1
|
Federspiel JM, Reil JC, Xu A, Scholtz S, Batzner A, Maack C, Sequeira V. Retrofitting the Heart: Explaining the Enigmatic Septal Thickening in Hypertrophic Cardiomyopathy. Circ Heart Fail 2024; 17:e011435. [PMID: 38695186 DOI: 10.1161/circheartfailure.123.011435] [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: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 05/23/2024]
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiac disease and is characterized by left ventricular hypertrophy. Although this hypertrophy often associates with sarcomeric gene mutations, nongenetic factors also contribute to the disease, leading to diastolic dysfunction. Notably, this dysfunction manifests before hypertrophy and is linked to hypercontractility, as well as nonuniform contraction and relaxation (myofibril asynchrony) of the myocardium. Although the distribution of hypertrophy in hypertrophic cardiomyopathy can vary both between and within individuals, in most cases, it is primarily confined to the interventricular septum. The reasons for septal thickening remain largely unknown. In this article, we propose that alterations in muscle fiber geometry, present from birth, dictate the septal shape. When combined with hypercontractility and exacerbated by left ventricular outflow tract obstruction, these factors predispose the septum to an isometric type of contraction during systole, consequently constraining its mobility. This contraction, or more accurately, this focal increase in biomechanical stress, prompts the septum to adapt and undergo remodeling. Drawing a parallel, this is reminiscent of how earthquake-resistant buildings are retrofitted with vibration dampers to absorb the majority of the shock motion and load. Similarly, the heart adapts by synthesizing viscoelastic elements such as microtubules, titin, desmin, collagen, and intercalated disc components. This pronounced remodeling in the cytoskeletal structure leads to noticeable septal hypertrophy. This structural adaptation acts as a protective measure against damage by attenuating myofibril shortening while reducing cavity tension according to Laplace Law. By examining these events, we provide a coherent explanation for the septum's predisposition toward hypertrophy.
Collapse
Affiliation(s)
- Jan M Federspiel
- Comprehensive Heart Failure Center, Department of Translational Science University Clinic Würzburg, Germany (J.M.F., A.X., A.B., C.M., V.S.)
- Saarland University, Faculty of Medicine, Institute for Legal Medicine, Homburg (Saar), Germany (J.M.F.)
| | - Jan-Christian Reil
- Klinik für allgemeine und interventionelle Kardiologie, Herz- und Diabetes-Zentrum Nordrhein-Westphalen, Germany (J.-C.R., S.S.)
| | - Anton Xu
- Comprehensive Heart Failure Center, Department of Translational Science University Clinic Würzburg, Germany (J.M.F., A.X., A.B., C.M., V.S.)
| | - Smita Scholtz
- Klinik für allgemeine und interventionelle Kardiologie, Herz- und Diabetes-Zentrum Nordrhein-Westphalen, Germany (J.-C.R., S.S.)
| | - Angelika Batzner
- Comprehensive Heart Failure Center, Department of Translational Science University Clinic Würzburg, Germany (J.M.F., A.X., A.B., C.M., V.S.)
- Department of Internal Medicine I, University Hospital Würzburg, Germany (A.B.)
| | - Christoph Maack
- Comprehensive Heart Failure Center, Department of Translational Science University Clinic Würzburg, Germany (J.M.F., A.X., A.B., C.M., V.S.)
| | - Vasco Sequeira
- Comprehensive Heart Failure Center, Department of Translational Science University Clinic Würzburg, Germany (J.M.F., A.X., A.B., C.M., V.S.)
| |
Collapse
|
2
|
Topriceanu CC, Captur G. Aberrant Myocardial Dynamics in Subclinical Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2024; 17:e016572. [PMID: 38563165 DOI: 10.1161/circimaging.124.016572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Constantin-Cristian Topriceanu
- UCL MRC Unit for Lifelong Health and Ageing (C.-C.T., G.C.), University College London
- UCL Institute of Cardiovascular Science (C.-C.T., G.C.), University College London
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London (C.-C.T.)
- The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, London (C.-C.T., G.C.)
| | - Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing (C.-C.T., G.C.), University College London
- UCL Institute of Cardiovascular Science (C.-C.T., G.C.), University College London
- The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, London (C.-C.T., G.C.)
