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Pimpini L, Biscetti L, Matacchione G, Giammarchi C, Barbieri M, Antonicelli R. Atrial High-Rate Episodes in Elderly Patients: The Anticoagulation Therapy Dilemma. J Clin Med 2024; 13:3566. [PMID: 38930095 PMCID: PMC11204811 DOI: 10.3390/jcm13123566] [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: 05/03/2024] [Revised: 05/27/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Atrial fibrillation (AF) has been associated with higher morbidity and mortality rates, especially in older patients. Subclinical atrial fibrillation (SCAF) is defined as the presence of atrial high-rate episodes (AHREs) > 190 bpm for 10 consecutive beats > 6 min and <24 h, as detected by cardiac implanted electronic devices (CIEDs). The selection of eligible patients for anticoagulation therapy among elderly individuals with AHREs detected through CIEDs remains a contentious issue. The meta-analysis of ARTESiA and NOAH-AFNET 6 clinical trials revealed that taking Edoxaban or Apixaban as oral anticoagulation therapy can reduce the risk of stroke by approximately 32% while increasing the risk of major bleeding by approximately 62%. However, it is still unclear which are, among patients with SCAF, those who can take the highest net clinical benefit from anticoagulant therapy. The present review summarizes the current evidence on this intriguing issue and suggests strategies to try to better stratify the risk of stroke and systemic embolism in patients with AHREs. We propose incorporating some parameters including chronic kidney disease (CKD), obesity, enlarged left atrial volume, the efficacy in blood pressure management, and frailty into the traditional CHA2DS2-VASc score. Future trials will be needed to verify the clinical usefulness of the proposed prognostic score mainly in the view of a personalized therapeutic approach in patients with SCAF.
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Affiliation(s)
- Lorenzo Pimpini
- Cardiology Unit, IRCCS INRCA, Via della Montagnola 81, 60127 Ancona, Italy;
| | | | - Giulia Matacchione
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121 Ancona, Italy;
| | | | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
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Hollowell M, Banno J, Marsy D, Shrestha N, Tan J, McNamara R, Decker J, Albano A, Franey L, Abdallah W, Loyaga-Rendon R, Chalfoun N, Fermin D. Ventricular late gadolinium enhancement by cardiac MRI as a predictor of atrial fibrillation in hypertrophic cardiomyopathy. Int J Cardiol 2024; 411:132263. [PMID: 38878873 DOI: 10.1016/j.ijcard.2024.132263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/07/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) increases stroke and mortality in patients with hypertrophic cardiomyopathy (HCM). Cardiac MRI (CMR) is increasingly used to detect late gadolinium enhancement (LGE) as a reliable indicator of left ventricular fibrosis, a potential predisposing factor of AF. Our research explored the correlation between left ventricular LGE and AF prevalence in HCM. METHODS This retrospective study involved 351 HCM patients who underwent CMR. LGE percentages (0%, 1-5%, 6-14%, ≥15%) on CMR were compared with AF prevalence in HCM patients. Demographic, comorbidity, and imaging data were analyzed using appropriate univariate and multivariate analyses assessing for significant differences in AF prevalence. The predetermined significance level was p < 0.05. RESULTS CMR demonstrated increased LGE in those with AF (p = 0.004). Increased LGE correlated with increased AF rates: 27.6% (0% LGE), 38.5% (1-5% LGE), 44.4% (6-14% LGE), and 54.7% (≥15% LGE) (p = 0.101, p = 0.043, p = 0.002, respectively, vs. 0% LGE). Adjusted for age, differences persisted and were most evident for LGE >15% (p = 0.001). Multivariate analysis, factoring age, gender, BMI, RVSP, and LVEF, supported LGE (odds ratio of 1.20, p = 0.036) and LAVI (odds ratio 1.05, 1.02-1.07, p < 0.001) as predictive markers for AF prevalence. CONCLUSIONS Our study suggests a correlation between ventricular LGE and AF in patients with HCM. LGE exceeding 15% was associated with a significant increase in AF prevalence. These patients may require more frequent AF monitoring.
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Affiliation(s)
- Matthew Hollowell
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Joseph Banno
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Dana Marsy
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Nabin Shrestha
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Jose Tan
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Richard McNamara
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Jeffrey Decker
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Alfred Albano
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Laura Franey
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Wissam Abdallah
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Renzo Loyaga-Rendon
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - Nagib Chalfoun
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA
| | - David Fermin
- Corewell Health West Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA; Michigan State University, Grand Rapids, MI, USA.
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Hussain K, Nso N, Tsourdinis G, Haider S, Mian R, Sanagala T, Erwin JP, Pursnani A. A systematic review and meta-analysis of left atrial strain in hypertrophic cardiomyopathy and its prognostic utility. Curr Probl Cardiol 2024; 49:102146. [PMID: 37863460 DOI: 10.1016/j.cpcardiol.2023.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Despite advances in noninvasive imaging modalities to identify atrial fibrillation (AF) risk in Hypertrophic Cardiomyopathy (HCM), there is a paucity of evidence concerning the impact of low Left Atrial strain (LAS) on AF and major adverse cardiac events (MACE) incidence in these patients. This study investigated the diagnostic and prognostic significance of LAS in predicting AF and MACE in HCM. Findings revealed lower LA reservoir (MD: -11.79, 95% CI -14.83, -8.74; p<0.00001), booster (MD: -4.10, 95% CI -6.29, -1.91; p=0.0002), and conduit (MD: -7.52, 95% CI -9.39, -5.65; p<0.00001) strains in HCM patients versus healthy controls, and also indicated a significant association between low LA reservoir/conduit/booster strain and the development of new AF as well as MACE prevalence in HCM patients. The results from this study suggest the valuable role of LA strain in HCM and its utility in predicting the development of new AF and cardiac events in HCM patients.
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Affiliation(s)
- Kifah Hussain
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States.
| | - Nso Nso
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - George Tsourdinis
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Suha Haider
- University of Sussex, Brighton, United Kingdom
| | - Raza Mian
- Loyola University, Chicago, IL, United States
| | - Thriveni Sanagala
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - John P Erwin
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Amit Pursnani
- NorthShore University HealthSystem, Evanston, IL, United States; University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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Zahid S, Malik T, Peterson C, Tarabanis C, Dai M, Katz M, Bernstein SA, Barbhaiya C, Park DS, Knotts RJ, Holmes DS, Kushnir A, Aizer A, Chinitz LA, Jankelson L. Conduction velocity is reduced in the posterior wall of hypertrophic cardiomyopathy patients with normal bipolar voltage undergoing ablation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:203-210. [PMID: 36952090 DOI: 10.1007/s10840-023-01533-9] [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: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage. BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood. METHODS We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients. RESULTS There were no differences in baseline demographics, atrial size, or valvular disease between HCM and control patients. Patients with HCM had significantly reduced atrial conduction velocity compared to controls (0.44 ± 0.17 vs 0.56 ± 0.10 m/s, p = 0.01), despite no significant differences in bipolar voltage amplitude (1.23 ± 0.38 vs 1.20 ± 0.41 mV, p = 0.76). There was a statistically significant reduction in conduction velocity in the posterior left atrium in HCM patients relative to controls (0.43 ± 0.18 vs 0.58 ± 0.10 m/s, p = 0.003), but not in the anterior left atrium (0.46 ± 0.17 vs 0.55 ± 0.10 m/s, p = 0.05). There was a significant association between conduction velocity and interventricular septal thickness (slope = -0.013, R2 = 0.13, p = 0.03). CONCLUSIONS Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
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Affiliation(s)
- Sohail Zahid
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA.
| | - Tahir Malik
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Connor Peterson
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Moshe Katz
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Scott A Bernstein
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Douglas S Holmes
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA.
