < 0.0001). After adjustment, PLAS was independently associated with events with an odds ratio of 0.42 (95% confidence interval 0.29-0.61; P < 0.0001). Stroke occurred in 67% of the patients without any clinical AA. The PLAS with a cut-off of under 15.5% provided event prediction with 91% specificity. Using a 15% cut-off, PLAS also demonstrated a predictive value for new-onset of AA. CONCLUSION The decrease in PLAS was strongly associated with the risk of stroke, even in patients without any documented AA. Its value for guiding the management of patients with HCM requires further investigation.
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Affiliation(s)
- Adrien Al Wazzan
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Marion Lacout
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Elise Paven
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | | | - Frederic Schnell
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University of Rennes, Rennes, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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Meucci MC, Fortuni F, Galloo X, Bootsma M, Crea F, Bax JJ, Marsan NA, Delgado V. Left atrioventricular coupling index in hypertrophic cardiomyopathy and risk of new-onset atrial fibrillation. Int J Cardiol 2022; 363:87-93. [PMID: 35716931 DOI: 10.1016/j.ijcard.2022.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUNDS This study aimed to investigate the association between left atrioventricular coupling index (LACI) and the occurrence of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). METHODS A total of 373 patients with HCM and no history of AF were evaluated by transthoracic echocardiography. LACI was defined by the ratio of left atrial (LA) end-diastolic volume divided by left ventricular (LV) end-diastolic volume. The cut-off value for LACI (≥40%) to identify LA-LV uncoupling was chosen based on the risk excess of new-onset AF described with a spline curve analysis. RESULTS The median LACI was 37.5% (IQR: 24.4-56.7) and LA-LV uncoupling (LACI ≥40%) was observed in 171 (45.8%) patients. During a median follow-up of 11 (IQR 7-15) years, 118 (31.6%) subjects developed new-onset AF. The cumulative event-free survival at 10 years was 53% for patients with LA-LV uncoupling versus 94% for patients without LA-LV uncoupling (p < 0.001). Multivariable Cox regression analyses performed separately for each LA parameter showed an independent association between new-onset AF and LACI (hazard ratio [HR], 1.021; 95% CI, 1.017-1.026), LA maximum volume indexed (HR, 1.028; 95% CI, 1.017-1.039), LA minimum volume indexed (HR, 1.047; 95% CI, 1.037-1.060) and LA emptying fraction (HR, 0.967; 95% CI, 0.959-0.977, all p < 0.001). The inclusion of LACI in the multivariate model provided a larger improvement in the risk stratification for new-onset AF, as compared to conventional LA parameters. CONCLUSION In patients with HCM, LACI was more predictive of the occurrence of new-onset AF than conventional LA parameters.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Cardiology, Brussels, Belgium
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Hospital University Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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Nagueh SF, Phelan D, Abraham T, Armour A, Desai MY, Dragulescu A, Gilliland Y, Lester SJ, Maldonado Y, Mohiddin S, Nieman K, Sperry BW, Woo A. Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy: An Update from the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2022; 35:533-569. [PMID: 35659037 DOI: 10.1016/j.echo.2022.03.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is defined by the presence of left ventricular hypertrophy in the absence of other potentially causative cardiac, systemic, syndromic, or metabolic diseases. Symptoms can be related to a range of pathophysiologic mechanisms including left ventricular outflow tract obstruction with or without significant mitral regurgitation, diastolic dysfunction with heart failure with preserved and heart failure with reduced ejection fraction, autonomic dysfunction, ischemia, and arrhythmias. Appropriate understanding and utilization of multimodality imaging is fundamental to accurate diagnosis as well as longitudinal care of patients with HCM. Resting and stress imaging provide comprehensive and complementary information to help clarify mechanism(s) responsible for symptoms such that appropriate and timely treatment strategies may be implemented. Advanced imaging is relied upon to guide certain treatment options including septal reduction therapy and mitral valve repair. Using both clinical and imaging parameters, enhanced algorithms for sudden cardiac death risk stratification facilitate selection of HCM patients most likely to benefit from implantable cardioverter-defibrillators.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Saidi Mohiddin
- Inherited/Acquired Myocardial Diseases, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Koen Nieman
- Cardiovascular Medicine and Radiology (CV Imaging), Stanford University Medical Center, CA
| | - Brett W Sperry
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Anna Woo
- Toronto General Hospital, Toronto, Canada
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Zegkos T, Kamperidis V, Gossios T, Ntelios D, Parcharidou D, Papanastasiou CA, Panagiotidis T, Tsianaka T, Rouskas P, Katranas S, Karvounis H, Efthimiadis G. Mitral regurgitation impact on left atrial myopathy in hypertrophic cardiomyopathy. Echocardiography 2022; 39:819-826. [DOI: 10.1111/echo.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Thomas Zegkos
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Vasileios Kamperidis
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Thomas Gossios
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Dimitris Ntelios
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Despoina Parcharidou
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | | | - Theofilos Panagiotidis
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Theodora Tsianaka
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Pavlos Rouskas