| |
Collapse
|
3
|
Negri F, Sanna GD, Di Giovanna G, Cittar M, Grilli G, De Luca A, Dal Ferro M, Baracchini N, Burelli M, Paldino A, Del Franco A, Pradella S, Todiere G, Olivotto I, Imazio M, Sinagra G, Merlo M. Cardiac Magnetic Resonance Feature-Tracking Identifies Preclinical Abnormalities in Hypertrophic Cardiomyopathy Sarcomere Gene Mutation Carriers. Circ Cardiovasc Imaging 2024; 17:e016042. [PMID: 38563190 DOI: 10.1161/circimaging.123.016042] [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: 08/25/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Assessing myocardial strain by cardiac magnetic resonance feature tracking (FT) has been found to be useful in patients with overt hypertrophic cardiomyopathy (HCM). Little is known, however, of its role in sarcomere gene mutation carriers without overt left ventricular hypertrophy (subclinical HCM). METHODS Thirty-eight subclinical HCM subjects and 42 healthy volunteers were enrolled in this multicenter case-control study. They underwent a comprehensive cardiac magnetic resonance study. Two-dimensional global radial, circumferential, and longitudinal strain of the left ventricle (LV) were evaluated by FT analysis. RESULTS The subclinical HCM sample was 41 (22-51) years old and 32% were men. FT analysis revealed a reduction in global radial strain (29±7.2 versus 47.9±7.4; P<0.0001), global circumferential strain (-17.3±2.6 -versus -20.8±7.4; P<0.0001) and global longitudinal strain (-16.9±2.4 versus -20.5±2.6; P<0.0001) in subclinical HCM compared with control subjects. The significant differences persisted when considering the 23 individuals free of all the structural and functional ECG and cardiac magnetic resonance abnormalities previously described. Receiver operating characteristic curve analyses showed that the differential diagnostic performances of FT in discriminating subclinical HCM from normal subjects were good to excellent (global radial strain with optimal cut-off value of 40.43%: AUC, 0.946 [95% CI, 0.93-1.00]; sensitivity 90.48%, specificity 94.44%; global circumferential strain with cut-off, -18.54%: AUC, 0.849 [95% CI, 0.76-0.94]; sensitivity, 88.10%; specificity, 72.22%; global longitudinal strain with cut-off, -19.06%: AUC, 0.843 [95% CI, 0.76-0.93]; sensitivity, 78.57%; specificity, 78.95%). Similar values were found for discriminating those subclinical HCM subjects without other phenotypic abnormalities from healthy volunteers (global radial strain with optimal cut-off 40.43%: AUC, 0.966 [95% CI, 0.92-1.00]; sensitivity, 90.48%; specificity, 95.45%; global circumferential strain with cut-off, -18.44%: AUC, 0.866 [95% CI, 0.76-0.96]; sensitivity, 92.86%; specificity, 77.27%; global longitudinal strain with cut-off, -17.32%: AUC, 0.838 [95% CI, 0.73-0.94]; sensitivity, 90.48%; specificity, 65.22%). CONCLUSIONS Cardiac magnetic resonance FT-derived parameters are consistently lower in subclinical patients with HCM, and they could emerge as a good tool for discovering the disease during a preclinical phase.
Collapse
Affiliation(s)
- Francesco Negri
- Cardiology Department, University Hospital "Santa Maria della Misericordia," Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy (F.N., M.I.)
| | | | - Giulia Di Giovanna
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Marco Cittar
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Giulia Grilli
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Antonio De Luca
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Matteo Dal Ferro
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Nikita Baracchini
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Massimo Burelli
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Alessia Paldino
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Annamaria Del Franco
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (A.D.F., I.O.)
| | - Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Florence (Italy) (S.P.)
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (A.D.F., I.O.)
- Department of Experimental and Clinical Medicine, Meyer Children's Hospital, University of Florence, Italy (I.O.)
| | - Massimo Imazio
- Cardiology Department, University Hospital "Santa Maria della Misericordia," Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy (F.N., M.I.)
- Department of Medicine, University of Udine, Italy (M.I.)
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| | - Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Italy (G.d.G., M.C., G.G., A.D.L., M.d.F., N.B., M.B., A.P., G.S., M.M.)
| |
Collapse
|
4
|
Castiglione V, Aimo A, Todiere G, Barison A, Fabiani I, Panichella G, Genovesi D, Bonino L, Clemente A, Cademartiri F, Giannoni A, Passino C, Emdin M, Vergaro G. Role of Imaging in Cardiomyopathies. Card Fail Rev 2023; 9:e08. [PMID: 37427006 PMCID: PMC10326670 DOI: 10.15420/cfr.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 07/11/2023] Open
Abstract
Imaging has a central role in the diagnosis, classification, and clinical management of cardiomyopathies. While echocardiography is the first-line technique, given its wide availability and safety, advanced imaging, including cardiovascular magnetic resonance (CMR), nuclear medicine and CT, is increasingly needed to refine the diagnosis or guide therapeutic decision-making. In selected cases, such as in transthyretin-related cardiac amyloidosis or in arrhythmogenic cardiomyopathy, the demonstration of histological features of the disease can be avoided when typical findings are observed at bone-tracer scintigraphy or CMR, respectively. Findings from imaging techniques should always be integrated with data from the clinical, electrocardiographic, biomarker, genetic and functional evaluation to pursue an individualised approach to patients with cardiomyopathy.
Collapse
Affiliation(s)
- Vincenzo Castiglione
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Alberto Aimo
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giancarlo Todiere
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Andrea Barison
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Iacopo Fabiani
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Giorgia Panichella
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Dario Genovesi
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Lucrezia Bonino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Clemente
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Filippo Cademartiri
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Giannoni
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Claudio Passino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Michele Emdin
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giuseppe Vergaro
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| |
Collapse
|
5
|
Ismail TF, Frey S, Kaufmann BA, Winkel DJ, Boll DT, Zellweger MJ, Haaf P. Hypertensive Heart Disease-The Imaging Perspective. J Clin Med 2023; 12:jcm12093122. [PMID: 37176563 PMCID: PMC10179093 DOI: 10.3390/jcm12093122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.
Collapse
Affiliation(s)
- Tevfik F Ismail
- King's College London & Cardiology Department, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Simon Frey
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - David J Winkel
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| |
Collapse
|
6
|
Goyal N, Keir G, Esterson YB, Saba SG, Cohen S, Rowin E, Romashko M, Chusid J. Hypertrophic cardiomyopathy - phenotypic variations beyond wall thickness. Clin Imaging 2023; 95:80-89. [PMID: 36680913 DOI: 10.1016/j.clinimag.2023.01.003] [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: 07/05/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (LVH) in the absence of another causal disease. Several morphologic and histologic changes have been described. Given the morbidity and mortality associated with HCM, understanding these anatomic variations is key to interpreting imaging. This is especially important since many patients exhibit these associated findings in the absence of LVH and prompt early detection of these variations may lead to early diagnosis and treatment. This article describes the appearance of morphologic variations seen in HCM beyond myocardial thickening including: papillary muscle and mitral valve variants, myocardial crypts, left ventricular myocardial bands, and dystrophic calcification related to increased wall tension.
