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Xu W, Zhu F, Zhang Y, Li P, Sheng Y. An overview of the treatments for hypertrophic cardiomyopathy. Front Cardiovasc Med 2024; 11:1387596. [PMID: 38887447 PMCID: PMC11180737 DOI: 10.3389/fcvm.2024.1387596] [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: 02/18/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a very prevalent inherited disease with a wide global distribution and a prevalence rate of approximately 0.2% in the general population. Left ventricular hypertrophy (LVH) caused by sarcomere mutation is the primary reason of HCM. The histopathology feature is that cardiomyocyte hypertrophy, myocyte disorder and myocardial fibrosis lead to diminished diastolic function, left ventricular outflow tract obstruction (LVOTO) and arrhythmia, all of which result in serious cardiac complications. Previously, HCM was considered a malignant disease that was almost untreatable. With the improvement of medical standards and increasing awareness of HCM, it has become a highly treatable disease in contemporary times, with a significant decrease in mortality rates. However, there are still significant unmet requirements in the therapy of HCM. This paper draws on more than 100 references from the past four decades and summarizes current advances in the treatment of HCM. The article will review the pathogenesis and types, recent development in pharmacotherapy, invasive treatments and gene therapies, as well as dilemma and future development of HCM.
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Affiliation(s)
- Wenna Xu
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Fuyu Zhu
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yue Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peng Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yanhui Sheng
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
- Department of Cardiology, Jiangsu Province Hospital, Nanjing, Jiangsu, China
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Tokita Y, Matsuda J, Imori Y. Favorable Long-Term Outcomes After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy in Japan. Circ J 2023; 88:133-134. [PMID: 38057102 DOI: 10.1253/circj.cj-23-0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School
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Nakano S, Yamamoto H, Takahashi N, Takaya T. Bailout MitraClip therapy for deteriorated systolic anterior motion-related severe mitral regurgitation post-alcohol septal ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad599. [PMID: 38089119 PMCID: PMC10711538 DOI: 10.1093/ehjcr/ytad599] [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: 06/08/2023] [Revised: 11/18/2023] [Accepted: 11/24/2023] [Indexed: 03/07/2024]
Abstract
Background Percutaneous alcohol septal ablation (ASA) is a non-surgical treatment for symptomatic hypertrophic obstructive cardiomyopathy. It has a potential risk for systolic anterior motion (SAM)-related mitral regurgitation (MR) deterioration, leading to acute congestive heart failure. In such clinical scenarios, additional surgical interventions for SAM-MR are risky. Case summary A 70-year-old man experienced acutely deteriorated heart failure caused by SAM-related MR following ASA, for which venous-arterial extracorporeal membrane oxygenation (ECMO) and a percutaneous left ventricular assist device (Impella CP, Abiomed, MA, USA) were required. Transoesophageal echocardiography showed that an interventricular septal oedematous protrusion led to a large coaptation gap of mitral leaflets with a pseudo-prolapse of the posterior mitral leaflet (PML). Because of his prohibitive surgical risks, we opted for transcatheter edge-to-edge mitral valve repair with MitraClip therapy. After removing the Impella device, an XT clip (Abbott Vascular, CA, USA) was located to cover the pseudo-prolapsed PML, resulting in optimal MR reduction with an acceptable mean transmitral valve-pressure gradient. Thereafter, his heart failure was well controlled, and venous-arterial ECMO was successfully removed on post-MitraClip Day 2. Discussion This case demonstrated that MitraClip therapy rescued the patient from a rare complication of severe acute heart failure with haemodynamic collapse caused by massive SAM-related MR following ASA. MitraClip therapy can be a feasible, less-invasive interventional therapy for SAM-related MR in cases with acceptable severity of iatrogenic mitral stenosis post-MitraClip implantation.
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Affiliation(s)
- Shinsuke Nakano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
| | - Nobuyuki Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 670-8560, Japan
- Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Maekawa Y, Takamisawa I, Takano H, Takayama M. Percutaneous transluminal septal myocardial ablation: past, present, and future. J Cardiol 2021; 80:211-217. [PMID: 34924238 DOI: 10.1016/j.jjcc.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
About 30% of patients with hypertrophic cardiomyopathy have a significant left ventricular pressure gradient at rest, and 60%-70% of these patients are diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) because an induced pressure gradient is also present. Percutaneous transluminal septal myocardial ablation (PTSMA) is a procedure in which ethanol is used to ablate the portion of the septal myocardium that is involved in the pathogenesis of the left ventricular outflow tract pressure gradient (LVOT PG). In 1995, Sigwart et al. reported three cases of PTSMA in The Lancet. The introduction of PTSMA into clinical practice has enabled the reduction of LVOT PG and improvement of heart failure symptoms in elderly and high-risk patients with symptomatic, drug-refractory HOCM. In 1998, Faber et al. published a report in Circulation on selective septal myocardial ablation using myocardial contrast echocardiography (MCE). MCE-guided PTSMA is now recognized as the standard method of PTSMA in many countries and regions, including Europe, North America, and Asia, and is estimated to be performed on about 300 to 400 patients per year in Japan based on reports from the Japanese Circulation Society's Clinical Practice Survey. The current problems with this technique are: 1) the outcome is greatly influenced by operators' and institutional experience, and 2) it is difficult to determine in advance whether the patient is a PTSMA responder or not. Recently, advancements in imaging modalities, including cardiac computed tomography and magnetic resonance imaging, have facilitated clarification of the mechanisms of LVOT obstruction. Therefore, more appropriate decisions regarding PTSMA and surgical myectomy (SM) are now made. Better treatment selection will undoubtedly improve the prognosis of patients with drug-refractory HOCM complicated by heart failure, and further elucidation of the pathogenesis of LVOT obstruction and technical advances in PTSMA and SM are eagerly awaited.