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Sotiris Katranas
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Haralambos Karvounis
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
| | - Georgios Efthimiadis
- 1st Department of Cardiology AHEPA University Hospital Aristotle University Thessaloniki Greece
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Mandeş L, Roşca M, Ciupercă D, Călin A, Beladan CC, Enache R, Cuculici A, Băicuş C, Jurcuţ R, Ginghină C, Popescu BA. Electrocardiographic and Echocardiographic Predictors of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2022; 9:905128. [PMID: 35711369 PMCID: PMC9196883 DOI: 10.3389/fcvm.2022.905128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with hypertrophic cardiomyopathy (HCM) have an increased prevalence of atrial fibrillation (AF) compared to the general population, and left atrium (LA) remodeling is strongly correlated with the risk of AF. This prospective, monocentric study aimed to assess the role of LA electrocardiographic and echocardiographic (structural and functional) parameters in predicting the risk for incident AF in patients with HCM.Methods and ResultsThe study population consisted of 126 HCM patients in sinus rhythm (52.6 ± 16.2 years, 54 men), 118 of them without documented AF. During a median follow-up of 56 (7–124) months, 39 (30.9%) developed a new episode of AF. Multivariable analysis showed that LA booster pump function (assessed by ASr, HR = 4.24, CI = 1.84–9.75, and p = 0.038) and electrical dispersion (assessed by P wave dispersion – Pd, HR = 1.044, CI = 1.029–1.058, and p = 0.001), and not structural parameters (LA diameter, LA volume) were independent predictors of incident AF. Seventy-two patients had a LA diameter < 45 mm, and 16 of them (22.2%) had an AF episode during follow-up. In this subgroup, only Pd emerged as an independent predictor for incident AF (HR = 1.105, CI = 1.059–1.154, and p = 0.002), with good accuracy (AUC = 0.89).ConclusionLeft atrium booster pump function (ASr) and electrical dispersion (Pd) are related to the risk of incident AF in HCM patients. These parameters can provide further stratification of the risk for AF in this setting, including in patients considered at lower risk for AF based on the conventional assessment of LA size.
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Affiliation(s)
- Leonard Mandeş
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Monica Roşca
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Daniela Ciupercă
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
| | - Andreea Călin
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Carmen C. Beladan
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Roxana Enache
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Andreea Cuculici
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Cristian Băicuş
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
| | - Ruxandra Jurcuţ
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Carmen Ginghină
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Bogdan A. Popescu
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”- Euroecolab, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
- *Correspondence: Bogdan A. Popescu,
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Moral S, Abulí M, Vilardell P, Trucco E, Ballesteros E, Brugada R. Multimodality Imaging in the Study of the Left Atrium. J Clin Med 2022; 11:jcm11102854. [PMID: 35628980 PMCID: PMC9147196 DOI: 10.3390/jcm11102854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
The left atrium (LA) plays a vital role in maintaining normal cardiac function. Many cardiac diseases involve the functioning of the LA directly or indirectly. For this reason, the study of the LA has become a priority for today's imaging techniques. Assessment of LA size, function and wall characteristics is routinely performed in cardiac imaging laboratories when a patient undergoes transthoracic echocardiography. However, in cases when the LA is the focus of disease management, such as in atrial fibrillation or left atrial appendage closure, the use of multimodality is critical. Knowledge of the usefulness of each cardiac imaging technique for the study of LA in these patients is crucial in order to choose the most appropriate treatment. While echocardiography is the most widely performed technique for its evaluation and the study of wall deformation analysis is increasingly becoming more reliable, multidetector computed tomography allows a detailed analysis of its anatomy to be carried out in 3D reconstructions that help in the approach to interventional treatments. In addition, the evaluation of the wall by cardiac magnetic resonance imaging or the generation of electroanatomical maps in the electrophysiology room have become essential tools in the treatment of multiple atrial pathologies. For this reason, the goal of this review article is to describe the basic anatomical and functional information of the LA as well as their study employing the main imaging techniques currently available, so that practitioners specializing in cardiac imaging techniques can use these tools in an accurate and clinically useful manner.
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Affiliation(s)
- Sergio Moral
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain; (M.A.); (P.V.); (E.T.); (R.B.)
- Correspondence: ; Tel.: +34-972-940-200; Fax: +34-972-940-270
| | - Marc Abulí
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain; (M.A.); (P.V.); (E.T.); (R.B.)
| | - Pau Vilardell
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain; (M.A.); (P.V.); (E.T.); (R.B.)
| | - Emilce Trucco
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain; (M.A.); (P.V.); (E.T.); (R.B.)
| | - Esther Ballesteros
- Dirección Territorial de Radiologia i Medicina Nuclear de Girona, Insititut de Diagnòstic per la Imatge (IDI), Institut D’Investigació Biomèdica de Girona (IDIBGI), 17007 Girona, Spain;
| | - Ramon Brugada
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain; (M.A.); (P.V.); (E.T.); (R.B.)
