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Narayanan CA, Bokhari N, Rowin EJ, Maron MS, Maron BJ, Link MS, Madias C. Maintenance of Subcutaneous Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy Patients With Iatrogenic Left Bundle-Branch Block After Septal Myectomy. J Am Heart Assoc 2024; 13:e033728. [PMID: 38563365 DOI: 10.1161/jaha.123.033728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024]
Affiliation(s)
| | | | | | | | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas TX USA
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Maron BA, Wang RS, Shevtsov S, Drakos SG, Arons E, Wever-Pinzon O, Huggins GS, Samokhin AO, Oldham WM, Aguib Y, Yacoub MH, Rowin EJ, Maron BJ, Maron MS, Loscalzo J. Author Correction: Individualized interactomes for network-based precision medicine in hypertrophic cardiomyopathy with implications for other clinical pathophenotypes. Nat Commun 2024; 15:3038. [PMID: 38589351 PMCID: PMC11002015 DOI: 10.1038/s41467-024-45814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Rui-Sheng Wang
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sergei Shevtsov
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elena Arons
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gordon S Huggins
- Hypertrophic Cardiomyopathy Center, Cardiology Division, Tufts Medical Center, Boston, MA, USA
| | - Andriy O Samokhin
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William M Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yasmine Aguib
- Department of Cardiac Surgery, Imperial College of London, London, UK
- The Magdi Yacoub Heart Center, Aswan, Egypt
| | - Magdi H Yacoub
- Department of Cardiac Surgery, Imperial College of London, London, UK
- The Magdi Yacoub Heart Center, Aswan, Egypt
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Cardiology Division, Tufts Medical Center, Boston, MA, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Cardiology Division, Tufts Medical Center, Boston, MA, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Cardiology Division, Tufts Medical Center, Boston, MA, USA
| | - Joseph Loscalzo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Rowin EJ, Wadid M, Maron MS, White M, Hook BG, Harnish P, Silver JS, Reynolds MR, Maron BJ. Assessing the impact of atrial fibrillation on symptoms and quality of life in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:654-663. [PMID: 38288888 DOI: 10.1111/jce.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) has historically been regarded to have a deleterious impact on clinical course, strongly associated with progressive heart failure (HF) symptoms. However, there is a paucity of information regarding the impact of AF on HCM employing validated quality of life (QoL) surveys. Therefore, we evaluated the impact of AF on QoL utilizing patient reported outcome measures (PROMs). METHODS 218 consecutive HCM patients with or without AF at the Lahey HCM center in 2022 completed PROMs at their most recent visit evaluating HF (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and AF symptoms (AF Effect on QoL [AFEQT]). RESULTS Among the 218 patients, 50 (23%) had a history of AF and comprise the primary study cohort. AF was diagnosed at 55 ± 10 years of age, median of 5.5 years before PROM, with 66% of patients treated with a rhythm control strategy with antiarrhythmic drug and/or AF ablation. AFEQT indicated that 52% of patients experienced no or minimal AF-related disability, mild to moderate in 22%, and severe in 26%. There was no substantial difference in HCM phenotype in patients with no or minimal AF disability compared to those with severe disability. HF symptoms for most HCM patients with prior AF history was consistent with no or minimal (59%) or only mild (27%) disability as measured by KCCQ overall summary scores. In addition, with multivariate analysis, AF history was associated with less HF symptoms and improved QoL (OR 0.4, p = 0.02). CONCLUSION In contrast to prior perceptions, HCM patients with prior AF history were less likely to incur HF symptoms impairing QoL compared to HCM patients without AF. After treatment, prior history of AF did not substantially impact current QoL. These data provide a realistic appraisal for the impact that AF has on HCM patients and also offers a measure of reassurance for this patient subgroup.