Collapse
Affiliation(s)
- Nikhil Goyal
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Graham Keir
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Yonah B Esterson
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Shahryar G Saba
- Department of Cardiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Stuart Cohen
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Ethan Rowin
- Department of Cardiology, New England Medical Center, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Mikhail Romashko
- Department of Cardiology, New England Medical Center, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Jesse Chusid
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| |
Collapse
|
7
|
Merlo M, Gagno G, Baritussio A, Bauce B, Biagini E, Canepa M, Cipriani A, Castelletti S, Dellegrottaglie S, Guaricci AI, Imazio M, Limongelli G, Musumeci MB, Parisi V, Pica S, Pontone G, Todiere G, Torlasco C, Basso C, Sinagra G, Filardi PP, Indolfi C, Autore C, Barison A. Clinical application of CMR in cardiomyopathies: evolving concepts and techniques : A position paper of myocardial and pericardial diseases and cardiac magnetic resonance working groups of Italian society of cardiology. Heart Fail Rev 2023; 28:77-95. [PMID: 35536402 PMCID: PMC9902331 DOI: 10.1007/s10741-022-10235-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Cardiac magnetic resonance (CMR) has become an essential tool for the evaluation of patients affected or at risk of developing cardiomyopathies (CMPs). In fact, CMR not only provides precise data on cardiac volumes, wall thickness, mass and systolic function but it also a non-invasive characterization of myocardial tissue, thus helping the early diagnosis and the precise phenotyping of the different CMPs, which is essential for early and individualized treatment of patients. Furthermore, several CMR characteristics, such as the presence of extensive LGE or abnormal mapping values, are emerging as prognostic markers, therefore helping to define patients' risk. Lastly new experimental CMR techniques are under investigation and might contribute to widen our knowledge in the field of CMPs. In this perspective, CMR appears an essential tool to be systematically applied in the diagnostic and prognostic work-up of CMPs in clinical practice. This review provides a deep overview of clinical applicability of standard and emerging CMR techniques in the management of CMPs.
Collapse
Affiliation(s)
- Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
| | - Giulia Gagno
- grid.5133.40000 0001 1941 4308Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Anna Baritussio
- grid.5608.b0000 0004 1757 3470Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Barbara Bauce
- grid.5608.b0000 0004 1757 3470Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Elena Biagini
- grid.412311.4Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, 40138 Bologna, Italy
| | - Marco Canepa
- grid.410345.70000 0004 1756 7871Cardiologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy ,grid.5606.50000 0001 2151 3065Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
| | - Alberto Cipriani
- grid.5608.b0000 0004 1757 3470Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvia Castelletti
- grid.418224.90000 0004 1757 9530Department of Cardiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, 80011 Acerra, Naples, Italy
| | - Andrea Igoren Guaricci
- grid.7644.10000 0001 0120 3326University Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
| | - Massimo Imazio
- grid.411492.bCardiothoracic Department, University Hospital “Santa Maria Della Misericordia”, Udine, Italy
| | - Giuseppe Limongelli
- grid.416052.40000 0004 1755 4122Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Dei Colli, Monaldi Hospital, Naples, Italy
| | - Maria Beatrice Musumeci
- grid.7841.aCardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Vanda Parisi
- grid.412311.4Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, 40138 Bologna, Italy
| | - Silvia Pica
- grid.419557.b0000 0004 1766 7370Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Pontone
- grid.418230.c0000 0004 1760 1750Dipartimento di Cardiologia Perioperatoria e Imaging Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giancarlo Todiere
- grid.452599.60000 0004 1781 8976Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Camilla Torlasco
- grid.418224.90000 0004 1757 9530Department of Cardiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Cristina Basso
- grid.5608.b0000 0004 1757 3470Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianfranco Sinagra
- grid.5133.40000 0001 1941 4308Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Pasquale Perrone Filardi
- grid.4691.a0000 0001 0790 385XDipartimento Scienze Biomediche Avanzate, Università degli Studi Federico II, Mediterranea CardioCentro, Naples, Italy
| | - Ciro Indolfi
- grid.477084.80000 0004 1787 3414Dipartimento di Scienze Mediche e Chirurgiche, Cattedra di Cardiologia, Università Magna Graecia, Catanzaro, Mediterranea Cardiocentro, Napoli, Italy
| | - Camillo Autore
- grid.7841.aCardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Andrea Barison
- grid.452599.60000 0004 1781 8976Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
8
|
Todiere G, Barison A, Baritussio A, Cipriani A, Guaricci AI, Pica S, Indolfi C, Pontone G, Dellegrottaglie S. Acute clinical presentation of nonischemic cardiomyopathies: early detection by cardiovascular magnetic resonance. J Cardiovasc Med (Hagerstown) 2022; 24:e36-e46. [PMID: 36729634 DOI: 10.2459/jcm.0000000000001412] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nonischemic cardiomyopathies include a wide range of dilated, hypertrophic and arrhythmogenic heart muscle disorders, not explained by coronary artery disease, hypertension, valvular or congenital heart disease. Advances in medical treatments and the availability of implantable cardioverter defibrillators to prevent sudden cardiac death have allowed a substantial increase in the survival of affected individuals, thus making early diagnosis and tailored treatment mandatory. The characterization of cardiomyopathies has received a great boost from the recent advances in cardiovascular magnetic resonance (CMR) imaging, which, to date, represents the gold standard for noninvasive assessment of cardiac morphology, function and myocardial tissue changes. An acute clinical presentation has been reported in a nonnegligible proportion of patients with nonischemic cardiomyopathies, usually complaining of acute chest pain, worsening dyspnoea or palpitations; 'hot phases' of cardiomyopathies are characterized by a dynamic rise in high-sensitivity troponin, myocardial oedema on CMR, arrhythmic instability, and by an increased long-term risk of adverse remodelling, progression of myocardial fibrosis, heart failure and malignant ventricular arrhythmias. Prompt recognition of 'hot phases' of nonischemic cardiomyopathies is of utmost importance to start an early, individualized treatment in these high-risk patients. On the one hand, CMR represents the gold standard imaging technique to detect early and typical signs of ongoing myocardial remodelling in patients presenting with a 'hot phase' nonischemic cardiomyopathy, including myocardial oedema, perfusion abnormalities and pathological mapping values. On the other hand, CMR allows the differential diagnosis of other acute heart conditions, such as acute coronary syndromes, takotsubo syndrome, myocarditis, pericarditis and sarcoidosis. This review provides a deep overview of standard and novel CMR techniques to detect 'hot phases' of cardiomyopathies, as well as their clinical and prognostic utility.