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
- Centro Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Atrial fibrillation in hypertrophic cardiomyopathy-a contemporary mini review. Hellenic J Cardiol 2022; 67:66-72. [DOI: 10.1016/j.hjc.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
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Edelberg JM, Sehnert AJ, Mealiffe ME, Del Rio CL, McDowell R. The Impact of Mavacamten on the Pathophysiology of Hypertrophic Cardiomyopathy: A Narrative Review. Am J Cardiovasc Drugs 2022; 22:497-510. [PMID: 35435607 PMCID: PMC9467968 DOI: 10.1007/s40256-022-00532-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a chronic, progressive disease of the cardiomyocyte with a diverse and heterogeneous clinical presentation and course. This diversity and heterogeneity have added to the complexity of modeling the pathophysiological pathways that contribute to the disease burden. The development of novel therapeutic approaches targeting precise mechanisms within the underlying biology of HCM provides a tool to model and test these pathways. Here, we integrate the results of clinical observations with mavacamten, an allosteric, selective, and reversible inhibitor of cardiac myosin, the motor unit of the sarcomere, to develop an integrated pathophysiological pathway model of HCM, confirming the key role of excess sarcomeric activity. This model may serve as a foundation to understand the role of HCM pathophysiological pathways in the clinical presentation of the disease, and how a targeted therapeutic intervention capable of normalizing sarcomeric activity and repopulating low-energy utilization states may reduce the impact of these pathways in HCM and potentially related disease states.
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Affiliation(s)
- Jay M Edelberg
- Clinical Development, Cardiovascular Global Drug Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Amy J Sehnert
- Clinical Development, Cardiovascular Global Drug Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Matthew E Mealiffe
- Early Clinical Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Carlos L Del Rio
- Clinical Development, Cardiovascular Global Drug Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Robert McDowell
- Research & Early Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, 1000 Sierra Point Parkway, Brisbane, CA, 94005, USA.
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Lee HJ, Kim HK, Rhee TM, Choi YJ, Hwang IC, Yoon YE, Park JB, Lee SP, Kim YJ, Cho GY. Left Atrial Reservoir Strain-Based Left Ventricular Diastolic Function Grading and Incident Heart Failure in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2022; 15:e013556. [PMID: 35439039 DOI: 10.1161/circimaging.121.013556] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The echocardiographic assessment of left ventricular (LV) diastolic dysfunction (LVDD) in patients with hypertrophic cardiomyopathy is complex and not well-established. We investigated whether the left atrial reservoir strain (LARS) could be used to categorize LVDD and whether this grading is predictive of heart failure (HF) events in hypertrophic cardiomyopathy. METHODS A total of 414 patients with hypertrophic cardiomyopathy (aged 58.3±12.8 years; 65.7% male) were categorized using LARS-defined LVDD (LARS-DD) grades: ≥35% (grade 0), ≥24% to <35%, ≥19% to <24%, and <19% (grade 3). Patients were followed for a median of 6.9 years to assess hospitalization for HF or HF-related death. RESULTS An increase in LARS-DD grade was associated with worse conventional echocardiographic parameters of LVDD, such as lower e', higher E/e' ratio, greater maximum tricuspid regurgitation velocity, and restrictive mitral inflow pattern. Higher LARS-DD grade was also associated with parameters reflecting increased LV filling pressure, such as greater LV wall thickness, greater extent of fibrosis, obstructive physiology, and decreased LV longitudinal strain. Furthermore, higher LARS-DD grade was associated with worse HF-free survival (log-rank P<0.001). Patients with LARS-DD grades 0, 1, 2, and 3 showed 10-year HF-free survival of 100%, 91.6%, 84.1%, and 67.5%, respectively. LARS-DD grade was an independent predictor of HF events after adjusting for clinical and echocardiographic variables (hazard ratio, 1.53 [95% CI, 1.03-2.28], per 1-grade increase). The LARS-DD grade also had incremental prognostic value for incident HF events over the traditional echocardiographic LVDD parameters and grading system. The prognostic value of advanced LARS-DD grade was consistent in sensitivity analyses and various patient subgroups. CONCLUSIONS LARS can be used as a simple single or supplemental index to categorize LV diastolic function and predict HF events in hypertrophic cardiomyopathy.
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Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
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Zhou D, Yang W, Yang Y, Yin G, Li S, Zhuang B, Xu J, He J, Wu W, Jiang Y, Sun X, Wang Y, Sirajuddin A, Zhao S, Lu M. Left atrial dysfunction may precede left atrial enlargement and abnormal left ventricular longitudinal function: a cardiac MR feature tracking study. BMC Cardiovasc Disord 2022; 22:99. [PMID: 35282817 PMCID: PMC8919633 DOI: 10.1186/s12872-022-02532-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/28/2022] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
The role of the dysfunction of left atrium in the occurrence and development of cardiovascular disease has been gradually recognized. We aim to compare the impact on left atrial (LA) function between patients with hypertrophic cardiomyopathy (HCM) and hypertension (HTN) without LA enlargement using cardiovascular magnetic resonance feature tracking (CMR-FT), and if possible, explore the capability of LA function for providing clinical implication and predicting clinical adverse events in the early stage of cardiovascular disease.