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Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Mark Wadid
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Maggie White
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bruce G Hook
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Paul Harnish
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jonathan S Silver
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Matthew R Reynolds
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Maron MS, Mahmod M, Abd Samat AH, Choudhury L, Massera D, Phelan DMJ, Cresci S, Martinez MW, Masri A, Abraham TP, Adler E, Wever-Pinzon O, Nagueh SF, Lewis GD, Chamberlin P, Patel J, Yavari A, Dehbi HM, Sarwar R, Raman B, Valkovič L, Neubauer S, Udelson JE, Watkins H. Safety and Efficacy of Metabolic Modulation With Ninerafaxstat in Patients With Nonobstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2024:S0735-1097(24)06684-1. [PMID: 38599256 DOI: 10.1016/j.jacc.2024.03.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND In nonobstructive hypertrophic cardiomyopathy (nHCM), there are no approved medical therapies. Impaired myocardial energetics is a potential cause of symptoms and exercise limitation. Ninerafaxstat, a novel cardiac mitotrope, enhances cardiac energetics. OBJECTIVES To evaluate the safety and efficacy of ninerafaxstat in nHCM. METHODS Patients with HCM and left ventricular (LV) outflow gradient <30 mmHg, ejection fraction ≥50% and peak VO2 <80% predicted, were randomized to ninerafaxstat 200 mg BID or placebo (1:1) for 12 weeks. Primary endpoint was safety and tolerability with efficacy outcomes also assessed as secondary endpoints. RESULTS A total of 67 patients with nHCM were enrolled at 12 centers (57 yrs ± 11.8; 55% women). Serious adverse events occurred in 11.8% (4/34) in the ninerafaxstat group and 6.1% of patients (2/33) in placebo. From baseline to 12 weeks, ninerafaxstat was associated with significantly better ventilatory efficiency (VE/VCO2 slope) compared to placebo with a least square (LS) mean difference between the groups of -2.1 (95% CI, -3.4, -0.6; p=0.006), with no significant difference in pVO2 (p=0.9). KCCQ-CCS was directionally though not significantly improved with ninerafaxstat vs. placebo (LS mean, 3.2 [95% CI, -2.9, 9.2; p=0.2]), though was statistically significant when analyzed post-hoc in the 35 patients with baseline KCCQ-CSS ≤80 (LS mean, 9.4 [95% CI, 0.2, 18.5; p=0.04]). CONCLUSIONS In symptomatic nHCM, novel drug therapy targeting myocardial energetics was safe and well tolerated and associated with better exercise performance and health status among those most symptomatically limited. The findings support assessing ninerafaxstat in a Phase 3 study.
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Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, 67 South Bedford St, Suite 302W, Burlington, Massachusetts 01805, USA.
| | - Masliza Mahmod
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Azlan Helmy Abd Samat
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lubna Choudhury
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, IL, USA
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Dermot M J Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Sharon Cresci
- Center for Cardiovascular Research, Washington University School of Medicine, Saint Louis, MO, USA
| | - Matthew W Martinez
- Division of Cardiology, Atlantic Health System, Morristown, New Jersey, USA
| | - Ahmad Masri
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Theodore P Abraham
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah and Salt Lake Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Gregory D Lewis
- Cardiology Division and Pulmonary Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jai Patel
- Imbria Pharmaceuticals, Boston, Massachusetts, USA
| | - Arash Yavari
- Imbria Pharmaceuticals, Boston, Massachusetts, USA
| | | | | | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA, USA
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Masri A, Sherrid MV, Abraham TP, Choudhury L, Garcia-Pavia P, Kramer CM, Barriales-Villa R, Owens AT, Rader F, Nagueh SF, Olivotto I, Saberi S, Tower-Rader A, Wong TC, Coats CJ, Watkins H, Fifer MA, Solomon SD, Heitner SB, Jacoby DL, Kupfer S, Malik FI, Meng L, Sohn RL, Wohltman A, Maron MS. Efficacy and Safety of Aficamten in Symptomatic Nonobstructive Hypertrophic Cardiomyopathy: Results From the REDWOOD-HCM Trial, Cohort 4. J Card Fail 2024:S1071-9164(24)00082-4. [PMID: 38493832 DOI: 10.1016/j.cardfail.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This open-label phase 2 trial evaluated the safety and efficacy of aficamten in patients with nonobstructive hypertrophic cardiomyopathy (nHCM). METHODS Patients with symptomatic nHCM (left ventricular outflow tract obstruction gradient ≤ 30 mmHg, left ventricular ejection fraction [LVEF] ≥ 60%, N-terminal pro-B-type natriuretic peptide [NT-proBNP] > 300 pg/mL) received aficamten 5-15 mg once daily (doses adjusted according to echocardiographic LVEF) for 10 weeks. RESULTS We enrolled 41 patients (mean ± SD age 56 ± 16 years; 59% female). At Week 10, 22 (55%) patients experienced an improvement of ≥ 1 New York Heart Association class; 11 (29%) became asymptomatic. Clinically relevant improvements in Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores occurred in 22 (55%) patients. Symptom relief was paralleled by reductions in NT-proBNP levels (56%; P < 0.001) and high-sensitivity cardiac troponin I (22%; P < 0.005). Modest reductions in LVEF (mean ± SD) of -5.4% ± 10 to 64.6% ± 9.1 were observed. Three (8%) patients had asymptomatic reduction in LVEF < 50% (range: 41%-48%), all returning to normal after 2 weeks of washout. One patient with prior history of aborted sudden cardiac death experienced a fatal arrhythmia during the study. CONCLUSIONS Aficamten administration for symptomatic nHCM was generally safe and was associated with improvements in heart failure symptoms and cardiac biomarkers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04219826.