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:107-117. [PMID: 37857929 DOI: 10.1007/s10554-023-02968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean LA pressure/LA reservoir strain). Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N = 41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active, i.e. active atrial contraction, phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index overall (R = 0.59, p < 0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R = 0.32) and the time to peak reservoir strain rate (R = 0.32) (both p < 0.01), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R = 0.95, p < 0.001) and LA minimum volume (r = 0.82, p < 0.001). In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA pressure/ LA reservoir strain, a metric of stiffness, correlates with LA fibrosis (LA LGE), reflecting Hook's Law.
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Affiliation(s)
- Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Roy Taoutel
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Romy Chamoun
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Joseph Akar
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | | | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Lauren A Baldassarre
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Judith Meadows
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA.
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Barefield DY, Tonino P, Woulfe KC, Rahmanseresht S, O’Leary TS, Burnham HV, Wasserstrom JA, Kirk JA, Previs MJ, Granzier HL, McNally EM. Myosin-binding protein H-like regulates myosin-binding protein distribution and function in atrial cardiomyocytes. Proc Natl Acad Sci U S A 2023; 120:e2314920120. [PMID: 38091294 PMCID: PMC10741380 DOI: 10.1073/pnas.2314920120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
Mutations in atrial-enriched genes can cause a primary atrial myopathy that can contribute to overall cardiovascular dysfunction. MYBPHL encodes myosin-binding protein H-like (MyBP-HL), an atrial sarcomere protein that shares domain homology with the carboxy-terminus of cardiac myosin-binding protein-C (cMyBP-C). The function of MyBP-HL and the relationship between MyBP-HL and cMyBP-C is unknown. To decipher the roles of MyBP-HL, we used structured illumination microscopy, immuno-electron microscopy, and mass spectrometry to establish the localization and stoichiometry of MyBP-HL. We found levels of cMyBP-C, a major regulator of myosin function, were half as abundant compared to levels in the ventricle. In genetic mouse models, loss of MyBP-HL doubled cMyBP-C abundance in the atria, and loss of cMyBP-C doubled MyBP-HL abundance in the atria. Structured illumination microscopy showed that both proteins colocalize in the C-zone of the A-band, with MyBP-HL enriched closer to the M-line. Immuno-electron microscopy of mouse atria showed MyBP-HL strongly localized 161 nm from the M-line, consistent with localization to the third 43 nm repeat of myosin heads. Both cMyBP-C and MyBP-HL had less-defined sarcomere localization in the atria compared to ventricle, yet areas with the expected 43 nm repeat distance were observed for both proteins. Isometric force measurements taken from control and Mybphl null single atrial myofibrils revealed that loss of Mybphl accelerated the linear phase of relaxation. These findings support a mechanism where MyBP-HL regulates cMyBP-C abundance to alter the kinetics of sarcomere relaxation in atrial sarcomeres.
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Affiliation(s)
- David Y. Barefield
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL60153
| | - Paola Tonino
- Department of Cell and Molecular Medicine, University of Arizona, Tucson, AZ85724
| | - Kathleen C. Woulfe
- Division of Cardiology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO80045
| | - Sheema Rahmanseresht
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT01655
| | - Thomas S. O’Leary
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT01655
| | - Hope V. Burnham
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL60153
| | - J. Andrew Wasserstrom
- Department of Medicine and The Feinberg Cardiovascular and Renal Institute, Northwestern University Feinberg School of Medicine, Chicago, IL60611
| | - Jonathan A. Kirk
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, IL60153
| | - Michael J. Previs
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT01655
| | - Henk L. Granzier
- Department of Cell and Molecular Medicine, University of Arizona, Tucson, AZ85724
| | - Elizabeth M. McNally
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
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Ramos-Mondragón R, Lozhkin A, Vendrov AE, Runge MS, Isom LL, Madamanchi NR. NADPH Oxidases and Oxidative Stress in the Pathogenesis of Atrial Fibrillation. Antioxidants (Basel) 2023; 12:1833. [PMID: 37891912 PMCID: PMC10604902 DOI: 10.3390/antiox12101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and its prevalence increases with age. The irregular and rapid contraction of the atria can lead to ineffective blood pumping, local blood stasis, blood clots, ischemic stroke, and heart failure. NADPH oxidases (NOX) and mitochondria are the main sources of reactive oxygen species in the heart, and dysregulated activation of NOX and mitochondrial dysfunction are associated with AF pathogenesis. NOX- and mitochondria-derived oxidative stress contribute to the onset of paroxysmal AF by inducing electrophysiological changes in atrial myocytes and structural remodeling in the atria. Because high atrial activity causes cardiac myocytes to expend extremely high energy to maintain excitation-contraction coupling during persistent AF, mitochondria, the primary energy source, undergo metabolic stress, affecting their morphology, Ca2+ handling, and ATP generation. In this review, we discuss the role of oxidative stress in activating AF-triggered activities, regulating intracellular Ca2+ handling, and functional and anatomical reentry mechanisms, all of which are associated with AF initiation, perpetuation, and progression. Changes in the extracellular matrix, inflammation, ion channel expression and function, myofibril structure, and mitochondrial function occur during the early transitional stages of AF, opening a window of opportunity to target NOX and mitochondria-derived oxidative stress using isoform-specific NOX inhibitors and mitochondrial ROS scavengers, as well as drugs that improve mitochondrial dynamics and metabolism to treat persistent AF and its transition to permanent AF.
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Affiliation(s)
- Roberto Ramos-Mondragón
- Department of Pharmacology, University of Michigan, 1150 West Medical Center Drive, 2301 Medical Science Research Building III, Ann Arbor, MI 48109, USA; (R.R.-M.); (L.L.I.)
| | - Andrey Lozhkin
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
| | - Aleksandr E. Vendrov
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
| | - Marschall S. Runge
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
| | - Lori L. Isom
- Department of Pharmacology, University of Michigan, 1150 West Medical Center Drive, 2301 Medical Science Research Building III, Ann Arbor, MI 48109, USA; (R.R.-M.); (L.L.I.)
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nageswara R. Madamanchi
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48019, USA; (A.L.); (A.E.V.); (M.S.R.)
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8
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Glavaški M, Velicki L, Vučinić N. Hypertrophic Cardiomyopathy: Genetic Foundations, Outcomes, Interconnections, and Their Modifiers. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1424. [PMID: 37629714 PMCID: PMC10456451 DOI: 10.3390/medicina59081424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most prevalent heritable cardiomyopathy. HCM is considered to be caused by mutations in cardiac sarcomeric protein genes. Recent research suggests that the genetic foundation of HCM is much more complex than originally postulated. The clinical presentations of HCM are very variable. Some mutation carriers remain asymptomatic, while others develop severe HCM, terminal heart failure, or sudden cardiac death. Heterogeneity regarding both genetic mutations and the clinical course of HCM hinders the establishment of universal genotype-phenotype correlations. However, some trends have been identified. The presence of a mutation in some genes encoding sarcomeric proteins is associated with earlier HCM onset, more severe left ventricular hypertrophy, and worse clinical outcomes. There is a diversity in the mechanisms implicated in the pathogenesis of HCM. They may be classified into groups, but they are interrelated. The lack of known supplementary elements that control the progression of HCM indicates that molecular mechanisms that exist between genotype and clinical presentations may be crucial. Secondary molecular changes in pathways implicated in HCM pathogenesis, post-translational protein modifications, and epigenetic factors affect HCM phenotypes. Cardiac loading conditions, exercise, hypertension, diet, alcohol consumption, microbial infection, obstructive sleep apnea, obesity, and environmental factors are non-molecular aspects that change the HCM phenotype. Many mechanisms are implicated in the course of HCM. They are mostly interconnected and contribute to some extent to final outcomes.