Methods
Consecutive 60 HCM patients and 60 HTN patients with normal LA size among 1413 patients who underwent CMR were retrospectively analyzed as well as 60 controls. Left atrial and ventricular functions were quantified by volumetric and CMR-FT derived strain analysis from long and short left ventricular view cines. The primary endpoint was a composite of all-cause death, stroke, new-onset or worsening heart failure to hospitalization, and paroxysmal or persistent atrial fibrillation.
Results
Compared to the controls, both HTN and HCM participants had impaired LA reservoir function (εs) and conduit function (εe) with the different stage of LA booster pump dysfunction (εa). LA strain was more sensitive than LV longitudinal strain (GLS) for evaluate primary endpoint (εs: 33.9% ± 7.5 vs. 41.2% ± 14.3, p = 0.02; εe: 13.6% ± 6.2 vs. 17.4% ± 10.4, p = 0.03; εa: 20.2% ± 6.0 vs. 23.7% ± 8.8, p = 0.07; GLS: -19.4% ± 6.4 vs. -20.0% ± 6.8, p = 0.70, respectively). After a mean follow-up of 6.8 years, 23 patients reached primary endpoint. Cox regression analyses indicated impaired LA reservoir and booster pump strain were associated with clinical outcomes in patients at the early stage of HTN and HCM (p < 0.05).
Conclusions
CMR-FT-derived strain is a potential and robust tool in demonstrating impaired LA mechanics, quantifying LA dynamics and underlining the impacts on LA-LV coupling in patients with HTN and HCM without LA enlargement. The corresponding LA dysfunction is a promising metric to assess clinical implication and predict prognosis at the early stage, superior to GLS.
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Nakao R, Nagao M, Higuchi S, Minami Y, Shoda M, Ando K, Yamamoto A, Sakai A, Watanabe E, Sakai S, Hagiwara N. Relation of Left Atrial Flow, Volume, and Strain to Paroxysmal Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 166:72-80. [PMID: 34930615 DOI: 10.1016/j.amjcard.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
This study aims to characterize flow, volume, and strain of the left atrium in hypertrophic cardiomyopathy (HC) with atrial fibrillation (AF) using cine cardiovascular magnetic resonance (CMR) imaging. Cine CMR data for 144 patients with HC, including 29 patients with episodes of paroxysmal AF and 13 patients with persistent AF, were retrospectively analyzed. The vortex flow of the left atrial (LA, %) was measured using a vortex flow map and was used as an estimate of flow. The LA end-systolic volume index (ml/m2), LA ejection fraction (%) and global peak longitudinal LA strain (%) derived from a feature-tracking method were used as estimates of volume and strain. Vortex flow of the LA in patients with paroxysmal AF was significantly smaller than in patients without AF (vertical long-axis view; 26.7 ± 10.8% vs 33.2 ± 12.2%, p <0.005). The patients with paroxysmal AF had greater LA end-systolic volume index and global peak longitudinal LA strain and lower LA ejection fraction compared with those without AF. In conclusion, patients with HC with paroxysmal AF are characterized by small vortex flow, large volume, and decreased strain of LA on cine CMR.
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Ding B, Liu P, Zhang F, Hui J, He L. Predicting Values of Neutrophil-to-Lymphocyte Ratio (NLR), High-Sensitivity C-Reactive Protein (hs-CRP), and Left Atrial Diameter (LAD) in Patients with Nonvalvular Atrial Fibrillation Recurrence After Radiofrequency Ablation. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934569. [PMID: 35082255 PMCID: PMC8805343 DOI: 10.12659/msm.934569] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive values of lipid level, inflammatory biomarkers, and echocardiographic parameters in late NVAF (nonvalvular atrial fibrillation) recurrence after RFA (radiofrequency ablation). MATERIAL AND METHODS This retrospective single-center study enrolled 263 patients with paroxysmal or persistent NVAF who underwent initial RFA from Jan 2017 to Jan 2019. The patients were divided into a Recurrent group (n=70) and a Nonrecurrent group (n=193). Univariate and multivariate logistic regression analyses were used for evaluating the predictive factors of late NVAF recurrence. Receiver operating characteristic (ROC) curves were constructed to assess the predictive performance and the optimum cut-off level of variables. RESULTS Late NVAF recurrence occurred in 70 patients (26.6%) after initial RFA within 12-month follow-up. Patients in the Recurrent group had significant higher NLR (neutrophil-to-lymphocyte ratio), hs-CRP (high-sensitivity C-reactive protein), LVEDD (left ventricular end-diastolic dimension), LVESD (left ventricular end-systolic dimension), and LAD (left atrial diameter) than those in the Nonrecurrent group (P<0.05). In multivariate analysis, increased NLR (HR=1.438, 95% CI: 1.036-1.995, P<0.05), hs-CRP (HR=1.137, 95% CI: 1.029-1.257, P<0.05) and LAD (HR=1.089, 95% CI: 1.036-1.146, P<0.05) were independent predictors of NVAF recurrence. The area under the curve (AUC) of NLR and hs-CRP was 0.603 (95% CI 0.525-0.681) and 0.584 (95% CI 0.501-0.666), respectively. The combination of NLR, hs-CRP, and LAD revealed an AUC of 0.684 (95% CI 0.611-0.757), with cut-off values of 2.33, 2.025 ng/L, and 44.5 mm, respectively. CONCLUSIONS The combination of preoperative NLR, hs-CRP, and LAD can predict late NVAF recurrence.