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Affiliation(s)
- Ahmad Masri
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | | | - Lubna Choudhury
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro de Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | | | | | | | - Sherif F Nagueh
- Section of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Timothy C Wong
- University of Pittsburgh School of Medicine, Division of Cardiology, Pittsburgh, PA, USA
| | - Caroline J Coats
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | - Stuart Kupfer
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Fady I Malik
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Lisa Meng
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Regina L Sohn
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Amy Wohltman
- Cytokinetics, Incorporated, South San Francisco, CA, USA
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Brignole M, Cecchi F, Anastasakis A, Crotti L, Deharo JC, Elliott PM, Fedorowski A, Kaski JP, Limongelli G, Maron MS, Olivotto I, Ommen SR, Parati G, Shen W, Ungar A, Wilde A. Corrigendum to 'Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management' [International Journal of Cardiology, 2023, 41:180-186]. Int J Cardiol 2024; 397:131589. [PMID: 38000974 DOI: 10.1016/j.ijcard.2023.131589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Affiliation(s)
- Michele Brignole
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy.
| | - Franco Cecchi
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Kallithea, Greece
| | - Lia Crotti
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Jean Claude Deharo
- Hopitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France; Aix Marseille Universitè, C2VN, Marseille, France
| | - Perry M Elliott
- Institute of Cardiological Sciences, University College London, UK
| | - Artur Fedorowski
- Dept. of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Juan Pablo Kaski
- Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital, London, UK
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi VanvitellI", AO Dei Colli-Monaldi Hospital, Naples, Italy
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Steve R Ommen
- Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, University of Milano Bicocca, Milan, Italy
| | - Win Shen
- Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arthur Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische Centra, Location AMC, Amsterdam, the Netherlands
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Maron BJ, Rowin EJ, Maron MS. Advances in the Management of Hypertrophic Cardiomyopathy Leading to Low Disease-Related Mortality in 2023. Am J Cardiol 2024; 212S:S77-S82. [PMID: 38368039 DOI: 10.1016/j.amjcard.2023.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common often inherited heart disease encumbered throughout much of its almost 60-year history by the expectation of an unfavorable outcome with shortened longevity. However, it is notable that in 2023, most patients affected with HCM can now achieve normal or extended life expectancy without major disability because of a comprehensive constellation of management strategies that have evolved largely over the last 20 years. Distinct adverse disease pathways dictate high-benefit low-risk personalized treatments, without reliance on genomics and sarcomere mutations, including: primary prevention implantable defibrillators for sudden cardiac death prevention, surgical myectomy and percutaneous alcohol septal ablation to reverse heart failure symptoms, anticoagulation to prevent embolic stroke associated with concomitant atrial fibrillation, external defibrillation and hypothermia for out-of-hospital cardiac arrest, and heart transplant in a small patient subgroup with end-stage disease. Large cohort studies using these contemporary management strategies achieved remarkably low HCM-related mortality (0.5%/year) across all age groups, which is lower than in the other cardiac or noncardiac risks of living, and largely confined to nonobstructive patients with progressive heart failure, including those awaiting heart transplant.
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Affiliation(s)
- Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Maron MS, Rowin EJ, Maron BJ. The Paradigm of Sudden Death Prevention in Hypertrophic Cardiomyopathy. Am J Cardiol 2024; 212S:S64-S76. [PMID: 38368038 DOI: 10.1016/j.amjcard.2023.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common and, often, inherited cardiac disease, once regarded as largely untreatable with ominous prognosis and, perhaps, most visibly as a common cause of sudden cardiac death (SCD) in the young. However, HCM is now more accurately considered a treatable disease with management options that significantly alter its clinical course. This is particularly true for SCD because the penetration of implantable cardioverter-defibrillators into HCM practice enables primary prevention device therapy that reliably terminates potentially lethal ventricular tachyarrhythmias (3% to 4%/year). This therapeutic advance is largely responsible for >10-fold decrease in the overall disease-related mortality to 0.5%/year, independent of patient age. A guideline-based clinical risk stratification algorithm has evolved, which included variables identifiable with cardiac magnetic resonance: ≥1 risk markers judged major within the clinical profile of an individual patient, associated with a measure of physician judgment and shared decision-making, can be sufficient to consider the recommendation of a prophylactic defibrillator implant. Implantable cardioverter-defibrillator decisions using the American College of Cardiology and the American Heart Association traditional major risk marker strategy are associated with a 95% sensitivity for identifying those patients who subsequently experience appropriate therapy, albeit often 5 to 10+ years after implant but without heart failure deterioration or death after a device intervention. A mathematical SCD risk score proposed by European Society of Cardiology is associated with a relatively low sensitivity (33%) for predicting and preventing SCD events but with potential for less device overtreatment.
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Affiliation(s)
- Martin S Maron
- Lahey Hospital and Medical Center, HCM Center, Burlington, Massachusetts.