Collapse
Affiliation(s)
| | | | - Anna Baritussio
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua
| | - Alberto Cipriani
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan
| | - Ciro Indolfi
- Division of Cardiology, Magna Graecia University, Catanzaro
| | | | - Santo Dellegrottaglie
- Advanced Cardiovascular Imaging Unit, Clinica Villa dei Fiori, Acerra, Naples, Italy
| | | |
Collapse
|
9
|
Hughes RK, Camaioni C, Augusto JB, Knott K, Quinn E, Captur G, Seraphim A, Joy G, Syrris P, Elliott PM, Mohiddin S, Kellman P, Xue H, Lopes LR, Moon JC. Myocardial Perfusion Defects in Hypertrophic Cardiomyopathy Mutation Carriers. J Am Heart Assoc 2021; 10:e020227. [PMID: 34310159 PMCID: PMC8475659 DOI: 10.1161/jaha.120.020227] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Impaired myocardial blood flow (MBF) in the absence of epicardial coronary disease is a feature of hypertrophic cardiomyopathy (HCM). Although most evident in hypertrophied or scarred segments, reduced MBF can occur in apparently normal segments. We hypothesized that impaired MBF and myocardial perfusion reserve, quantified using perfusion mapping cardiac magnetic resonance, might occur in the absence of overt left ventricular hypertrophy (LVH) and late gadolinium enhancement, in mutation carriers without LVH criteria for HCM (genotype‐positive, left ventricular hypertrophy‐negative). Methods and Results A single center, case‐control study investigated MBF and myocardial perfusion reserve (the ratio of MBF at stress:rest), along with other pre‐phenotypic features of HCM. Individuals with genotype‐positive, left ventricular hypertrophy‐negative (n=50) with likely pathogenic/pathogenic variants and no evidence of LVH, and matched controls (n=28) underwent cardiac magnetic resonance. Cardiac magnetic resonance identified LVH‐fulfilling criteria for HCM in 5 patients who were excluded. Individuals with genotype‐positive, left ventricular hypertrophy‐negative had longer indexed anterior mitral valve leaflet length (12.52±2.1 versus 11.55±1.6 mm/m2, P=0.03), lower left ventricular end‐systolic volume (21.0±6.9 versus 26.7±6.2 mm/m2, P≤0.005) and higher left ventricular ejection fraction (71.9±5.5 versus 65.8±4.4%, P≤0.005). Maximum wall thickness was not significantly different (9.03±1.95 versus 8.37±1.2 mm, P=0.075), and no subject had significant late gadolinium enhancement (minor right ventricle‒insertion point late gadolinium enhancement only). Perfusion mapping demonstrated visual perfusion defects in 9 (20%) carriers versus 0 controls (P=0.011). These were almost all septal or near right ventricle insertion points. Globally, myocardial perfusion reserve was lower in carriers (2.77±0.83 versus 3.24±0.63, P=0.009), with a subendocardial:subepicardial myocardial perfusion reserve gradient (2.55±0.75 versus 3.2±0.65, P=<0.005; 3.01±0.96 versus 3.47±0.75, P=0.026) but equivalent MBF (2.75±0.82 versus 2.65±0.69 mL/g per min, P=0.826). Conclusions Regional and global impaired myocardial perfusion can occur in HCM mutation carriers, in the absence of significant hypertrophy or scarring.
Collapse
Affiliation(s)
- Rebecca K Hughes
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - Claudia Camaioni
- Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - João B Augusto
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - Kristopher Knott
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - Ellie Quinn
- Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - Gabriella Captur
- Institute of Cardiovascular ScienceUniversity College London London UK.,Department of Cardiology Inherited Heart Muscle Conditions ClinicRoyal Free HospitalNHS Trust London UK.,University College London MRC Unit of Lifelong Health and Ageing London UK
| | - Andreas Seraphim
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - George Joy
- Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - Petros Syrris
- Institute of Cardiovascular ScienceUniversity College London London UK
| | - Perry M Elliott
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - Saidi Mohiddin
- Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK.,William Harvey instituteQueen Mary University of London London UK
| | - Peter Kellman
- National Heart, Lung, and Blood InstituteNational Institutes of HealthDHHS Bethesda MD
| | - Hui Xue
- National Heart, Lung, and Blood InstituteNational Institutes of HealthDHHS Bethesda MD
| | - Luis R Lopes
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| | - James C Moon
- Institute of Cardiovascular ScienceUniversity College London London UK.,Barts Heart CentreThe Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases UnitSt Bartholomew's Hospital London UK
| |
Collapse
|
10
|
Pei J, Schuldt M, Nagyova E, Gu Z, El Bouhaddani S, Yiangou L, Jansen M, Calis JJA, Dorsch LM, Blok CS, van den Dungen NAM, Lansu N, Boukens BJ, Efimov IR, Michels M, Verhaar MC, de Weger R, Vink A, van Steenbeek FG, Baas AF, Davis RP, Uh HW, Kuster DWD, Cheng C, Mokry M, van der Velden J, Asselbergs FW, Harakalova M. Multi-omics integration identifies key upstream regulators of pathomechanisms in hypertrophic cardiomyopathy due to truncating MYBPC3 mutations. Clin Epigenetics 2021; 13:61. [PMID: 33757590 PMCID: PMC7989210 DOI: 10.1186/s13148-021-01043-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common genetic disease of the cardiac muscle, frequently caused by mutations in MYBPC3. However, little is known about the upstream pathways and key regulators causing the disease. Therefore, we employed a multi-omics approach to study the pathomechanisms underlying HCM comparing patient hearts harboring MYBPC3 mutations to control hearts. RESULTS Using H3K27ac ChIP-seq and RNA-seq we obtained 9310 differentially acetylated regions and 2033 differentially expressed genes, respectively, between 13 HCM and 10 control hearts. We obtained 441 differentially expressed proteins between 11 HCM and 8 control hearts using proteomics. By integrating multi-omics datasets, we identified a set of DNA regions and genes that differentiate HCM from control hearts and 53 protein-coding genes as the major contributors. This comprehensive analysis consistently points toward altered extracellular matrix formation, muscle contraction, and metabolism. Therefore, we studied enriched transcription factor (TF) binding motifs and identified 9 motif-encoded TFs, including KLF15, ETV4, AR, CLOCK, ETS2, GATA5, MEIS1, RXRA, and ZFX. Selected candidates were examined in stem cell-derived cardiomyocytes with and without mutated MYBPC3. Furthermore, we observed an abundance of acetylation signals and transcripts derived from cardiomyocytes compared to non-myocyte populations. CONCLUSIONS By integrating histone acetylome, transcriptome, and proteome profiles, we identified major effector genes and protein networks that drive the pathological changes in HCM with mutated MYBPC3. Our work identifies 38 highly affected protein-coding genes as potential plasma HCM biomarkers and 9 TFs as potential upstream regulators of these pathomechanisms that may serve as possible therapeutic targets.