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Affiliation(s)
- Mila Glavaški
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (L.V.)
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (L.V.)
- Institute of Cardiovascular Diseases Vojvodina, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Nataša Vučinić
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (L.V.)
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9
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial Fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. RESEARCH SQUARE 2023:rs.3.rs-2818190. [PMID: 37131741 PMCID: PMC10153380 DOI: 10.21203/rs.3.rs-2818190/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Aims A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean pressure/LA reservoir strain). Methods and Results Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N=41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index (LA mean pressure/LA reservoir strain) overall (R=0.59, p<0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R=0.32) and the time to peak reservoir strain rate (R=0.32), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R=0.95, p<0.001) and LA minimum volume (r=0.82, p<0.001). Conclusion In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA LGE is a strong marker of stiffness.
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10
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Faraz F, Rehman MEU, Sabir B, Ghaffar A, Iftikhar A, Maqsood A, Ahmad Cheema H, Yasmin F, Aamir M, Ahmed MU, Asghar MS. Efficacy of Catheter Ablation for Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101524. [PMID: 36455792 DOI: 10.1016/j.cpcardiol.2022.101524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Catheter ablation (CA) has emerged as an effective therapy for AF. We conducted a meta-analysis to update the current clinical evidence on the efficacy of CA for AF in patients with HCM. We searched PubMed, Embase, Cochrane and Clinicaltrials.gov for interventional and observational studies assessing single and multiple procedure success rate of CA in HCM patients. Our meta-analysis included 25 studies involving 1817 patients. Success rate following single procedure was 40.4% (95% CI 33.1 to 48.0%) at latest follow-up. The pooled success rate following multiple procedures was 51.4% (95% CI 42.9% to 60.0%) at latest follow-up. In the subgroup analysis for AF subtype, TCA was more successful for paroxysmal AF compared to non-paroxysmal AF. For the subset of studies reporting drug-free success rate, single and multiple procedures had a success rate of 33.4% (95% CI 19.3 to 49.1%) and 51.8% (95% CI 41.3 to 62.2%) at latest follow-up, respectively. CA is a suitable option for AF in patients with HCM. Success rate is greater in paroxysmal AF, after multiple procedures and with antiarrhythmic drugs.
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Affiliation(s)
- Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Beenish Sabir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Areeba Ghaffar
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ahmad Iftikhar
- Department of Medicine, The University of Arizona, Tucson, AZ
| | - Aimen Maqsood
- Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad and Jammu Kashmir
| | | | - Farah Yasmin
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Aamir
- Lehigh Valley Heart Specialists, Lehigh Valley Health Network, Allentown, PA
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11
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Cheung M, Husain A, Du D, Li COY, Parker J, Weissler-Snir A, Geske JB, Ong K, Laksman Z. International Practice Patterns in the Detection and Management of Arrhythmias in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2022; 11:e027385. [PMID: 36193937 PMCID: PMC9673716 DOI: 10.1161/jaha.122.027385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Cheung
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Ali Husain
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Darson Du
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Christopher O Y Li
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Jeremy Parker
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | | | - Jeffrey B Geske
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Zachary Laksman
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
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12
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Miyamoto Y, Kubo T, Ochi Y, Baba Y, Hirota T, Yamasaki N, Kawai K, Yamamoto K, Kondo F, Bando K, Yamada E, Furuno T, Yabe T, Doi YL, Kitaoka H. Clinical Features of Heart Failure in Patients With Hypertrophic Cardiomyopathy in a Regional Japanese Cohort - Results From the Kochi RYOMA Study. Circ J 2022; 86:1934-1940. [PMID: 35675987 DOI: 10.1253/circj.cj-22-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical features of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM) in Japan have not been fully elucidated.Methods and Results: In 293 patients with HCM (median age at registration, 65 (57-72) years) in a prospective cardiomyopathy registration network in Kochi Prefecture (Kochi RYOMA study), HF events (HF death or hospitalization for HF) occurred in 35 patients (11.9%) (median age, 76 (69-80) years), including 11 HF deaths during a median follow-up of 6.1 years. The 5-year HF events rate was 9.6%. Atrial fibrillation, low percentage of fractional shortening, and high B-type natriuretic peptide level at registration were predictors of HF events. The combination of these 3 factors had a relatively high positive predictive value (55%) for HF events and none of them had a high negative predictive value (99%). There were 4 types of HF profile: left ventricular (LV) systolic dysfunction (40%), severe LV diastolic dysfunction (34%), LV outflow tract obstruction (LVOTO) (20%), and primary mitral regurgitation (MR) (6%). HF deaths occurred in patients with LV systolic dysfunction or LV diastolic dysfunction, but none of patients with LVOTO or primary MR due to additional invasive therapies. CONCLUSIONS In a Japanese HCM cohort, HF was an important complication, requiring careful follow-up and appropriate treatment.
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Affiliation(s)
- Yuya Miyamoto
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kazuya Kawai
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Katsuhito Yamamoto
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Fumiaki Kondo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kanji Bando
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Eisuke Yamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takashi Furuno
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toshikazu Yabe
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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13
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Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol 2022; 65:287-326. [PMID: 35419669 DOI: 10.1007/s10840-022-01195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. The aim of this review was to evaluate the progress made in the management of AF over the two last decades. RESULTS Clinical classification of AF is usually based on the presence of symptoms, the duration of AF episodes and their possible recurrence over time, although incidental diagnosis is not uncommon. The majority of patients with AF have associated cardiovascular diseases and more recently the recognition of modifiable risk factors both cardiovascular and non-cardiovascular which should be considered in its management. Among AF-related complications, stroke and transient ischaemic accidents (TIAs) carry considerable morbidity and mortality risk. The use of implantable devices such as pacemakers and defibrillators, wearable garments and subcutaneous cardiac monitors with recording capabilities has enabled to access the burden of "subclinical AF". The recent introduction of non-vitamin K antagonists has led to improve the prevention of stroke and peripheral embolism. Agents capable of reversing non-vitamin K antagonists have also become available in case of clinically relevant major bleeding. Transcatheter closure of left atrial appendage represents an option for patients unable to take oral anticoagulation. When treating patients with AF, clinicians need to select the most suitable strategy, i.e. control of heart rate and/or restoration and maintenance of sinus rhythm. The studies comparing these two strategies have not shown differences in terms of mortality. If an AF episode is poorly tolerated from a haemodynamic standpoint, electrical cardioversion is indicated. Otherwise, restoration of sinus rhythm can be obtained using intravenous pharmacological cardioversion and oral class I or class III antiarrhythmic is used to prevent recurrences. During the last two decades after its introduction in daily practice, catheter ablation has gained considerable escalation in popularity. Progress has also been made in AF associated with heart failure with reduced or preserved ejection fraction. CONCLUSIONS Significant progress has been made within the past 2 decades both in the pharmacological and non-pharmacological managements of this cardiac arrhythmia.