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, HCM Center, Burlington, Massachusetts
| | - Barry J Maron
- Lahey Hospital and Medical Center, HCM Center, Burlington, Massachusetts
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Carrick RT, Ahamed H, Sung E, Maron MS, Madias C, Avula V, Studley R, Bao C, Bokhari N, Quintana E, Rajesh-Kannan R, Maron BJ, Wu KC, Rowin EJ. Identification of high-risk imaging features in hypertrophic cardiomyopathy using electrocardiography: A deep-learning approach. Heart Rhythm 2024:S1547-5271(24)00085-7. [PMID: 38280624 DOI: 10.1016/j.hrthm.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) are at risk of sudden death, and individuals with ≥1 major risk markers are considered for primary prevention implantable cardioverter-defibrillators. Guidelines recommend cardiac magnetic resonance (CMR) imaging to identify high-risk imaging features. However, CMR imaging is resource intensive and is not widely accessible worldwide. OBJECTIVE The purpose of this study was to develop electrocardiogram (ECG) deep-learning (DL) models for the identification of patients with HCM and high-risk imaging features. METHODS Patients with HCM evaluated at Tufts Medical Center (N = 1930; Boston, MA) were used to develop ECG-DL models for the prediction of high-risk imaging features: systolic dysfunction, massive hypertrophy (≥30 mm), apical aneurysm, and extensive late gadolinium enhancement. ECG-DL models were externally validated in a cohort of patients with HCM from the Amrita Hospital HCM Center (N = 233; Kochi, India). RESULTS ECG-DL models reliably identified high-risk features (systolic dysfunction, massive hypertrophy, apical aneurysm, and extensive late gadolinium enhancement) during holdout testing (c-statistic 0.72, 0.83, 0.93, and 0.76) and external validation (c-statistic 0.71, 0.76, 0.91, and 0.68). A hypothetical screening strategy using echocardiography combined with ECG-DL-guided selective CMR use demonstrated a sensitivity of 97% for identifying patients with high-risk features while reducing the number of recommended CMRs by 61%. The negative predictive value with this screening strategy for the absence of high-risk features in patients without ECG-DL recommendation for CMR was 99.5%. CONCLUSION In HCM, novel ECG-DL models reliably identified patients with high-risk imaging features while offering the potential to reduce CMR testing requirements in underresourced areas.
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Affiliation(s)
- Richard T Carrick
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland.
| | - Hisham Ahamed
- Amrita Institute of Medical Sciences and Research Centre, Amrita Hypertrophic Cardiomyopathy Center, Kochi, Kerala, India
| | - Eric Sung
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland
| | - Martin S Maron
- Lahey Hospital and Medical Center, Hypertrophic Cardiomyopathy Center, Burlington, Massachusetts
| | | | - Vennela Avula
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland
| | - Rachael Studley
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Chen Bao
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Nadia Bokhari
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Erick Quintana
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts
| | - Ramiah Rajesh-Kannan
- Amrita Institute of Medical Sciences and Research Centre, Amrita Hypertrophic Cardiomyopathy Center, Kochi, Kerala, India
| | - Barry J Maron
- Lahey Hospital and Medical Center, Hypertrophic Cardiomyopathy Center, Burlington, Massachusetts
| | - Katherine C Wu
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Hypertrophic Cardiomyopathy Center, Burlington, Massachusetts
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10
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Coats CJ, Maron MS, Abraham TP, Olivotto I, Lee MMY, Arad M, Cardim N, Ma CS, Choudhury L, Düngen HD, Garcia-Pavia P, Hagège AA, Lewis GD, Michels M, Oreziak A, Owens AT, Tfelt-Hansen J, Veselka J, Watkins HC, Heitner SB, Jacoby DL, Kupfer S, Malik FI, Meng L, Wohltman A, Masri A. Exercise Capacity in Patients With Obstructive Hypertrophic Cardiomyopathy: SEQUOIA-HCM Baseline Characteristics and Study Design. JACC Heart Fail 2024; 12:199-215. [PMID: 38032573 DOI: 10.1016/j.jchf.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Patients with obstructive hypertrophic cardiomyopathy (oHCM) have increased risk of arrhythmia, stroke, heart failure, and sudden death. Contemporary management of oHCM has decreased annual hospitalization and mortality rates, yet patients have worsening health-related quality of life due to impaired exercise capacity and persistent residual symptoms. Here we consider the design of clinical trials evaluating potential oHCM therapies in the context of SEQUOIA-HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM). This large, phase 3 trial is now fully enrolled (N = 282). Baseline characteristics reflect an ethnically diverse population with characteristics typical of patients encountered clinically with substantial functional and symptom burden. The study will assess the effect of aficamten vs placebo, in addition to standard-of-care medications, on functional capacity and symptoms over 24 weeks. Future clinical trials could model the approach in SEQUOIA-HCM to evaluate the effect of potential therapies on the burden of oHCM. (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM [SEQUOIA-HCM]; NCT05186818).