Collapse
Affiliation(s)
- J Pei
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, DIG-D, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M Schuldt
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Nagyova
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
| | - Z Gu
- Department of Biostatistics and Research Support, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - S El Bouhaddani
- Department of Biostatistics and Research Support, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - L Yiangou
- Department of Anatomy and Embryology, LUMC, Leiden, The Netherlands
| | - M Jansen
- Department of Genetics, Division of Laboratories, Pharmacy and Biomedical Genetics, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J J A Calis
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
| | - L M Dorsch
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Snijders Blok
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
| | - N A M van den Dungen
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
| | - N Lansu
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
| | - B J Boukens
- Department of Medical Biology, AMC, Amsterdam, The Netherlands
| | - I R Efimov
- Department of Biomedical Engineering, GWU, Washington, DC, USA
| | - M Michels
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M C Verhaar
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, DIG-D, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - R de Weger
- Department of Pathology, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A Vink
- Department of Pathology, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F G van Steenbeek
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, Utrecht, The Netherlands
| | - A F Baas
- Department of Genetics, Division of Laboratories, Pharmacy and Biomedical Genetics, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - R P Davis
- Department of Anatomy and Embryology, LUMC, Leiden, The Netherlands
| | - H W Uh
- Department of Biostatistics and Research Support, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D W D Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Cheng
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, DIG-D, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Biomedical Engineering, GWU, Washington, DC, USA
| | - M Mokry
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands
- Division of Paediatrics, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F W Asselbergs
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands.
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK.
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Room E03.818, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - M Harakalova
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands.
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, 3584 CT, Utrecht, The Netherlands.
| |
Collapse
|
11
|
Regional myocardial function at preclinical disease stage of hypertrophic cardiomyopathy in female gene variant carriers. Int J Cardiovasc Imaging 2021; 37:2001-2010. [PMID: 33559798 PMCID: PMC8255263 DOI: 10.1007/s10554-020-02156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/31/2020] [Indexed: 10/29/2022]
Abstract
We recently showed more severe diastolic dysfunction at the time of myectomy in female compared to male patients with obstructive hypertrophic cardiomyopathy. Early recognition of aberrant cardiac contracility using cardiovascular magnetic resonance (CMR) imaging may identify women at risk of cardiac dysfunction. To define myocardial function at an early disease stage, we studied regional cardiac function using CMR imaging with tissue tagging in asymptomatic female gene variant carriers. CMR imaging with tissue tagging was done in 13 MYBPC3, 11 MYH7 and 6 TNNT2 gene carriers and 16 age-matched controls. Regional peak circumferential strain was derived from tissue tagging images of the basal and midventricular segments of the septum and lateral wall. Left ventricular wall thickness and global function were comparable between MYBPC3, MYH7, TNNT2 carriers and controls. MYH7 gene variant carriers showed a different strain pattern as compared to the other groups, with higher septal peak circumferential strain at the basal segments compared to the lateral wall, whereas MYBPC3, TNNT2 carriers and controls showed higher strain at the lateral wall compared to the septum. Only subtle gene-specific changes in strain pattern occur in the myocardium preceding development of cardiac hypertrophy. Overall, our study shows that there are no major contractile deficits in asymptomatic females carrying a pathogenic gene variant, which would justify the use of CMR imaging for earlier diagnosis.
Collapse
|
12
|
Dual SA, Anthamatten L, Shah P, Meboldt M, Schmid Daners M. Ultrasound-based prediction of interventricular septum positioning during left ventricular support-an experimental study. J Cardiovasc Transl Res 2020; 13:1055-1064. [PMID: 32671647 DOI: 10.1007/s12265-020-10034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
The implantation of left ventricular assist devices (LVADs) is often complicated by arrhythmias and right ventricular failure (RVF). Today, the pump speed is titrated to optimize device support using single observations of interventricular septum (IVS) positioning with echocardiographic ultrasound (US). The study demonstrates the applicability of three integrated US transducers in the LVAD cannula to monitor IVS positioning continuously and robustly in real time. In vitro, the predictor of the IVS shift shows an overall prediction error for all volume states of less than 20% and provides a continuous assessment for 99% of cases in four differently sized heart phantoms. The prediction of IVS shift depending on the cannula position is robust for azimuthal and polar deviations of ± 20° and ± 8°, respectively. This intracardiac US concept results in a viable predictor for IVS positioning and represents a promising approach to continuously monitor the IVS and ventricular loading in LVAD patients. Graphical abstract.