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Affiliation(s)
- Bing Ding
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Pengfei Liu
- Department of Cardiology, The First People's Hospital of Kunshan, Suzhou, Jiangsu, China (mainland)
| | - Fangfang Zhang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jie Hui
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Linyan He
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Bandera F, Mollo A, Frigelli M, Guglielmi G, Ventrella N, Pastore MC, Cameli M, Guazzi M. Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages. Front Cardiovasc Med 2022; 8:750139. [PMID: 35096989 PMCID: PMC8792604 DOI: 10.3389/fcvm.2021.750139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022] Open
Abstract
The left atrium (LA) is emerging as a key element in the pathophysiology of several cardiac diseases due to having an active role in contrasting heart failure (HF) progression. Its morphological and functional remodeling occurs progressively according to pressure or volume overload generated by the underlying disease, and its ability of adaptation contributes to avoid pulmonary circulation congestion and to postpone HF symptoms. Moreover, early signs of LA dysfunction can anticipate and predict the clinical course of HF diseases before the symptom onset which, particularly, also applies to patients with increased risk of HF with still normal cardiac structure (stage A HF). The study of LA mechanics (chamber morphology and function) is moving from a research interest to a clinical application thanks to a great clinical, prognostic, and pathophysiological significance. This process is promoted by the technological progress of cardiac imaging which increases the availability of easy-to-use tools for clinicians and HF specialists. Two-dimensional (2D) speckle tracking echocardiography and feature tracking cardiac magnetic resonance are becoming essential for daily practice. In this context, a deep understanding of LA mechanics, its prognostic significance, and the available approaches are essential to improve clinical practice. The present review will focus on LA mechanics, discussing atrial physiology and pathophysiology of main cardiac diseases across the HF stages with specific attention to the prognostic significance. Imaging techniques for LA mechanics assessment will be discussed with an overlook on the dynamic (under stress) evaluation of the chamber.
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Affiliation(s)
- Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Anita Mollo
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Frigelli
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Giulia Guglielmi
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicoletta Ventrella
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Marco Guazzi
- Department of Biological Sciences, University of Milano, Milan, Italy
- Cardiology Division, San Paolo Hospital, Milan, Italy
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Novo Matos J, Payne JR, Seo J, Luis Fuentes V. Natural history of hypertrophic cardiomyopathy in cats from rehoming centers: The CatScan II study. J Vet Intern Med 2022; 36:1900-1912. [PMID: 36315028 PMCID: PMC9708425 DOI: 10.1111/jvim.16576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The natural history of hypertrophic cardiomyopathy (HCM) in cats has been mainly studied in cats referred for suspected heart disease, which can skew the results towards cats with clinical signs. Few data are available on factors associated with development of HCM in cats. HYPOTHESES (1) Clinical variables can predict which cats will develop HCM; (2) HCM in cats not referred for suspected heart disease is associated with a low rate of cardiovascular events. ANIMALS One hundred seven cats from rehoming centers without a history of clinical signs of cardiac or systemic disease at the time of adoption. METHODS Prospective longitudinal study. After rehoming, shelter cats were reexamined for serial echocardiograms. Cox regression analysis was used to identify predictors of development of HCM in cats that were normal at baseline. Adverse cardiovascular events including heart failure, thromboembolism, or sudden death were recorded. RESULTS Cats were monitored for a median of 5.6 [1.2-9.2] years. At baseline, 68/107 cats were normal, 18/107 were equivocal and 21/107 had HCM. Nineteen cats developed HCM during the study period. The factors at baseline associated with increased hazard of developing HCM were lower left atrial fractional shortening, higher left ventricular fractional shortening, and higher body weight. Cardiovascular events were observed in 21% of cats with HCM. CONCLUSIONS AND CLINICAL IMPORTANCE Cardiovascular events were common in cats with HCM from a rehoming center study sample. Lower left atrial systolic function appears to precede overt HCM.