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14
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Nakao R, Nagao M, Higuchi S, Minami Y, Shoda M, Ando K, Yamamoto A, Sakai A, Watanabe E, Sakai S, Hagiwara N. Relation of Left Atrial Flow, Volume, and Strain to Paroxysmal Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 166:72-80. [PMID: 34930615 DOI: 10.1016/j.amjcard.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
This study aims to characterize flow, volume, and strain of the left atrium in hypertrophic cardiomyopathy (HC) with atrial fibrillation (AF) using cine cardiovascular magnetic resonance (CMR) imaging. Cine CMR data for 144 patients with HC, including 29 patients with episodes of paroxysmal AF and 13 patients with persistent AF, were retrospectively analyzed. The vortex flow of the left atrial (LA, %) was measured using a vortex flow map and was used as an estimate of flow. The LA end-systolic volume index (ml/m2), LA ejection fraction (%) and global peak longitudinal LA strain (%) derived from a feature-tracking method were used as estimates of volume and strain. Vortex flow of the LA in patients with paroxysmal AF was significantly smaller than in patients without AF (vertical long-axis view; 26.7 ± 10.8% vs 33.2 ± 12.2%, p <0.005). The patients with paroxysmal AF had greater LA end-systolic volume index and global peak longitudinal LA strain and lower LA ejection fraction compared with those without AF. In conclusion, patients with HC with paroxysmal AF are characterized by small vortex flow, large volume, and decreased strain of LA on cine CMR.
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15
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de la Rosa A, Shah M, Shiota T, Siegel R, Rader F. Comparing echocardiographic characteristics in genotype positive-phenotype positive hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2022; 23:340-348. [PMID: 34694376 DOI: 10.1093/ehjci/jeab217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS There is little information about hypertrophic cardiomyopathy (HCM) with pathologic genetic mutations and concurrent hypertension (HTN). Hypertensive left ventricular hypertrophy (LVH) does not exclude an underlying genetic aetiology. METHODS AND RESULTS This was a single-centre case-control study of 39 adults with pathologic HCM mutations, confirmed by genetic testing, compared to 39 age- and gender-matched patients with hypertensive LVH. The gene-positive HCM cohort was further stratified by the coexisting presence or absence of HTN. Clinical and echocardiographic characteristics were compared. Of 39 gene-positive HCM, 43.6% (17/39) had concurrent HTN. The gene-positive HCM cohort had larger left atrial (LA) area (22.1 cm2 vs. 18.9 cm2, P = 0.002), more diastolic predominant pulmonary vein flow (38.5% vs. 7.7%, P = 0.001), and more moderate diastolic dysfunction (33.3% vs. 12.8%, P = 0.032) when compared with the hypertensive LVH cohort. Greater left ventricular (LV) mass (277.7 g vs. 207.7 g, P = 0.025), increased frequency of severe LVH (58.8% vs. 27.3%, P = 0.047), and more abnormal global longitudinal strain (GLS) (-14.1% vs. -16.9%, P = 0.049) was observed in the gene-positive HCM cohort with concurrent HTN. CONCLUSION Gene-positive HCM, compared to hypertensive LVH, is characterized by more advanced diastolic dysfunction and larger LA size. Gene-positive HCM patients with concomitant HTN had greater LV mass, more severe LVH, and more abnormal GLS, suggesting HTN may negatively affect the progression of myocardial dysfunction in genetic HCM. LVH out-of-proportion to pressure burden in HTN patients should raise suspicion of underlying genetic HCM.
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Affiliation(s)
- Angelo de la Rosa
- Department of Internal Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 5512, Los Angeles, CA 90048, USA
| | - Maulin Shah
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
| | - Takahiro Shiota
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
| | - Robert Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
| | - Florian Rader
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, #A3600, Los Angeles, CA 90048, USA
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16
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Vriz O, AlSergani H, Elshaer AN, Shaik A, Mushtaq AH, Lioncino M, Alamro B, Monda E, Caiazza M, Mauro C, Bossone E, Al-Hassnan ZN, Albert-Brotons D, Limongelli G. A complex unit for a complex disease: the HCM-Family Unit. Monaldi Arch Chest Dis 2021; 92. [PMID: 34964577 DOI: 10.4081/monaldi.2021.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a group of heterogeneous disorders that are most commonly passed on in a heritable manner. It is a relatively rare disease around the globe, but due to increased rates of consanguinity within the Kingdom of Saudi Arabia, we speculate a high incidence of undiagnosed cases. The aim of this paper is to elucidate a systematic approach in dealing with HCM patients and since HCM has variable presentation, we have summarized differentials for diagnosis and how different subtypes and genes can have an impact on the clinical picture, management and prognosis. Moreover, we propose a referral multi-disciplinary team HCM-Family Unit in Saudi Arabia and an integrated role in a network between King Faisal Hospital and Inherited and Rare Cardiovascular Disease Unit-Monaldi Hospital, Italy (among the 24 excellence centers of the European Reference Network (ERN) GUARD-Heart). Graphical Abstract.
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Affiliation(s)
- Olga Vriz
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Hani AlSergani
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | | | | | | | - Michele Lioncino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
| | - Bandar Alamro
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
| | - Ciro Mauro
- Department of Cardiology, Cardarelli Hospital, Naples.
| | | | - Zuhair N Al-Hassnan
- Cardiovascular Genetics Program and Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh.
| | - Dimpna Albert-Brotons
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
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17
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Afanasyev AV, Bogachev-Prokophiev AV, Zheleznev SI, Zalesov AS, Budagaev SA, Shajahmetova SV, Nazarov VM, Demin II, Sharifulin RM, Pivkin AN, Astapov DA, Cherniavsky AM. Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy. Asian Cardiovasc Thorac Ann 2021; 30:74-83. [PMID: 34757854 DOI: 10.1177/02184923211056133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. METHODS We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. RESULTS The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02-11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. CONCLUSIONS The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.
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Affiliation(s)
- Alexandr V Afanasyev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexandr V Bogachev-Prokophiev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.,Directorate, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Sergei I Zheleznev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Anton S Zalesov
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Sergei A Budagaev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Svetlana V Shajahmetova
- Magnetic Resonance Imaging Centre, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Vladimir M Nazarov
- Educational Centre, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Igor I Demin
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ravil M Sharifulin
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey N Pivkin
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Dmitriy A Astapov
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.,Directorate, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexandr M Cherniavsky
- Directorate, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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Salem A, Aly A, Ortiz JF, Cohen RA. Post-ablation Dyspnea a Case Report to Highlight the Differential Diagnoses. Cureus 2021; 13:e17793. [PMID: 34660003 PMCID: PMC8496496 DOI: 10.7759/cureus.17793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of post-cardiac ablation pericarditis is difficult as it requires the exclusion of the more common causes of chest pain, but in the right setting, non-invasive diagnostic tools are adequate. Here we present the case of a 60-year-old man who underwent atrial fibrillation ablation and subsequently developed severe mid-sternal chest pain and dyspnea one day later without significant electrocardiographic findings, a mildly elevated troponin T, and elevation of the right hemidiaphragm. The patient was managed conservatively. A two-dimensional transthoracic echocardiogram showed no regional wall motion abnormalities, significant transvalvular gradients, but showed minimal pericardial effusion. A sniff test was negative for diaphragmatic paralysis. After the diagnosis, the patient’s symptoms resolved with non-steroidal anti-inflammatory drugs and colchicine. This case of pericarditis after cardiac ablation highlights the possible differential diagnosis when confronted with post-ablation cardiac symptoms. Despite the classic presentation, the electrocardiogram showed no significant ST/PR changes. In the right clinical setting, non-invasive imaging may be appropriate management.