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Affiliation(s)
- Caroline J Coats
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Medical Center, Burlington, Massachusetts, USA
| | | | - Iacopo Olivotto
- Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Florence, Italy
| | - Matthew M Y Lee
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center, Israel; Tel Aviv University, Medical School, Israel
| | | | - Chang-Sheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lubna Choudhury
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro de Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Albert A Hagège
- Département de Cardiologie, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | | | | | | | - Anjali T Owens
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Tfelt-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Josef Veselka
- University Hospital Motol and 2nd Medical School, Charles University, Prague, Czech Republic
| | - Hugh C Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Daniel L Jacoby
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Stuart Kupfer
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Lisa Meng
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Amy Wohltman
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Ahmad Masri
- Oregon Health and Science University, Portland, Oregon, USA
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11
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Bataiosu R, Hoss S, Scolari FL, Cooper C, Tsoi M, Brahmbhatt DH, Billia F, Lee DZJ, Chan R, Ha ACT, Maron BJ, Rowin E, Maron MS, Ralph-Edwards A, Rakowski H, Adler A. Clinical Significance of Postoperative Atrial Fibrillation in Hypertrophic Cardiomyopathy Patients Undergoing Septal Myectomy. Can J Cardiol 2023; 39:1931-1937. [PMID: 37355230 DOI: 10.1016/j.cjca.2023.06.415] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The optimal management of hypertrophic cardiomyopathy (HCM) patients with postoperative atrial fibrillation (POAF) after surgical myectomy remains unknown. We sought to investigate the association between POAF and atrial fibrillation (AF) or cardioembolic events during follow-up to bridge this gap. METHODS Patients undergoing surgical myectomy at 2 HCM referral centres in North America from 2002 to 2020 were included in this study. Patients with preoperative AF were excluded. POAF was defined as any episode of AF within 30 days after surgery. RESULTS Of 1176 patients, 375 (31.9%) had POAF. Age (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.06; P < 0.001), premyectomy left atrial diameter (LAD; adjusted HR 1.6, 95% CI 1.32-2.02; P < 0.001), and smoking (adjusted HR 1.60, 95% CI 1.17-2.20; P = 0.001) were associated with POAF on multivariable analysis. Of 934 patients with follow-up data, of duration 4.3 ± 4.1 years, AF was detected in 86 (9.2%). Only POAF (HR 4.20, 95% CI 2.44-7.23; P < 0.001), previous history of stroke (HR 4.81, 95% CI 1.63-14.17; P = 0.01), and postmyectomy LAD (HR 1.80, 95% CI 1.21-2.70; P = 0.004) were associated with AF incidence during follow-up. Cardioembolic events occurred in only 15 patients (1.6%). POAF was not associated with increased cardioembolic risk, with only 3 patients with POAF suffering such an event, all more than 4 years after surgery. CONCLUSIONS POAF is common in HCM patients undergoing myectomy and is a predictor of AF during follow-up. Over long-term follow-up, cardioembolic events are uncommon. These findings suggest that routine long-term anticoagulation for all HCM patients with postmyectomy AF is not justified after the initial postoperative period.
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Affiliation(s)
- Roxana Bataiosu
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Sara Hoss
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Fernando L Scolari
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Craig Cooper
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Melissa Tsoi
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Darshan H Brahmbhatt
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Deacon Z J Lee
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Raymond Chan
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Andrew C T Ha
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Anthony Ralph-Edwards
- University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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12
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Maron BJ, Rowin EJ, Maron MS. Commotio cordis…once again: Unusual occurrence in a noncontact sport. HeartRhythm Case Rep 2023; 9:855-857. [PMID: 38204836 PMCID: PMC10774598 DOI: 10.1016/j.hrcr.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Barry J. Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Ethan J. Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S. Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
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13
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Rowin EJ, Link MS, Maron MS, Maron BJ. Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Circulation 2023; 148:1797-1811. [PMID: 38011245 DOI: 10.1161/circulationaha.123.065037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with clinical and subclinical episodes occurring in nearly one-half of patients. AF in HCM historically has been characterized as a decisive disease complication associated with substantial risk for thromboembolic stroke and increased morbidity and mortality. However, there have been many advances in treatment strategy resulting in improved outcomes for this patient group. For example, stroke risk in HCM has been greatly reduced by using systemic oral anticoagulation initiated after the first clinical (symptomatic) AF episode, usually with preference given to direct anticoagulants over warfarin. In contrast, stroke risk scoring systems (such as CHA2DS2-VASc score) are not informative in HCM given the substantial potential for stroke events in patients with low scores, and therefore should not be used for anticoagulation decisions in this disease. A novel risk score specifically designed for HCM (HCM-AF score) can reliably identify most patients with HCM at risk for future AF. Although a strategy focused on controlling ventricular rate is effective in asymptomatic (or minimally symptomatic) patients with AF, restoring and maintaining sinus rhythm is required for most patients with marked AF symptom burden and impaired quality of life. Several antiarrhythmic drugs such as sotalol, disopyramide, and amiodarone, can be effective in suppressing AF episodes; albeit safe, long-term efficacy is supported by only limited data. Catheter AF ablation has emerged as an important treatment option for some patients, although freedom from AF after a single ablation is relatively low (35% at 3 years), multiple ablations and the concomitant use of antiarrhythmic drugs can control AF with more than two-thirds of patients maintaining sinus rhythm at 5 years. Surgical AF ablation with biatrial Cox-Maze IV performed as an adjunctive procedure during myectomy can reduce symptomatic AF episodes (70% of patients free from AF at 5 years). For the vast majority of patients who have HCM with AF, the implementation of contemporary therapies has allowed for improved quality of life and low HCM-related mortality.