Collapse
Affiliation(s)
- Seraina Anne Dual
- Product Development Group Zurich, ETH Zurich, CLA G 21.1, Tannenstrasse 3, 8092, Zurich, Switzerland
- Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Lucien Anthamatten
- Product Development Group Zurich, ETH Zurich, CLA G 21.1, Tannenstrasse 3, 8092, Zurich, Switzerland
| | - Palak Shah
- Department of Heart Failure & Transplantation, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Mirko Meboldt
- Product Development Group Zurich, ETH Zurich, CLA G 21.1, Tannenstrasse 3, 8092, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, ETH Zurich, CLA G 21.1, Tannenstrasse 3, 8092, Zurich, Switzerland.
| |
Collapse
|
13
|
Pradella S, Grazzini G, De Amicis C, Letteriello M, Acquafresca M, Miele V. Cardiac magnetic resonance in hypertrophic and dilated cardiomyopathies. Radiol Med 2020; 125:1056-1071. [PMID: 32946001 DOI: 10.1007/s11547-020-01276-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Cardiomyopathies are a heterogeneous entity. The progress in the field of genetics has allowed over the years to determine its origin more and more often. The classification of these pathologies has changed over the years; it has been updated with new knowledge. Imaging allows to define the phenotypic characteristics of the different forms of cardiomyopathy. Cardiac magnetic resonance (CMR) allows a morphological evaluation of the associated (and sometimes pathognomonic) cardiac findings of any form of cardiomyopathy. The tissue characterization sequences also make magnetic resonance imaging unique in its ability to detect changes in myocardial tissue. This review aims to define the features that can be highlighted by CMR in hypertrophic and dilated forms and the possible differential diagnoses. In hypertrophic forms, CMR provides: precise evaluation of wall thickness in all segments, ventricular function and size and evaluation of possible presence of areas of fibrosis as well as changes in myocardial tissue (measurement of T1 mapping and extracellular volume values). In dilated forms, cardiac resonance is the gold standard in the assessment of ventricular volumes. CMR highlights also the potential alterations of the myocardial tissue.
Collapse
Affiliation(s)
- Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Cristian De Amicis
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Mayla Letteriello
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Manlio Acquafresca
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| |
Collapse
|
14
|
Piras P, Torromeo C, Evangelista A, Esposito G, Nardinocchi P, Teresi L, Madeo A, Re F, Chialastri C, Schiariti M, Varano V, Puddu PE. Non-invasive prediction of genotype positive-phenotype negative in hypertrophic cardiomyopathy by 3D modern shape analysis. Exp Physiol 2019; 104:1688-1700. [PMID: 31424582 DOI: 10.1113/ep087551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 08/14/2019] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Can impaired deformational indicators for genotype positive for hypertrophic cardiomyopathy in subjects that do not exhibit a left-ventricular wall hypertrophy condition (G+LVH-) be determined using non-invasive 3D echocardiography? What is the main finding and its importance? Using 3D-STE and modern shape analysis, peculiar deformational impairments can be detected in G+LVH- subjects that can be classified with good accuracy. Moreover, the patterns of impairment are located mainly on the apical region in agreement with other evidence coming from previous biomechanical investigations. ABSTRACT We propose a non-invasive procedure for predicting genotype positive for hypertrophic cardiomyopathy (HCM) in subjects that do not exhibit a left-ventricular wall hypertrophy condition (G+LVH-); the procedure is based on the enhanced analysis of medical imaging from 3D speckle tracking echocardiography (3D-STE). 3D-STE, due to its low quality images, has not been used so far to detect effectively the G+LVH- condition. Here, we post-processed echocardiographic images exploiting the tools of modern shape analysis, and we studied the motion of the left ventricle (LV) during an entire cycle. We enrolled 82 controls, 21 HCM patients and 11 G+LVH- subjects. We followed two steps: (i) we selected the most impaired regions of the LV by analysing its strains; and (ii) we used shape analysis on these regions to classify the subjects. The G+LVH- subjects showed different trajectories and deformational attributes. We found high classification performance in terms of area under the receiver operating characteristic curve (∼90), sensitivity (∼78) and specificity (∼79). Our results showed that (i) G+LVH- subjects present important deformational impairments relative to healthy controls and (ii) modern shape analysis can efficiently predict genotype by means of a non-invasive and inexpensive technique such as 3D-STE.