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Affiliation(s)
- Jose Novo Matos
- Clinical Science and ServicesRoyal Veterinary CollegeHertfordshireUK
| | - Jessie Rose Payne
- Langford Vets Small Animal Referral HospitalUniversity of BristolBristolUK
| | - Joonbum Seo
- Animal Referral CentreAucklandNew Zealand,School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
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Lee HJ, Kim J, Chang SA, Kim YJ, Kim HK, Lee SC. Major Clinical Issues in Hypertrophic Cardiomyopathy. Korean Circ J 2022; 52:563-575. [PMID: 35929051 PMCID: PMC9353251 DOI: 10.4070/kcj.2022.0159] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
By actively implementing contemporary management strategies in hypertrophic cardiomyopathy, morbidity and mortality can be substantially reduced. In this review, we discuss the pathophysiology and management of the major clinical issues in hypertrophic cardiomyopathy, including sudden cardiac death, atrial fibrillation and thromboembolism, dynamic left ventricular outflow tract obstruction, and heart failure progression. Although echocardiography and cardiac magnetic resonance imaging currently play an essential and complementary role in the management of hypertrophic cardiomyopathy, further studies are needed to establish how developing techniques such as myocardial deformation and late gadolinium enhancement can provide better risk stratification and guide treatment. Hypertrophic cardiomyopathy (HCM) is one of the most common inheritable cardiomyopathies. Contemporary management strategies, including the advent of implantable cardioverter-defibrillators and effective anticoagulation, have substantially improved the clinical course of HCM patients; however, the disease burden of HCM is still high in Korea. Sudden cardiac death (SCD), atrial fibrillation and thromboembolic risk, dynamic left ventricular outflow tract (LVOT) obstruction, and heart failure (HF) progression remain important issues in HCM. SCD in HCM can be effectively prevented with implantable cardioverter-defibrillators. However, appropriate patient selection is important for primary prevention, and the 5-year SCD risk score and the presence of major SCD risk factors should be considered. Anticoagulation should be initiated in all HCM patients with atrial fibrillation regardless of the CHA2DS2-VASc score, and non-vitamin K antagonist oral anticoagulants are the first option. Symptomatic dynamic LVOT obstruction is first treated medically with negative inotropes, and if symptoms persist, septal reduction therapy is considered. The recently approved myosin inhibitor mavacamten is promising. HF in HCM is usually related to diastolic dysfunction, while about 5% of HCM patients show reduced left ventricular ejection fraction <50%, also referred to as “end-stage” HCM. Myocardial fibrosis plays an important role in the progression to advanced HF in patients with HCM. Patients who do not respond to guideline-directed medical therapy can be considered for heart transplantation. The development of imaging techniques, such as myocardial deformation on echocardiography and late gadolinium enhancement on cardiac magnetic resonance, can provide better risk evaluation and decision-making for management strategies in HCM.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
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Okune M, Yasuda M, Soejima N, Kakehi K, Kawamura T, Kurita T, Nakazawa G, Iwanaga Y. Not Baseline Atrial Fibrillation but New-Onset Atrial Fibrillation and the Loss of Left Atrial Function Are Essential for Predicting Poor Outcomes in Non-ischemic Cardiomyopathy. Front Cardiovasc Med 2022; 8:781125. [PMID: 34970609 PMCID: PMC8712486 DOI: 10.3389/fcvm.2021.781125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The clinical impact of the type of atrial fibrillation (AF) has not been completely elucidated in non-ischemic cardiomyopathy (NICM). Although the structure and function of the left atrium (LA) provide prognostic information in patients with heart failure, the relationship of the AF type with LA structure and function in NICM is unclear. Methods: Consecutive patients with NICM who underwent cardiac magnetic resonance were evaluated and followed. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for major adverse cardiovascular events (MACE) related to the AF type, such as paroxysmal AF, chronic AF, and new-onset AF (NOAF). Results: Among 625 patients with NICM (mean age, 64.4 ± 14.2 years; women, 39.7%), 133 had a history of AF at baseline; of these, 60 had paroxysmal AF. Each baseline AF type was associated with higher LA volume and lower LA emptying fraction but not with an increased incidence of MACE (p = 0.245). New-onset AF developed in 5.9% of patients with sinus rhythm over a median follow-up period of 609 days, and maximum LA volume was a strong and independent predictor [p < 0.001, area under the ROC curve (AUC): 0.795]. Maximum LA volume was superior to LA emptying fraction and B-type natriuretic peptide (AUC: 0.683 and 0.680, respectively). The use of β-blocker and the age of the patient were associated with the incidence of NOAF (HR: 0.37, 95% CI: 0.16-0.84 and HR: 1.05, 95% CI: 1.01-1.09, respectively). Kaplan-Meier analysis showed that patients with NOAF had a higher incidence of MACE than those with sinus rhythm or baseline AF (p = 0.002). NOAF and LA emptying fraction were independent predictors of MACE (HR: 2.28, 95% CI: 1.20-3.97 and HR: 0.98, 95% CI: 0.96-0.99, respectively) after adjusting for age, sex, body mass index, and diagnosis. Conclusions: Paroxysmal and chronic AF in patients with NICM were not associated with an increased incidence of MACE despite their association with LA volume and function. NOAF was independently associated with poor prognosis. Higher maximum LA volume predicted the onset and lower LA emptying fraction was independently associated with poor prognosis.