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Affiliation(s)
- Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, MA (E.J.R., M.S.M., B.J.M.)
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas (M.S.L.)
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, MA (E.J.R., M.S.M., B.J.M.)
| | - Barry J Maron
- Lahey Hospital and Medical Center, Burlington, MA (E.J.R., M.S.M., B.J.M.)
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14
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Studley R, Madias C, Bokhari N, Carrick RT, Quintana E, Bao C, Maron BJ, Maron MS, Rowin EJ. QRS Fragmentation as a Risk Marker for Sudden Death in Hypertrophic Cardiomyopathy. JACC Clin Electrophysiol 2023; 9:2353-2355. [PMID: 37632508 DOI: 10.1016/j.jacep.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Rachael Studley
- CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Nadia Bokhari
- CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Richard T Carrick
- Johns Hopkins University School of Medicine, Heart and Vascular Institute, Baltimore, Maryland, USA
| | - Erick Quintana
- CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Chen Bao
- CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington Massachusetts, USA
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington Massachusetts, USA.
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15
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Owens AT, Masri A, Abraham TP, Choudhury L, Rader F, Symanski JD, Turer AT, Wong TC, Tower-Rader A, Coats CJ, Fifer MA, Olivotto I, Solomon SD, Watkins HC, Heitner SB, Jacoby DL, Kupfer S, Malik FI, Meng L, Sohn R, Wohltman A, Maron MS. Aficamten for Drug-Refractory Severe Obstructive Hypertrophic Cardiomyopathy in Patients Receiving Disopyramide: REDWOOD-HCM Cohort 3. J Card Fail 2023; 29:1576-1582. [PMID: 37473912 DOI: 10.1016/j.cardfail.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Anjali T Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Ahmad Masri
- Oregon Health and Science University, Portland, OR, USA
| | | | - Lubna Choudhury
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, IL, USA
| | - Florian Rader
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - John D Symanski
- Atrium Health, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Aslan T Turer
- University of Texas Southwestern Medical Center, Dallas, USA
| | - Timothy C Wong
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Caroline J Coats
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Michael A Fifer
- Massachusetts General Hospital, Cardiovascular Division, Boston, MA, USA
| | - Iacopo Olivotto
- Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Florence, Italy
| | | | | | | | | | - Stuart Kupfer
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Fady I Malik
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Lisa Meng
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Regina Sohn
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Amy Wohltman
- Cytokinetics, Incorporated, South San Francisco, CA, USA
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16
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Maron MS, Mitten M, Borchers J, Rowin EJ, Maron BJ. Medical and Legal Determinants of Sports Eligibility for Young Competitive Athletes With Cardiovascular Disease. J Am Coll Cardiol 2023; 82:828-832. [PMID: 37542484 DOI: 10.1016/j.jacc.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Medical Center and Hospital, Burlington, Massachusetts, USA.