Collapse
Affiliation(s)
- Paolo Piras
- Department of Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Rome, 00161, Italy
| | - Concetta Torromeo
- Department of Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Rome, 00161, Italy
| | | | - Giuseppe Esposito
- Department of Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Rome, 00161, Italy
| | - Paola Nardinocchi
- Department of Structural Engineering & Geotechnics, Sapienza Università di Roma, Rome, 00161, Italy
| | - Luciano Teresi
- Department of Mathematics & Physics, Roma Tre University, Rome, 00146, Italy
| | - Andrea Madeo
- Ospedale San Camillo-Forlanini, Rome, 00152, Italy
| | - Federica Re
- Ospedale San Camillo-Forlanini, Rome, 00152, Italy
| | | | - Michele Schiariti
- Department of Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Rome, 00161, Italy
| | - Valerio Varano
- Department of Architecture, Roma Tre University, Rome, 00146, Italy
| | - Paolo Emilio Puddu
- Department of Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Rome, 00161, Italy
| |
Collapse
|
15
|
Tarkiainen M, Sipola P, Jalanko M, Heliö T, Jääskeläinen P, Kivelä K, Laine M, Lauerma K, Kuusisto J. CMR derived left ventricular septal convexity in carriers of the hypertrophic cardiomyopathy-causing MYBPC3-Q1061X mutation. Sci Rep 2019; 9:5960. [PMID: 30976029 PMCID: PMC6459818 DOI: 10.1038/s41598-019-42376-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 03/25/2019] [Indexed: 11/09/2022] Open
Abstract
This manuscript has not been published before and is not currently being considered for publication elsewhere. Increased septal convexity of left ventricle has been described in subjects with hypertrophic cardiomyopathy (HCM) -causing mutations without left ventricular hypertrophy (LVH). Our objective was to study septal convexity by cardiac magnetic resonance (CMR) in subjects with the Finnish founder mutation Q1016X in the myosin-binding protein C gene (MYBPC3). Septal convexity was measured in end-diastolic 4-chamber CMR image in 67 study subjects (47 subjects with the MYBPC3-Q1061X mutation and 20 healthy relatives without the mutation). Septal convexity was significantly increased in subjects with the MYBPC3-Q1061X mutation and LVH (n = 32) compared to controls (11.4 ± 4.3 vs 2.7 ± 3.2 mm, P < 0.001). In mutation carriers without LVH, there was a trend for increased septal convexity compared to controls (4.9 ± 2.5 vs 2.7 ± 3.2 mm, P = 0.074). When indexed for BSA, septal convexity in mutation carriers without LVH was 2.8 ± 1.4 mm/m2 and 1.5 ± 1.6 mm/m2 in controls (P = 0.036). In all mutation carriers, septal convexity correlated significantly with body surface area, age, maximal LV wall thickness, LV mass, and late gadolinium enhancement. Subjects with the MYBPC3–Q10961X mutation have increased septal convexity irrespective of the presence of LVH. Septal convexity appears to reflect septal remodeling, and could be useful in recognizing LVH negative mutation carriers.
Collapse
Affiliation(s)
- Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Jalanko
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Kati Kivelä
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi Lauerma
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Kuusisto
- Centre for Medicine and Clinical Research, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
16
|
Boban M, Pesa V, Antic Kauzlaric H, Brusich S, Rotim A, Madzar T, Zulj M, Vcev A. Ventricular diastolic dimension over maximal myocardial thickness is robust landmark of systolic impairment in patients with hypertrophic cardiomyopathy. Med Sci Monit 2018; 24:1880-1886. [PMID: 29602944 PMCID: PMC5892461 DOI: 10.12659/msm.906111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The effects of focal hypertrophy on geometry of the left ventricle and systolic function have not been studied in patients with hypertrophic cardiomyopathy (HCM), despite the fact that the former is the most prominent disease characteristic. The aim of our study was to analyze systolic function over ventricle geometry, generating a functional index made from left ventricle end diastolic dimension (LVEDD) divided by end diastolic thickness of the region with maximal extent of hypertrophy and interventricular septum. Material/Methods Our hospital database of cardiac magnetic resonance was screened for HCM. Geometric functional index (GFI) was calculated for LVEDD over maximal end diastolic thickness (MaxEDT) giving GFI-M, while LVEDD over interventricular septum was expressed as GFI-I. There were 55 consecutive patients with HCM. Results There were 43 males (78.2%) and 12 females (21.8%). The mean age was 52.3±16.7 years (range: 15.5–76.4 years). A significant difference of GFI was found for preserved versus impaired systolic function of the left ventricle (preserved systolic function); GFI-M 2.28±0.60 versus 3.66±0.50 (p<0.001), and GFI-I 2.75±0.88 versus 3.81±0.87 (p<0.001), respectively. Diagnostic value was tested using receiver operating curve (ROC) analyzes, with GFI-M area under curve (AUC)=0.959 (95% CI: 0.868–0.994); (p<0.001) and GFI-I-AUC=0.847 (0.724–0.930); (p<0.001). GFI-M was superior to GFI-I for appraisal of left ventricle systolic dysfunction in HCM; ΔAUC=0.112 (0.018–0.207); (p=0.020). Conclusions GFI is a simple tool, with high sensitivity and specificity for detecting impairment of systolic function in patients with HCM. Further studies would be necessary to investigate its clinical and prognostic impacts, as well as reproducibility with prospective validation.
Collapse
Affiliation(s)
- Marko Boban
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia.,Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Osijek, Croatia
| | - Vladimir Pesa
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Helena Antic Kauzlaric
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Sandro Brusich
- Department of Cardiology, University Hospital Centre Rijeka, Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Ante Rotim
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Tomislav Madzar
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Osijek, Croatia
| | - Marinko Zulj
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijekk, Osijek, Croatia
| | - Aleksandar Vcev
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Osijek, Croatia
| |
Collapse
|
17
|
Zhao X, Tan RS, Tang HC, Teo SK, Su Y, Wan M, Leng S, Zhang JM, Allen J, Kassab GS, Zhong L. Left Ventricular Wall Stress Is Sensitive Marker of Hypertrophic Cardiomyopathy With Preserved Ejection Fraction. Front Physiol 2018; 9:250. [PMID: 29643812 PMCID: PMC5882847 DOI: 10.3389/fphys.2018.00250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/06/2018] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) patients present altered myocardial mechanics due to the hypertrophied ventricular wall and are typically diagnosed by the increase in myocardium wall thickness. This study aimed to quantify regional left ventricular (LV) shape, wall stress and deformation from cardiac magnetic resonance (MR) images in HCM patients and controls, in order to establish superior measures to differentiate HCM from controls. A total of 19 HCM patients and 19 controls underwent cardiac MR scans. The acquired MR images were used to reconstruct 3D LV geometrical models and compute the regional parameters (i.e., wall thickness, curvedness, wall stress, area strain and ejection fraction) based on the standard 16 segment model using our in-house software. HCM patients were further classified into four quartiles based on wall thickness at end diastole (ED) to assess the impact of wall thickness on these regional parameters. There was a significant difference between the HCM patients and controls for all regional parameters (P < 0.001). Wall thickness was greater in HCM patients at the end-diastolic and end-systolic phases, and thickness was most pronounced in segments at the septal regions. A multivariate stepwise selection algorithm identified wall stress index at ED (σi,ED) as the single best independent predictor of HCM (AUC = 0.947). At the cutoff value σi,ED < 1.64, both sensitivity and specificity were 94.7%. This suggests that the end-diastolic wall stress index incorporating regional wall curvature—an index based on mechanical principle—is a sensitive biomarker for HCM diagnosis with potential utility in diagnostic and therapeutic assessment.