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Affiliation(s)
- Mana Okune
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Naoko Soejima
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan.,Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
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Arrhythmia monitoring for risk stratification in hypertrophic cardiomyopathy. CJC Open 2022; 4:406-415. [PMID: 35495864 PMCID: PMC9039556 DOI: 10.1016/j.cjco.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy, presenting significant clinical heterogeneity. Arrhythmia risk stratification and detection are critical components in the evaluation and management of all cases of HCM. The 2020 American Heart Association/American College of Cardiology HCM guidelines provide new recommendations for periodic 24-48-hour ambulatory electrocardiogram monitoring to screen for atrial and ventricular arrhythmias. A strategy of more frequent or prolonged monitoring would lead to earlier arrhythmia recognition and the potential for appropriate treatment. However, whether such a strategy in patients with HCM results in improved outcomes is not yet established. The available evidence, knowledge gaps, and potential merits of such an approach are reviewed. Cardiac implantable electronic devices provide an opportunity for early arrhythmia detection, with the potential to enable early management strategies in order to improve outcomes.
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Hegde SM, Lester SJ, Solomon SD, Michels M, Elliott PM, Nagueh SF, Choudhury L, Zemanek D, Zwas DR, Jacoby D, Wang A, Ho CY, Li W, Sehnert AJ, Olivotto I, Abraham TP. Effect of Mavacamten on Echocardiographic Features in Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2021; 78:2518-2532. [PMID: 34915982 DOI: 10.1016/j.jacc.2021.09.1381] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND EXPLORER-HCM (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy) demonstrated that mavacamten, a cardiac myosin inhibitor, improves symptoms, exercise capacity, and left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (oHCM). OBJECTIVES The purpose of this study was to evaluate mavacamten's effect on measures of cardiac structure and function and its association with changes in other clinical measures. METHODS Key echocardiographic parameters from serial echocardiograms over 30 weeks from 251 symptomatic oHCM patients (mavacamten [n = 123], placebo [n = 128]) were assessed in a core laboratory. RESULTS More patients on mavacamten (80.9%; n = 76 of 94) vs placebo (34.0%; n = 33 of 97) showed complete resolution of mitral valve systolic anterior motion after 30 weeks (difference, 46.8%; P < 0.0001). Mavacamten also improved measures of diastolic function vs placebo, including left atrial volume index (LAVI) (mean ± SD baseline: 40 ± 12 mL/m2 vs 41 ± 14 mL/m2; mean change from baseline of -7.5 mL/m2 [95% CI: -9.0 to -6.1 mL/m2] vs -0.09 mL/m2 [95% CI: -1.6 to 1.5 mL/m2]; P < 0.0001) and lateral E/e' (baseline, 15 ± 6 vs 15 ± 8; change of -3.8 [95% CI: -4.7 to -2.8] vs 0.04 [95% CI: -0.9 to 1.0]; P < 0.0001). Among mavacamten-treated patients, improvement in resting, Valsalva, and post-exercise LVOT gradients, LAVI, and lateral E/e' was associated with reduction in N-terminal pro-B-type natriuretic peptide (P ≤ 0.03 for all). Reduction in LAVI was associated with improved peak exercise oxygen consumption (P = 0.04). CONCLUSIONS Mavacamten significantly improved measures of left ventricular diastolic function and systolic anterior motion. Improvement in LVOT obstruction, LAVI, and E/e' was associated with reduction in a biomarker of myocardial wall stress (N-terminal pro-B-type natriuretic peptide). These findings demonstrate improvement in important markers of the pathophysiology of oHCM with mavacamten. (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy; NCT03470545).
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Affiliation(s)
- Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Lubna Choudhury
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Zemanek
- 2nd Department of Internal Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Donna R Zwas
- Heart Institute, Hadassah University Medical Center, Jerusalem, Israel
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut, USA
| | - Andrew Wang
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wanying Li
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi and the University of Florence, Florence, Italy
| | - Theodore P Abraham
- UCSF HCM Center of Excellence, University of California San Francisco, San Francisco, California, USA
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48
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Notomi Y. Sniffing out an innate flavour. Eur Heart J Cardiovasc Imaging 2021; 23:349-351. [PMID: 34910124 DOI: 10.1093/ehjci/jeab269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yuichi Notomi
- Department of Internal/Preventive and Cardiovascular Medicine, Medical Imaging Laboratory, Healthcheck Clinic, 6-20 Kinko-cho, Kanagawa-ku, Yokohama 221-0056, Japan
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49