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Affiliation(s)
- Amr Salem
- Hospital Medicine, Brown University, Providence, USA
| | - Ahmed Aly
- Internal Medicine, Alexandria Faculty of Medicine, Alexandria, EGY
| | - Juan Fernando Ortiz
- Neurology, Universidad San Francisco de Quito, Quito, ECU.,Neurology, Larkin Community Hospital, Miami, USA
| | - Ronny A Cohen
- Cardiology, Woodhull Hospital, New York University (NYU) School of Medicine, New York, USA
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19
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Kwok MK, Schooling CM. Mendelian randomization study on atrial fibrillation and cardiovascular disease subtypes. Sci Rep 2021; 11:18682. [PMID: 34548541 PMCID: PMC8455674 DOI: 10.1038/s41598-021-98058-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022] Open
Abstract
Atrial fibrillation (AF) has been associated with numerous diseases. However, whether AF is a cause or consequence of these diseases is uncertain. To clarify, we assessed the causal role of AF on ischemic heart disease (IHD), stroke, other cardiovascular disease (CVD) subtypes, type 2 diabetes mellitus (T2DM), and late-onset AD using bi-directional two-sample Mendelian randomization (MR) among people primarily of European descent. Genetically predicted log odds of AF was associated with any stroke (odds ratio (OR) 1.22, 95% CI 1.18 to 1.27), particularly cardioembolic stroke and possibly subdural hemorrhage, with sensitivity analyses showing similar positive findings. Genetically predicted AF was also associated with arterial thromboembolism (1.32, 1.13 to 1.53), and heart failure (1.26, 1.21 to 1.30). No association of genetically predicted AF with IHD, T2DM, cognitive function, or late-onset AD was found. Conversely, genetically predicted IHD, heart failure and possibly ischemic stroke, particularly cardioembolic stroke, were positively associated with AF. Atrial fibrillation plays a role in any stroke, arterial thromboembolism, and heart failure, corroborating current clinical guidelines on the importance of preventing these complications by effective AF management. In addition, patients with IHD, heart failure or possibly ischemic stroke might be predisposed to developing AF, with implications for management.
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Affiliation(s)
- Man Ki Kwok
- School of Public Health, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pok Fu Lam, Hong Kong Special Administrative Region, China
| | - Catherine Mary Schooling
- School of Public Health, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pok Fu Lam, Hong Kong Special Administrative Region, China. .,City University of New York Graduate School of Public Health and Health Policy, New York, USA.
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20
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Meng Y, Zhang Y, Liu P, Zhu C, Lu T, Hu E, Yang Q, Nie C, Wang S. Clinical Efficacy and Safety of Cox-Maze IV Procedure for Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy. Front Cardiovasc Med 2021; 8:720950. [PMID: 34409083 PMCID: PMC8365245 DOI: 10.3389/fcvm.2021.720950] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Atrial fibrillation is the most prevalent persistent arrhythmia in patients with hypertrophic obstructive cardiomyopathy. Comparative analyses of the safety and effectiveness of septal myectomy with and without surgical ablation are limited. This study aimed to compare the outcomes of septal myectomy with and without the Cox-maze IV procedure in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. Methods: Ninety-four patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent septal myectomy were analyzed, we divided it into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox maze operation (no Cox-maze group). Freedom from atrial fibrillation recurrence and all-cause mortality after surgery were assessed. Results: Freedom from all-cause mortality after septal myectomy at 1, 3, and 5 years was 98.5 ± 1.5% each in the Cox-maze group and 90.8 ± 6.3%, 85.1 ± 8.1%, and 85.1 ± 8.1%, respectively, in the no Cox-maze group. Patients in the no Cox-maze group had lower survival, freedom from atrial fibrillation recurrence off antiarrhythmic drugs, and arrhythmia control rate (including patients with successful antiarrhythmic drug conversion) than those in the Cox-maze group (P = 0.046, P = 0.040, and P = 0.012, respectively). Patients who underwent the Cox-maze IV procedure had lower atrial fibrillation recurrence rate than those who did not (hazard ratio, 0.141; 95% confidence interval, 0.042-0.479; P = 0.002). Post-operative increases in left atrial diameters (hazard ratio, 1.099; 95% confidence interval, 1.024-1.179; P = 0.009) were associated with atrial fibrillation recurrence. Conclusions: The Cox-maze IV procedure combined with septal myectomy improved mid-term survival and reduced mid-term atrial fibrillation recurrence in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. The concomitant Cox-maze IV procedure was associated with a lower atrial fibrillation recurrence in patients with surgical hypertrophic obstructive cardiomyopathy and atrial fibrillation.
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Affiliation(s)
- Yanhai Meng
- Surgery Intensive Care Unit, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanbo Zhang
- Surgery Intensive Care Unit, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Liu
- Surgery Intensive Care Unit, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changsheng Zhu
- Adult Cardiac Surgery, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Lu
- Adult Cardiac Surgery, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Enci Hu
- Surgery Intensive Care Unit, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiulan Yang
- Surgery Intensive Care Unit, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changrong Nie
- Adult Cardiac Surgery, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuiyun Wang
- Adult Cardiac Surgery, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Tjahjadi C, Hiemstra YL, van der Bijl P, Pio SM, Bootsma M, Ajmone Marsan N, Delgado V, Bax JJ. Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 22:589-596. [PMID: 32588037 DOI: 10.1093/ehjci/jeaa174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/29/2020] [Indexed: 01/09/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is frequently observed in hypertrophic cardiomyopathy (HCM) and is associated with poor clinical outcome. Total atrial conduction time, estimated by tissue Doppler imaging (TDI), the so-called PA-TDI duration, reflects the left atrial (LA) structural and electrical remodelling. The aim of this study was to evaluate the association between PA-TDI and new-onset AF in patients with HCM. METHODS AND RESULTS From a large cohort of patients with HCM, 208 patients (64% male, mean age 53 ± 14 years) without AF were selected. PA-TDI duration was measured from the onset P wave on electrocardiogram to the peak A' wave of the lateral LA wall using TDI. The incidence of new-onset AF was 20% over a median follow-up of 7.3 (3.5-10.5) years. Patients with incident AF had longer PA-TDI duration when compared with patients without AF (133.7 ± 23.0 vs. 110.5 ± 30.0 ms, P < 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01-1.05, P < 0.001). CONCLUSION Prolonged PA-TDI duration was independently associated with new-onset AF in patients with HCM. This novel parameter could be useful to risk-stratify patients with HCM who are at risk of having AF.
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Affiliation(s)
- Catherina Tjahjadi
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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22
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Hourqueig M, Bouzille G, Mirabel M, Huttin O, Damy T, Labombarda F, Eicher JC, Charron P, Habib G, Réant P, Hagège A, Donal E. Hypertrophic cardiomyopathies requiring more monitoring for less atrial fibrillation-related complications: a clustering analysis based on the French registry on hypertrophic cardiomyopathy (REMY). Clin Res Cardiol 2021; 111:163-174. [PMID: 34043053 DOI: 10.1007/s00392-020-01797-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
AIMS Defining the risk of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients is an important clinical and prognostic challenge. The aim of this study is to determine HCM phenogroups with different risk of AF occurrence at 5 years. METHODS AND RESULTS We applied retrospectively the Bayesian method, which can analyze a large number of variables, to differentiate phenogroups of patients with different risks of AF and prognoses across a French prospective on-going hospital-based registry of adult HCM patients (REMY). Clinical and imaging data were prospectively recorded, and patients were followed for 5 years. A total of 1431 HCM patients were recruited, including 1275 analyzed in the present study after exclusion criteria. The population included 412 women, 369 patients with obstructive HCM, and 252 implanted with an ICD. AF occurred in 167 (11.6%) patients during the 5 year follow-up. Three phenogroups were defined according to their common clinical and echocardiographic characteristics. Patients at the highest risk were oldest, more often female, with more frequent comorbidities, anteroposterior diameter of the left atrium was significantly greater, with diastolic dysfunction, outflow-tract obstruction, and mitral valve abnormality, and presented higher pulmonary artery pressure and/or right-ventricular dysfunction. These also had a higher risk of all-cause hospitalizations and death. CONCLUSION Based on a clustering analysis, three phenogroups of HCM according to the risk of AF occurrence can be identified. It can indicate which patients should be more monitored and/or treated, particular to prevent the risk of stroke.