Collapse
Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Hak-Chiaw Tang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soo-Kng Teo
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yi Su
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Min Wan
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, China
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Jun-Mei Zhang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - John Allen
- Duke-NUS Medical School, Singapore, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
18
|
Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
Collapse
Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
19
|
Pennell DJ, Baksi AJ, Prasad SK, Mohiaddin RH, Alpendurada F, Babu-Narayan SV, Schneider JE, Firmin DN. Review of Journal of Cardiovascular Magnetic Resonance 2015. J Cardiovasc Magn Reson 2016; 18:86. [PMID: 27846914 PMCID: PMC5111217 DOI: 10.1186/s12968-016-0305-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022] Open
Abstract
There were 116 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2015, which is a 14 % increase on the 102 articles published in 2014. The quality of the submissions continues to increase. The 2015 JCMR Impact Factor (which is published in June 2016) rose to 5.75 from 4.72 for 2014 (as published in June 2015), which is the highest impact factor ever recorded for JCMR. The 2015 impact factor means that the JCMR papers that were published in 2013 and 2014 were cited on average 5.75 times in 2015. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.
Collapse
Affiliation(s)
- D. J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - A. J. Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - S. K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - R. H. Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - F. Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - S. V. Babu-Narayan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - J. E. Schneider
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - D. N. Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| |
Collapse
|
20
|
Sen-Chowdhry S, Jacoby D, Moon JC, McKenna WJ. Update on hypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol 2016; 13:651-675. [PMID: 27681577 DOI: 10.1038/nrcardio.2016.140] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM.
Collapse
Affiliation(s)
- Srijita Sen-Chowdhry
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.,Department of Epidemiology, Imperial College, St Mary's Campus, Norfolk Place, London W2 1NY, UK
| | - Daniel Jacoby
- Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - William J McKenna
- Heart Hospital, Hamad Medical Corporation, Al Rayyan Road, Doha, Qatar
| |
Collapse
|
21
|
Tarkiainen M, Sipola P, Jalanko M, Heliö T, Laine M, Järvinen V, Häyrinen K, Lauerma K, Kuusisto J. Cardiovascular magnetic resonance of mitral valve length in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2016; 18:33. [PMID: 27259862 PMCID: PMC4893285 DOI: 10.1186/s12968-016-0250-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous data suggest that mitral valve leaflets are elongated in hypertrophic cardiomyopathy (HCM), and mitral valve leaflet elongation may constitute a primary phenotypic expression of HCM. Our objective was to measure the length of mitral valve leaflets by cardiovascular magnetic resonance (CMR) in subjects with HCM caused by a Finnish founder mutation in the myosin-binding protein C gene (MYBPC3-Q1061X), carriers of the same mutation without left ventricular hypertrophy, as well as in unselected consecutive patients with HCM, and respective controls. METHODS Anterior mitral valve leaflet (AML) and posterior mitral valve leaflet (PML) lengths were measured by CMR in 47 subjects with the Q1061X mutation in the gene encoding MYBPC3 and in 20 healthy relatives without the mutation. In addition, mitral valve leaflet lengths were measured by CMR in 80 consecutive non-genotyped patients with HCM in CMR and 71 age- and gender-matched healthy subjects. RESULTS Of the subjects with the MYBPC-Q1016X mutation, 32 had left ventricular hypertrophy (LVH, LV maximal wall thickness ≥ 13 mm in CMR) and 15 had no hypertrophy. PML was longer in patients with the MYBPC3-Q1061X mutation and LVH than in controls of the MYBPC group (12.8 ± 2.8 vs 10.6 ± 1.9 mm, P = 0.013), but the difference between the groups was not statistically significant when PML was indexed for BSA (P = 0.066), or when PML length was adjusted for BSA, age, gender, LV mass and ejection fraction (P = 0.195). There was no significant difference in the PML length in mutation carriers without LVH and controls (11.1 ± 3.4 vs 10.6 ± 1.9, P = 0.52). We found no difference in AML lengths between the MYBPC mutation carriers with or without hypertrophy and controls. In 80 consecutive non-genotyped patients with HCM, there was no difference either in AML or PML lengths in subjects with HCM compared to respective control subjects. CONCLUSIONS In subjects with HCM caused by the Q1061X mutation in the MYBPC3 gene, the posterior mitral valve leaflets may be elongated, but mitral valve elongation does not constitute primary phenotypic expression of the disease. Instead, elongated mitral valve leaflets seem to be associated with body size and left ventricular remodeling.
Collapse
Affiliation(s)
- Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Mikko Jalanko
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Laine
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Vesa Järvinen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, Hyvinkää Hospital, Hyvinkää, Finland
| | | | - Kirsi Lauerma
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Kuusisto
- Centre for Medicine and Clinical Research, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|