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Gupta AN, Avery R, Soulat G, Allen BD, Collins JD, Choudhury L, Bonow RO, Carr J, Markl M, Elbaz MSM. Direct mitral regurgitation quantification in hypertrophic cardiomyopathy using 4D flow CMR jet tracking: evaluation in comparison to conventional CMR. J Cardiovasc Magn Reson 2021; 23:138. [PMID: 34865629 PMCID: PMC8647422 DOI: 10.1186/s12968-021-00828-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Quantitative evaluation of mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCM) by cardiovascular magnetic resonance (CMR) relies on an indirect volumetric calculation. The aim of this study was to directly assess and quantify MR jets in patients with HCM using 4D flow CMR jet tracking in comparison to standard-of-care CMR indirect volumetric method. METHODS This retrospective study included patients with HCM undergoing 4D flow CMR. By the indirect volumetric method from CMR, MR volume was quantified as left ventricular stroke volume minus forward aortic volume. By 4D flow CMR direct jet tracking, multiplanar reformatted planes were positioned in the peak velocity of the MR jet during systole to calculate through-plane regurgitant flow. MR severity was collected for agreement analysis from a clinical echocardiograms performed within 1 month of CMR. Inter-method and inter-observer agreement were assessed by intraclass correlation coefficient (ICC), Bland-Altman analysis, and Cohen's kappa. RESULTS Thirty-seven patients with HCM were included. Direct jet tracking demonstrated good inter-method agreement of MR volume compared to the indirect volumetric method (ICC = 0.80, p = 0.004) and fair agreement of MR severity (kappa = 0.27, p = 0.03). Direct jet tracking showed higher agreement with echocardiography (kappa = 0.35, p = 0.04) than indirect volumetric method (kappa = 0.16, p = 0.35). Inter-observer reproducibility of indirect volumetric method components revealed the lowest reproducibility in end-systolic volume (ICC = 0.69, p = 0.15). Indirect volumetric method showed good agreement of MR volume (ICC = 0.80, p = 0.003) and fair agreement of MR severity (kappa = 0.38, p < 0.001). Direct jet tracking demonstrated (1) excellent inter-observer reproducibility of MR volume (ICC = 0.97, p < 0.001) and MR severity (kappa = 0.84, p < 0.001) and (2) excellent intra-observer reproducibility of MR volume (ICC = 0.98, p < 0.001) and MR severity (kappa = 0.88, p < 0.001). CONCLUSIONS Quantifying MR and assessing MR severity by indirect volumetric method in HCM patients has limited inter-observer reproducibility. 4D flow CMR jet tracking is a potential alternative technique to directly quantify and assess MR severity with excellent inter- and intra-observer reproducibility and higher agreement with echocardiography in this population.
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Affiliation(s)
- Aakash N Gupta
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Gilles Soulat
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | | | - Lubna Choudhury
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Robert O Bonow
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - James Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, 60208, USA
| | - Mohammed S M Elbaz
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA.
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50
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Zhu X, Wang Z, Ferrari MW, Ferrari‐Kuehne K, Bulter J, Xu X, Zhou Q, Zhang Y, Zhang J. Anticoagulation in cardiomyopathy: unravelling the hidden threat and challenging the threat individually. ESC Heart Fail 2021; 8:4737-4750. [PMID: 34498416 PMCID: PMC8712898 DOI: 10.1002/ehf2.13597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/07/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiomyopathy comprises a heterogeneous group of myocardial abnormalities, structural or functional in nature, in the absence of coronary artery disease and other abnormal loading conditions. These myocardial pathologies can result in premature death or disability from progressive heart failure, arrhythmia, stroke, or other embolic events. The European Cardiomyopathy Registry reports a high stroke risk in cardiomyopathy patients ranging from 2.1% to 4.5%, as well as high prevalence of atrial fibrillation ranging from 14.0% to 48.5%. There is a growing interest in evaluating the risk of thromboembolism depending on the type of cardiomyopathy, as well as if anticoagulation is indicated in patients with cardiomyopathy without atrial fibrillation. Data available do not unequivocally support anticoagulation therapy in all of these patients; the management of these patients remains challenging. Many published reports pertaining to the risk of thromboembolism and consecutive treatment strategies mainly focus on single cardiomyopathy subtype. We summarize essential pathophysiological knowledge and review current literature associated with thromboembolism in various cardiomyopathy subtypes, providing recommendations for the diagnostic evaluation as well as clinical management strategies in this field. Certain cardiomyopathy subtypes require anticoagulation independent of atrial fibrillation or CHA2 DS2 -VASc score. Despite the scarcity of evidence regarding the choice of anticoagulation regimen (vitamin K antagonist vs. non-vitamin K oral anticoagulants) in cardiomyopathy, it is discussed and reviewed in this article. Each patient should receive a tailored strategy based on thorough clinical evaluation, published evidence, and clinical experience, due to the current recommendations mostly developed on small-sample studies or empirical evidence. The future research priorities in this area are also addressed in this article.
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Affiliation(s)
- Xiaogang Zhu
- Department of Cardiology, Fu Xing HospitalCapital Medical UniversityBeijingChina
| | - Zhenhua Wang
- Department of CardiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Markus W. Ferrari
- Clinic of Internal Medicine 1, HSKClinic of the City of Wiesbaden and the HELIOS GroupWiesbadenGermany
| | | | - Javed Bulter
- Department of MedicineUniversity of MississippiJacksonMSUSA
| | - Xiuying Xu
- Department of Cardiology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Quanzhong Zhou
- Department of Radiology, The Center for Medical Imaging of Guizhou ProvinceAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College167 Beilishi RdBeijing100037China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College167 Beilishi RdBeijing100037China
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