| | - Matthew Mitten
- National Sports Law Institute, Marquette University Law School, Milwaukee, Wisconsin, USA
| | - James Borchers
- Division of Family Medicine-Sports Medicine, Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center at Lahey Medical Center and Hospital, Burlington, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center at Lahey Medical Center and Hospital, Burlington, Massachusetts, USA
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17
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Bonaventura J, Maron BJ, Berul CI, Rowin EJ, Maron MS. Analysis of risk stratification and prevention of sudden death in pediatric patients with hypertrophic cardiomyopathy: Dilemmas and clarity. Heart Rhythm O2 2023; 4:506-516. [PMID: 37645261 PMCID: PMC10461211 DOI: 10.1016/j.hroo.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has been considered the most common cause of sudden death (SD) in the young. However, introduction of implantable cardioverter-defibrillators (ICDs) in HCM has proved highly effective and the mainstay of preventing SD in children, adolescents, and adults by terminating malignant ventricular tachyarrhythmias. Nevertheless, ICD decision making is generally regarded as more difficult in pediatrics, and the strategy for selecting ICD patients from this population remains without consensus. Prospective studies in HCM children and adolescents have shown the American Heart Association/American College of Cardiology traditional major risk marker strategy to be reliable with >90% sensitivity in selecting patients for SD prevention. International data in >2000 young HCM patients assembled over 20 years who were stratified by major risk markers showed ICDs effectively prevented SD in 20%. Alternatively, novel quantitative risk scoring initiatives provide 5-year risk estimates that are potentially useful as adjunctive tools to facilitate discussion of prophylactic ICD risks vs benefit but are as yet unsupported by prospective outcome studies. Risk scoring strategies are characterized by reasonable discriminatory statistical power (C-statistic 0.69-0.76) for identifying patients with SD events but with relatively low sensitivity, albeit with specificity comparable with the risk marker strategy. While some reticence for obligating healthy-appearing young patients to lifelong device implants is understandable, underutilization of the ICD in high-risk children and adolescents can represent a lost opportunity for fulfilling the long-standing aspiration of SD prevention. This review provides a critical assessment of the current strengths and weaknesses of SD risk stratification strategies in young HCM patients in an effort to clarify clinical decision making in this challenging subpopulation.
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Affiliation(s)
- Jiri Bonaventura
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Barry J. Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Charles I. Berul
- Division of Cardiology, Children’s National Hospital, Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Ethan J. Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
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18
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Maron BJ, Estes NAM, Rowin EJ, Maron MS, Reynolds MR. Development of the Implantable Cardioverter-Defibrillator: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2023; 82:353-373. [PMID: 37468191 DOI: 10.1016/j.jacc.2023.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 07/21/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) represent transformational technology, arguably the most significant advance in cardiovascular medicine in 50 years. The vision and determination of pioneers Mirowski and Mower was fundamental to this monumental achievement, working with limited resources and confronted by skepticism/criticism from medical establishment. The inventors were followed >35 years in which a multitude of innovative clinical scientists and engineers introduced technological advances leading to the sophisticated devices in practice today. A pivotal patient experiment with automated termination of ventricular fibrillation (1980) led to U.S. Food and Drug Administration approval. Transvenous lead systems converted ICDs from thoracotomy-based secondary prevention to primary prevention of sudden death devices in countless patients worldwide. ICD acceptance was solidified by prospective randomized controlled trials showing reduced mortality superior to antiarrhythmic drugs. ICDs eventually expanded from coronary disease to inherited arrhythmia conditions (eg, hypertrophic cardiomyopathy). The ICD breakthrough story demonstrates how significant progress is possible in medicine against all odds, given fearless imagination to pursue novel ideas that conflict with accepted wisdom.
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Affiliation(s)
- Barry J Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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19
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Maron MS, Rowin EJ, Bonaventura J, Maron BJ. Do Implantable Cardioverter-Defibrillators Really Belong on the Athlete Field? Am J Cardiol 2023:S0002-9149(23)00343-0. [PMID: 37393157 DOI: 10.1016/j.amjcard.2023.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 07/03/2023]
Abstract
High-risk athletes with implanted cardioverter-defibrillators who are competing in intense sports represent a controversial issue in cardiovascular medicine. Such devices have the capability to protect patients with a variety of cardiovascular diseases from sudden death and have aborted potentially lethal events during competitive sports but they can also lead to adverse clinical consequences for athletes with implants and other participants. In conclusion, clinicians and athletes should consider the data presented here in making prudent and informed recommendations regarding the eligibility of this patient group with implanted cardioverter-defibrillators for intense competitive sports.
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Affiliation(s)
- Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts..