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Affiliation(s)
- Marion Hourqueig
- Service de Cardiologie-Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| | - Guillaume Bouzille
- Service de Cardiologie-Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| | - Mariana Mirabel
- Cardio-Oncology, Assistance Publique-Hôpitaux de Paris-Centre Université de Paris, University of Paris, Paris, France
| | - Olivier Huttin
- Cardiology Department, CHU de Nancy, Hopitaux de Brabois, Nancy, France
| | - Thibaud Damy
- IMRB and Cardiology Department, Assistance Publique-Hopitaux de Paris, Hopital Henri-Mondor, GRC Amyloid Research Institute, 94000, Creteil, France
| | - Fabien Labombarda
- Cardiology Department, CHU de Caen, Hopital Cote de Nacre, Caen, France
| | | | - Philippe Charron
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, APHP; Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Gilbert Habib
- Cardiology Department, Assistance Publique-Hopitaux de Marseille, Hopital La Timone, Marseille, France
| | - Patricia Réant
- Cardiology Department, CHU de Bordeaux, Hopital du Haut Leveque, University de Bordeaux, INSERM 1045, IHU Lyric, CIC 1401, Pessac, France
| | - Albert Hagège
- Cardiology Department, CHU de Nancy, Hopitaux de Brabois, Nancy, France
| | - Erwan Donal
- Service de Cardiologie-Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France.
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23
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Chen L, Fu G, Jiang C. Mendelian randomization as an approach to assess causal effects of inflammatory bowel disease on atrial fibrillation. Aging (Albany NY) 2021; 13:12016-12030. [PMID: 33824227 PMCID: PMC8109086 DOI: 10.18632/aging.202906] [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: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Background: Despite growing evidence indicating that patients with inflammatory bowel disease (IBD) have an increased risk of atrial fibrillation (AF), owing to the potential biases of confounding effects and reverse causation, the specific relationship between IBD and AF remains controversial. The aim of this study is to determine whether there is a causal effect of IBD on AF. Methods: A two-sample Mendelian randomization (MR) study was performed to evaluate the causal effect of IBD on AF. Statistical summaries for the associations between single nucleotide polymorphisms (SNPs) and traits of interest were obtained from independent consortia with European populations. The dataset of IBD was acquired from genome-wide association studies (GWAS), including more than 75,000 cases and controls. A GWAS with 60,620 AF cases and 970,216 controls was used to identify genetic variation underlying AF. The causal effect was estimated using the multiplicative random effects inverse-variance weighted method (IVW), followed by sensitivity analysis. Results: Using 81 SNPs, there was no evidence to suggest an association between genetically predicted IBD and risk of AF with multiplicative random-effects IVW MR analysis (odds ratio = 1.0000, 95% confidence interval: 0.9994 1.0005, p = 0.88). Conclusion: As opposed to current assumptions, no substantial evidence was found to support a causal role of IBD in the development of AF.
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Affiliation(s)
- LaiTe Chen
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - GuoSheng Fu
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - ChenYang Jiang
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
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24
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Liu L, Liu Z, Chen X, He S. Thromboembolism in Patients with Hypertrophic Cardiomyopathy. Int J Med Sci 2021; 18:727-735. [PMID: 33437207 PMCID: PMC7797548 DOI: 10.7150/ijms.50167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease, which has a marked heterogeneity in clinical expression, natural history, and prognosis. HCM is associated with a high prevalence of thromboembolic events (stroke and systemic embolic events), even if taking no account of atrial fibrillation (AF), leading to unexpected disability and death in patients of all ages. Several risk factors of thromboembolism such as AF, greater age, left atrial diameter, heart failure and others have been confirmed in patients with HCM. Conventional thromboembolic predictive models were estimated by several trials in HCM population but it turned out to be unsatisfactory. Based on those previous explorations, researchers tried to modify or develop novel models suitable for HCM population in thromboembolism prediction. In consideration of catastrophic advent events of thromboembolism, current guidelines have recommended life-long anticoagulant therapy after a single short AF. Therefore, early identification of risk factors for thromboembolism, accurate risk stratification, timely preventive measures and aggressive management may help to avoid serious adverse thromboembolic events in HCM population.
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Affiliation(s)
- Lu Liu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zheng Liu
- Nursing Department, West China School of Nursing, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
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25
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Stroke risk in hypertrophic cardiomyopathy patients with atrial fibrillation: a nationwide database study. Aging (Albany NY) 2020; 12:24219-24227. [PMID: 33226371 PMCID: PMC7762520 DOI: 10.18632/aging.104133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
Current treatment guidelines recommend anticoagulation for hypertrophic cardiomyopathy (HCM) with atrial fibrillation (AF) regardless of the CHA2DS2-VASc score. As aging and stroke risk factors (hypertension, diabetes mellitus) are confounders of ischemic stroke, young patients with a low stroke risk may not need anticoagulant treatment. This study aimed to determine the incidence of stroke and its risk factors in HCM patients with AF during a long-term follow-up. Using a national database, we retrospectively investigated 18,724 HCM patients from a systematic sample of 1,000,000 Taiwanese people between 1997 and 2013. The incidences of AF and stroke were estimated. Data were analyzed using Cox regression models. AF was identified in 598 patients (262 men, mean age 66.3±13.0 years) during a median follow-up of 7.0 years. The AF incidence in HCM patients was 5.83 per 1000 person-years, and the overall incidence of AF-associated stroke was 24.14 per 1000 person-years. The incidence of transient ischemic attack (TIA)/ischemic stroke varied from 20.41 to 60.55 per 1000 person-years, without proportionality to CHA2DS2-VASc score increase. Among patients aged <40 years, none experienced TIA/ischemic stroke. Univariate Cox regression models showed that age (p<0.001), prior TIA/ischemic stroke (p=0.02), and CHA2DS2-VASc score (p=0.003) were risk factors for TIA/ischemic stroke. Multivariate analysis indicated that age (hazard ratio 1.04, 95% confidence interval [CI] 1.02-1.06, p=0.001) and prior TIA/ischemic stroke (hazard ratio 2.82, 95% CI 1.27-6.25, p=0.011) were independently associated with TIA/ischemic stroke. Taiwanese patients with concomitant HCM and AF have a high stroke risk regardless of the CHA2DS2-VASc score. Aging is the main predictor. As the overall incidence of stroke was low in young patients, anticoagulants may not be needed in this subpopulation.
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26
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Falasconi G, Pannone L, Slavich M, Margonato A, Fragasso G, Spoladore R. Atrial fibrillation in hypertrophic cardiomyopathy: pathophysiology, diagnosis and management. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:409-418. [PMID: 33224592 PMCID: PMC7675160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, representing a leading cause of sudden cardiac death in the young and a prevalent cause of heart failure and stroke. Atrial fibrillation (AF) is frequently associated with HCM with a reported prevalence of about 20% to 25%. AF genesis is multifactorial, mostly genetically determined or secondary to hemodynamic alterations. AF has also a negative impact on HCM patients' prognosis because it may lead to an increased incidence of heart failure or stroke. We currently have several strategies which can be used during atrial fibrillation episodes and to prevent the arrhythmic recurrences.
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Affiliation(s)
- Giulio Falasconi
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
- Vita-Salute San Raffaele UniversityMilan, Italy
| | - Luigi Pannone
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
- Vita-Salute San Raffaele UniversityMilan, Italy
| | - Massimo Slavich
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
| | - Alberto Margonato
- Vita-Salute San Raffaele UniversityMilan, Italy
- Head of Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
| | - Gabriele Fragasso
- Head of Heart Failure Ambulatory, IRCCS San Raffaele University HospitalMilan, Italy
| | - Roberto Spoladore
- Head of Referral Ambulatory for Hypertrophic Cardiomyopathy, IRCCS San Raffaele University HospitalMilan, Italy
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27
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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation. J Clin Med 2020; 9:jcm9103081. [PMID: 32987820 PMCID: PMC7598705 DOI: 10.3390/jcm9103081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.