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Affiliation(s)
- Yuichiro Maekawa
- Internal Medicine III, Division of Cardiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiology, Nippon Medical School, Tokyo, Japan
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Akita K, Kaneko Y, Sato R, Iguchi K, Suwa K, Maekawa Y. 4D Computed Tomography Visualization of Effective Septal Reduction After Alcohol Septal Ablation for Fatal Hypertrophic Obstructive Cardiomyopathy. Circ J 2021; 86:725. [PMID: 34853278 DOI: 10.1253/circj.cj-21-0922] [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: 11/09/2022]
Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine.,Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center
| | - Yutaro Kaneko
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Ryota Sato
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
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Maekawa Y. Significance of Post-Alcohol Septal Ablation Right Bundle Branch Block. Circ J 2021; 85:1492-1493. [PMID: 34078826 DOI: 10.1253/circj.cj-21-0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
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Suwa K, Akita K, Iguchi K, Ushio T, Maekawa Y. Hemodynamic change in patients with hypertrophic obstructive cardiomyopathy before and after alcohol septal ablation using 4D flow magnetic resonance imaging: a retrospective observational study. BMC Cardiovasc Disord 2021; 21:198. [PMID: 33879058 PMCID: PMC8059221 DOI: 10.1186/s12872-021-02003-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background The hemodynamics in the left ventricle (LV) and the ascending aorta (AAO) before and after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) is elucidated. Our objective was to evaluate the pattern changes in AAO and intra-LV flow assessed by four-dimensional (4D) flow magnetic resonance imaging (MRI) before and after ASA and to clarify the association between 4D flow MRI-derived hemodynamic characteristics and the peak pressure gradient (PPG) in patients with drug-refractory HOCM. Methods In this retrospective observational study, 11 patients with HOCM underwent 4D flow MRI before and a week after ASA. The 4D flow MRI included blood flow visualization and quantification using streamline images. The combined score of vortex and helix in AAO was analyzed. The duration and phase count of the AAO vortex or helix flow and the size of the intra-LV anterior vortex were quantified. The correlation between the changes in hemodynamics and the resting PPG at LV outflow tract was also analyzed. We used the paired t-test for the comparison between before and after ASA and the Pearson’s correlation coefficient for the analysis. Results The combined score for the incidence of vortex and/or helix flow in AAO after ASA was significantly lower than that before ASA (1.45 ± 0.52 vs. 1.09 ± 0.30, p = 0.046). The duration (744 ± 291 ms vs. 467 ± 258 ms, p < 0.001) and phase count (14.8 ± 4.4 phases vs. 10.5 ± 5.8 phases, p < 0.001) of the vortex or helix flow in AAO were significantly decreased after ASA. The LV anterior vortex area after ASA was significantly larger than that before ASA (1628 ± 420 mm2 vs. 2974 ± 539 mm2, p = 0.009). The delta phase count of the AAO vortex or helix before and a week after ASA was significantly correlated with delta PPG before and a week after ASA (R = 0.79, p = 0.004) and with delta PPG before and 6 months after ASA (R = 0.83, p = 0.002). Conclusions Lower vortex or helix flow in AAO and larger diastolic vortex flow in LV were observed after ASA, which suggests the possibility to detect the changes of aberrant hemodynamics in HOCM. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02003-8.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan.
| | - Keitaro Akita
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
| | - Takasuke Ushio
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
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Hamana T, Iwasaki M, Otake H, Kokawa T, Fukuishi Y, Odajima S, Fujimoto W, Kuroda K, Hatani Y, Inoue T, Okamoto H, Okuda M, Hayashi T. A successful case of percutaneous transluminal septal myocardial ablation for left ventricular outflow tract obstruction caused by sigmoid septum. J Cardiol Cases 2020; 22:159-162. [DOI: 10.1016/j.jccase.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 05/26/2020] [Indexed: 11/15/2022] Open
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