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Zhang Y, Adamo M, Zou C, Porcari A, Tomasoni D, Rossi M, Merlo M, Liu H, Wang J, Zhou P, Metra M, Sinagra G, Zhang J. Management of hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2024; 25:399-419. [PMID: 38625835 PMCID: PMC11142653 DOI: 10.2459/jcm.0000000000001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
Hypertrophic cardiomyopathy is an important cause of heart failure and arrhythmias, including sudden death, with a major impact on the healthcare system. Genetic causes and different phenotypes are now increasingly being identified for this condition. In addition, specific medications, such as myosin inhibitors, have been recently shown as potentially able to modify its symptoms, hemodynamic abnormalities and clinical course. Our article aims to provide a comprehensive outline of the epidemiology, diagnosis and treatment of hypertrophic cardiomyopathy in the current era.
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Affiliation(s)
- Yuhui Zhang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Changhong Zou
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aldostefano Porcari
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Maddalena Rossi
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Marco Merlo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Huihui Liu
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jinxi Wang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ping Zhou
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Jian Zhang
- Heart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union of Medical College, National Center for Cardiovascular Diseases, Beijing, China
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Bi X, Song Y, Yang C, Song Y, Zhao S, Qiao S, Zhang J. Sex differences in atrial remodeling and its relationship with myocardial fibrosis in hypertrophic obstructive cardiomyopathy. Front Cardiovasc Med 2022; 9:947975. [PMID: 36531728 PMCID: PMC9748677 DOI: 10.3389/fcvm.2022.947975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/07/2022] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND This study aimed to explore the effect of sex on left atrial (LA) remodeling and its relationship with myocardial fibrosis in patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS A total of 85 patients with HOCM were enrolled. Myocardial fibrosis was quantified by the collagen volume fraction (CVF) in myocardial samples. The early atrial peak of emptying rate (PER-E) was assessed by LA volume/time (V/t) curves derived from cardiac magnetic resonance (CMR) imaging analysis. The PER-E index was PER-E normalized by left ventricular (LV) filling volume. Patients with HOCM showed a lower PER-E index than healthy controls (P = 0.027). Compared with men, the PER-E (P < 0.001) and the PER-E indexes (P = 0.012) in women were lower. In CVF-stratified subgroups, a sex difference in the PER-E index was eliminated (P > 0.05). The CVF was correlated with the PER-E and PER-E indexes in both sexes (all P-values were <0.05). In multivariate regression analysis, sex (P = 0.007) and CVF (P < 0.001) were independently correlated with PER-E (all P-values were <0.05). CONCLUSION Patients with HOCM presented LA reverse remodeling. Impaired LA function was more common in female patients with HOCM due to their susceptibility to myocardial fibrosis.
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Affiliation(s)
- Xuanye Bi
- Henan Province Key Laboratory of Cardiac Injury and Repair, Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- State Key Laboratory of Cardiovascular Disease, Department of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Song
- State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengzhi Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunhu Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinying Zhang
- Henan Province Key Laboratory of Cardiac Injury and Repair, Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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She JQ, Guo JJ, Yu YF, Zhao SH, Chen YY, Ge MY, Zeng MS, Jin H. Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking. J Magn Reson Imaging 2020; 53:51-60. [PMID: 32798304 DOI: 10.1002/jmri.27307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Myocardial strain for assessment of hypertrophic cardiomyopathy (HCM) is of importance and may play a role in identifying obstruction in HCM patients. PURPOSE To evaluate the utility of myocardial strain for detecting left ventricular (LV) outflow tract (LVOT) obstruction in HCM patients based on magnetic resonance tissue tracking. STUDY TYPE Retrospective. POPULATION In all, 44 adult HCM patients with LVOT obstruction and 108 adult HCM patients without LVOT obstruction. FIELD STRENGTH/SEQUENCE 1.5 T; Steady-state free-precession cine sequence; phase-sensitive inversion-prepared segmented gradient echo sequence for late gadolinium enhancement (LGE) imaging. ASSESSMENT Strain parameters including the local and global levels of LV myocardium and the subtraction (Sub) of myocardial strain variables between interventricular septal segments (IVSS) and noninterventricular septal segments (NIVSS) were measured for differentiating HCM with obstruction from nonobstruction. Average and maximum LV wall thickness (Average and Maximum LVWT) were also analyzed. STATISTICAL TESTS Univariate and multivariate logistic regression analysis, area under the receiver operating characteristic (ROC) curve (AUC), intraclass correlation coefficient. RESULTS In multivariate analysis, Average LVWT, Maximum LVWT, and the subtraction of radial peak strain (Sub Radial PS) between NIVSS and IVSS were independently associated with LVOT obstruction. The AUCs were 0.731, 0.840, and 0.890 for Average LVWT, Maximum LVWT, and Sub Radial PS, respectively. Sub Radial PS (cutoff value: 8.1%) demonstrated the highest sensitivity of 75.0% and a high specificity of 87.9% for identifying LVOT; Maximum LVWT (cutoff value: 22.9 mm) showed good sensitivity (72.7%) and specificity (83.3%). Combining Maximum LVWT >22.9 mm and Sub Radial PS > 8.1% achieved a better diagnostic performance (specificity 95.4%, sensitivity 70.5%). DATA CONCLUSION Combining Maximum LVWT >22.9 mm and Sub Radial PS >8.1% holds promise for objectively evaluating LVOT obstruction in HCM patients with very high specificity and acceptable sensitivity. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Jia-Qi She
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Jia-Jun Guo
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yun-Fei Yu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shi-Hai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Mei-Ying Ge
- Department of Radiology, The 5th People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
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Cardiovascular Magnetic Resonance Imaging Tissue Characterization in Non-ischemic Cardiomyopathies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00813-1] [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: 10/24/2022]
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