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28
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Bleszynski PA, Goldenberg I, Fernandez G, Howell E, Younis A, Chen AY, McNitt S, Bruckel J, Ling F, Cove C, Aktas MK. Risk of arrhythmic events after alcohol septal ablation for hypertrophic cardiomyopathy using continuous implantable cardiac monitoring. Heart Rhythm 2020; 18:50-56. [PMID: 32853778 DOI: 10.1016/j.hrthm.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/06/2020] [Accepted: 08/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) can lead to heart rhythm disturbances including complete heart block (CHB) and atrial and ventricular arrhythmias. OBJECTIVE We aimed to evaluate the utility of long-term arrhythmia monitoring with an implantable cardiac monitor (ICM) after ASA. METHODS Between February 2014 and March 2019, 56 patients with HCM undergoing ASA were enrolled in a prospective study and underwent ICM implantation. Kaplan-Meier survival analysis was used to assess the rate of ICM-detected arrhythmic events. RESULTS The mean age was 59 ± 11 years, and 20 (36%) were women. The median (25th, 75th percentile) resting left ventricular outflow tract gradient obtained by echocardiography was 43 (22, 81) mm Hg. Greater than 1 septal perforating artery was injected in 48 patients (86%). The Kaplan-Meier cumulative rate of ICM-detected arrhythmic events at 18 months of follow-up was 71%, with an event rate of 43% occurring within 3 months of ASA. The cumulative rate of the ICM-detected first atrial fibrillation event at 18 months was 37%, and the corresponding rate of CHB was 19%. All atrial fibrillation and CHB events were actionable, leading to the initiation of anticoagulation and pacemaker implantation, respectively. No baseline demographic or procedural variables were identified as independent predictors of an increased risk of developing ICM-detected arrhythmic events. CONCLUSION After ASA, ICM is effective in capturing clinically actionable arrhythmic events in patients with HCM regardless of patient's baseline risk factors.
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Affiliation(s)
- Peter A Bleszynski
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Ilan Goldenberg
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York; Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Genaro Fernandez
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Erik Howell
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Anita Y Chen
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York; Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey Bruckel
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Chris Cove
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York.
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29
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Rozen G, Elbaz-Greener G, Marai I, Andria N, Hosseini SM, Biton Y, Heist EK, Ruskin JN, Gavrilov Y, Carasso S, Ghanim D, Amir O. Utilization and Complications of Catheter Ablation for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2020; 9:e015721. [PMID: 32573325 PMCID: PMC7670519 DOI: 10.1161/jaha.119.015721] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Atrial fibrillation (AF) is common and bears a major clinical impact in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate the use and real‐world safety of catheter ablation for AF in patients with HCM. Methods and Results We drew data from the US National Inpatient Sample to identify cases of AF ablation in HCM patients between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of catheter ablation complications, mortality, and length of stay were analyzed, including trends between the early (2003–2008) and later (2009–2015) study years. Among a weighted total of 1563 catheter ablation cases in patients with HCM, the median age was 62 (interquartile range, 52–72), 832 (53.2%) were male, and 1150 (73.6%) were white. The average annual volume of AF ablations in patients with HCM doubled between the early and the later study period (79–156). At least 1 complication occurred in 16.1% of cases, and the in‐hospital mortality rate was 1%. Cardiac and pericardial complications declined from 8.8% to 2.3% and from 2.8% to 0.9%, respectively, between the early and the later study years (P<0.01). Independent predictors of complications included female sex (odds ratio [OR], 4.81; 95% CI, 2.72–8.51), diabetes mellitus (OR, 6.57; 95% CI, 2.68–16.09) and obesity (OR, 3.82; 95% CI, 1.61–9.06). Conclusions Despite some decline in procedural complications over the years, catheter ablation for AF is still associated with a relatively high periprocedural morbidity and even mortality in patients with HCM. This emphasizes the importance of careful clinical consideration, by an experienced electrophysiologist, in referring patients with HCM for an AF ablation.
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Affiliation(s)
- Guy Rozen
- Division of Cardiovascular Medicine Baruch Padeh Medical Center Poriya Israel.,Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA.,The Azrieli Faculty of Medicine in the Galilee Bar-Ilan University Safed Israel
| | | | - Ibrahim Marai
- Division of Cardiovascular Medicine Baruch Padeh Medical Center Poriya Israel.,The Azrieli Faculty of Medicine in the Galilee Bar-Ilan University Safed Israel
| | - Nizar Andria
- Division of Cardiovascular Medicine Baruch Padeh Medical Center Poriya Israel.,The Azrieli Faculty of Medicine in the Galilee Bar-Ilan University Safed Israel
| | | | - Yitschak Biton
- Department of Cardiology Hadassah Medical Center Jerusalem Israel
| | - E Kevin Heist
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | | | - Shemy Carasso
- Division of Cardiovascular Medicine Baruch Padeh Medical Center Poriya Israel.,The Azrieli Faculty of Medicine in the Galilee Bar-Ilan University Safed Israel
| | - Diab Ghanim
- Division of Cardiovascular Medicine Baruch Padeh Medical Center Poriya Israel.,The Azrieli Faculty of Medicine in the Galilee Bar-Ilan University Safed Israel
| | - Offer Amir
- The Azrieli Faculty of Medicine in the Galilee Bar-Ilan University Safed Israel.,Department of Cardiology Hadassah Medical Center Jerusalem Israel
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30
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Multimodality Imaging for Risk Assessment of Inherited Cardiomyopathies. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-0639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Makavos G, Κairis C, Tselegkidi ME, Karamitsos T, Rigopoulos AG, Noutsias M, Ikonomidis I. Hypertrophic cardiomyopathy: an updated review on diagnosis, prognosis, and treatment. Heart Fail Rev 2020; 24:439-459. [PMID: 30852773 DOI: 10.1007/s10741-019-09775-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) represents a phenotype of left ventricular hypertrophy unexplained by abnormal loading conditions. The definition is based on clinical criteria; however, there are numerous underlying etiologic factors. The MOGE(S) classification provides a standardized approach for multimodal characterization of HCM. HCM is associated with increased morbidity and mortality, and especially the assessment of the risk of sudden cardiac death is of paramount importance. In this review, we summarize essential knowledge and recently published data on clinical presentation, diagnosis, genetic analyses, differential diagnosis, prognosis, and treatment options that are necessary for understanding and management of HCM.
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Affiliation(s)
- George Makavos
- 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462, Haidari, Greece
| | - Chris Κairis
- 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462, Haidari, Greece
| | - Maria-Eirini Tselegkidi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, "Alexandra" Hospital, Vassilisis Sofias Avenue 80, 11528, Athens, Greece
| | - Theodoros Karamitsos
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 54621, Thessaloniki, Greece
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462, Haidari, Greece.
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Hughes RK, Knott KD, Malcolmson J, Augusto JB, Mohiddin SA, Kellman P, Moon JC, Captur G. Apical Hypertrophic Cardiomyopathy: The Variant Less Known. J Am Heart Assoc 2020; 9:e015294. [PMID: 32106746 PMCID: PMC7335568 DOI: 10.1161/jaha.119.015294] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Rebecca K Hughes
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - Kristopher D Knott
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - James Malcolmson
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - João B Augusto
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - Saidi A Mohiddin
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom.,William Harvey Institute Queen Mary University of London London United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute National Institutes of Health DHHS Bethesda MD
| | - James C Moon
- Institute of Cardiovascular Science University College London London United Kingdom.,The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit Barts Heart Center St Bartholomew's Hospital London United Kingdom
| | - Gabriella Captur
- Institute of Cardiovascular Science University College London London United Kingdom.,Inherited Heart Muscle Conditions Clinic Department of Cardiology Royal Free London NHS Foundation Trust Hampstead United Kingdom.,University College London MRC Unit of Lifelong Health and Ageing London United Kingdom
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Teekakirikul P, Zhu W, Huang HC, Fung E. Hypertrophic Cardiomyopathy: An Overview of Genetics and Management. Biomolecules 2019; 9:biom9120878. [PMID: 31888115 PMCID: PMC6995589 DOI: 10.3390/biom9120878] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/31/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically heterogeneous cardiac muscle disorder with a diverse natural history, characterized by unexplained left ventricular hypertrophy (LVH), with histopathological hallmarks including myocyte enlargement, myocyte disarray and myocardial fibrosis. Although these features can cause significant cardiac symptoms, many young individuals with HCM are asymptomatic or mildly symptomatic. Sudden cardiac death (SCD) may occur as the initial clinical manifestation. Over the past few decades, HCM has been considered a disease of sarcomere, and typically as an autosomal dominant disease with variable expressivity and incomplete penetrance. Important insights into the genetic landscape of HCM have enhanced our understanding of the molecular pathogenesis, empowered gene-based diagnostic testing to identify at-risk individuals, and offered potential targets for the development of therapeutic agents. This article reviews the current knowledge on the clinical genetics and management of HCM.
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Affiliation(s)
- Polakit Teekakirikul
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Centre for Cardiovascular Genomics and Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: (P.T.); (E.F.); Tel.: +852-3505-3139 (P.T.); +852-3505-3140 (E.F.)
| | - Wenjuan Zhu
- Centre for Cardiovascular Genomics and Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Helen C. Huang
- Department of Medicine (Cardiology), University of California, Los Angeles, CA 90095, USA
| | - Erik Fung
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital and Gerald Choa Cardiac Research Centre, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: (P.T.); (E.F.); Tel.: +852-3505-3139 (P.T.); +852-3505-3140 (E.F.)
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Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically heterogeneous cardiac muscle disorder with a diverse natural history, characterized by unexplained left ventricular hypertrophy (LVH), with histopathological hallmarks including myocyte enlargement, myocyte disarray and myocardial fibrosis. Although these features can cause significant cardiac symptoms, many young individuals with HCM are asymptomatic or mildly symptomatic. Sudden cardiac death (SCD) may occur as the initial clinical manifestation. Over the past few decades, HCM has been considered a disease of sarcomere, and typically as an autosomal dominant disease with variable expressivity and incomplete penetrance. Important insights into the genetic landscape of HCM have enhanced our understanding of the molecular pathogenesis, empowered gene-based diagnostic testing to identify at-risk individuals, and offered potential targets for the development of therapeutic agents. This article reviews the current knowledge on the clinical genetics and management of HCM.
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Larkin G, Bellomo T, Caze L. Hypertrophic cardiomyopathy: New hope for an old disease. Nursing 2019; 49:24-31. [PMID: 31365456 DOI: 10.1097/01.nurse.0000577688.41805.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hypertrophic cardiomyopathy (HCM), a common congenital heart disease, is the leading cause of sudden cardiac death in adolescents, young adults, and athletes. Older adults with HCM are less likely to experience sudden cardiac death, but their quality of life can be impaired. This article discusses diagnostic criteria, treatments, and nursing interventions, including patient teaching, for adults with HCM.
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Affiliation(s)
- Gail Larkin
- Gail Larkin and Lenel Caze are assistant professors in the Paramedic Program within the Nursing Department at Kingsborough Community College in Brooklyn, NY. Tamara Bellomo is an associate professor in the Nursing Program in the Nursing Department, also at Kingsborough Community College
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Afanasyev AV, Bogachev-Prokophiev AV, Ovcharov MA, Pivkin AN, Zalesov AS, Budagaev SA, Sharifulin RM, Zheleznev SI, Karaskov AM. Single-Centre Experience of Surgical Myectomy for Hypertrophic Obstructive Cardiomyopathy. Heart Lung Circ 2019; 29:949-955. [PMID: 31427226 DOI: 10.1016/j.hlc.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Septal myectomy is the gold standard treatment for hypertrophic obstructive cardiomyopathy. This study aimed to evaluate the results from patients with hypertrophic cardiomyopathy who had undergone septal myectomy. METHODS Data were analysed that has been prospectively collected over 7 years from 345 patients with hypertrophic cardiomyopathy who underwent septal myectomy at Meshalkin National Medical Research Center. RESULTS Six (6) patients (1.7%) died within 30 days of surgery. The mean (standard deviation, SD) resting left ventricular outflow tract gradients reduced from 83.4 (24.2) mmHg preoperatively to 16.2 (8.5) mmHg at discharge (p < 0.001). Of the 345 patients, 329 (95.4%) attended the most recent follow-up assessments, and of these, 254 (77.2%) were categorised as New York Heart Association (NYHA) class I, 64 (19.5%) class II, and 11 (3.3%) class III. The mean overall long-term survival rate after septal myectomy was 95.7% (SD 1.7%) (95% CI, 90.0-97.9). This did not differ from the age-matched and gender-matched general population (log-rank, p = 0.109). At the last follow-up assessments, six of 67 patients who had undergone concomitant Cox-Maze IV procedures had late atrial tachyarrhythmia recurrences. A preoperative short-axis view of left atrial diameter of 57.5 mm (hazard ratio, 1.30 (95% CI, 1.03-1.65), p < 0.001) predicted late atrial tachyarrhythmias (p < 0.002). CONCLUSIONS At this hypertrophic cardiomyopathy centre, septal myectomy is associated with low operative and early mortality rates (<2%), a low risk of early adverse events, and acceptable intermediate-term clinical and haemodynamic results.
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Affiliation(s)
- Alexander V Afanasyev
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
| | | | - Michail A Ovcharov
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey N Pivkin
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Anton S Zalesov
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Sergei A Budagaev
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ravil M Sharifulin
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Sergei I Zheleznev
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander M Karaskov
- Heart Valve Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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Leaphart D, Waring A, Suranyi P, Fernandes V. Call a Spade a Spade: Missed Diagnosis of Apical Hypertrophic Cardiomyopathy. Am J Med Sci 2019; 358:299-303. [PMID: 31353027 DOI: 10.1016/j.amjms.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/17/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy characterized by apical hypertrophy, deep T-wave inversions in precordial electrocardiogram (EKG) leads, and a ventriculogram shaped like the "Ace of Spades." Patients are often asymptomatic but sometimes present with atypical chest pain, angina, or atrial fibrillation. The deep T-wave inversions on EKG often mimic acute coronary syndrome. Coronary angiogram in these patients is unrevealing, but the characteristic left ventriculogram establishes this diagnosis. The deep T-wave inversions can appear suddenly or deepen over years, making the diagnosis difficult to establish early in the disease. Transthoracic echocardiogram may miss the hypertrophied apex, but echo contrast imaging or cardiac magnetic resonance imaging can reliably confirm the diagnosis and detect apical aneurysms. We present a case of apical hypertrophic cardiomyopathy which was not evident despite many admissions, EKGs, cardiac catheterizations and echocardiograms until the diagnosis was confirmed with left ventriculogram and cardiac magnetic resonance imaging 20 years after initial presentation.
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Affiliation(s)
| | - Ashley Waring
- Heart and Vascular Center, Division of Cardiology and
| | - Pal Suranyi
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
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Affiliation(s)
- Takumi J Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Advanced Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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