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jiri Bonaventura
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
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20
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Bonaventura J, Rowin EJ, Maron MS, Maron BJ. Is Hypertrophic Cardiomyopathy Always a Familial and Inherited Disease? J Am Heart Assoc 2023:e028974. [PMID: 37301765 DOI: 10.1161/jaha.122.028974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Jiri Bonaventura
- Hypertrophic Cardiomyopathy Center Lahey Hospital and Medical Center Burlington MA USA
- Department of Cardiology, 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center Lahey Hospital and Medical Center Burlington MA USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center Lahey Hospital and Medical Center Burlington MA USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center Lahey Hospital and Medical Center Burlington MA USA
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21
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Wang RS, Rowin EJ, Maron BJ, Maron MS, Maron BA. A novel patient-patient network medicine approach to refine hypertrophic cardiomyopathy subgrouping: implications for risk stratification. Cardiovasc Res 2023; 119:e125-e127. [PMID: 37129987 PMCID: PMC10409890 DOI: 10.1093/cvr/cvad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Rui-Sheng Wang
- Division of Cardiovascular Medicine, Department of Medicine, 77 Ave Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine, 77 Ave Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
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22
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Massera D, Sherrid MV, Maron MS, Rowin EJ, Maron BJ. How common is hypertrophic cardiomyopathy… really?: Disease prevalence revisited 27 years after CARDIA. Int J Cardiol 2023; 382:64-67. [PMID: 37028711 DOI: 10.1016/j.ijcard.2023.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a heterogeneous albeit treatable cardiac disease of variable severity, with the potential for heart failure, atrial fibrillation and arrhythmic sudden death, characterized by otherwise unexplained left ventricular (LV) hypertrophy and affecting all ages and races. Over the last 30 years, several studies have estimated the prevalence of HCM in the general population, employing echocardiography and cardiac magnetic resonance imaging (CMR), as well electronic health records and billing databases for clinical diagnosis. The estimated prevalence in the general population based on the disease phenotype of LV hypertrophy by imaging is 1:500 (0.2%). This prevalence was initially proposed in 1995 in the population-based CARDIA study employing echocardiography, and more recently confirmed by automated CMR analysis in the large UK Biobank cohort. The 1:500 prevalence appears most relevant to clinical assessment and management of HCM. These available data suggest that HCM is not a rare condition but likely underdiagnosed clinically and by extrapolation potentially affects about 700,000 Americans and possibly 15 million people worldwide.
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Affiliation(s)
- Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, United States of America.
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, United States of America
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA, United States of America
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Heydari B, Satriano A, Jerosch-Herold M, Kolm P, Kim DY, Cheng K, Choi YL, Antiochos P, White JA, Mahmod M, Chan K, Raman B, Desai MY, Ho CY, Dolman SF, Desvigne-Nickens P, Maron MS, Friedrich MG, Schulz-Menger J, Piechnik SK, Appelbaum E, Weintraub WS, Neubauer S, Kramer CM, Kwong RY. 3-Dimensional Strain Analysis of Hypertrophic Cardiomyopathy: Insights From the NHLBI International HCM Registry. JACC Cardiovasc Imaging 2023; 16:478-491. [PMID: 36648040 PMCID: PMC10802851 DOI: 10.1016/j.jcmg.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abnormal global longitudinal strain (GLS) has been independently associated with adverse cardiac outcomes in both obstructive and nonobstructive hypertrophic cardiomyopathy. OBJECTIVES The goal of this study was to understand predictors of abnormal GLS from baseline data from the National Heart, Lung, and Blood Institute (NHLBI) Hypertrophic Cardiomyopathy Registry (HCMR). METHODS The study evaluated comprehensive 3-dimensional left ventricular myocardial strain from cine cardiac magnetic resonance in 2,311 patients from HCMR using in-house validated feature-tracking software. These data were correlated with other imaging markers, serum biomarkers, and demographic variables. RESULTS Abnormal median GLS (> -11.0%) was associated with higher left ventricular (LV) mass index (93.8 ± 29.2 g/m2 vs 75.1 ± 19.7 g/m2; P < 0.0001) and maximal wall thickness (21.7 ± 5.2 mm vs 19.3 ± 4.1 mm; P < 0.0001), lower left (62% ± 9% vs 66% ± 7%; P < 0.0001) and right (68% ± 11% vs 69% ± 10%; P < 0.01) ventricular ejection fractions, lower left atrial emptying functions (P < 0.0001 for all), and higher presence and myocardial extent of late gadolinium enhancement (6 SD and visual quantification; P < 0.0001 for both). Elastic net regression showed that adjusted predictors of GLS included female sex, Black race, history of syncope, presence of systolic anterior motion of the mitral valve, reverse curvature and apical morphologies, LV ejection fraction, LV mass index, and both presence/extent of late gadolinium enhancement and baseline N-terminal pro-B-type natriuretic peptide and troponin levels. CONCLUSIONS Abnormal strain in hypertrophic cardiomyopathy is associated with other imaging and serum biomarkers of increased risk. Further follow-up of the HCMR cohort is needed to understand the independent relationship between LV strain and adverse cardiac outcomes in hypertrophic cardiomyopathy.
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | | | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James A White
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Chan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Martin S Maron
- Lahey Hospital & Medical Center, Boston, Massachusetts, USA
| | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Stefan Neubauer
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Maron MS, Rowin E, Spirito P, Maron BJ. Differing strategies for sudden death prevention in hypertrophic cardiomyopathy. Heart 2023; 109:589-594. [PMID: 36270782 PMCID: PMC10086464 DOI: 10.1136/heartjnl-2020-316693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 11/04/2022] Open
Abstract
Sudden death (SD) has traditionally been the most visible and feared complication of hypertrophic cardiomyopathy (HCM). Substantial progress in reducing the occurrence of these catastrophic events represents a new paradigm in disease management. Prevention of SD in HCM has resulted from introduction of primary prevention ICDs that reliably terminate life-threatening ventricular tachyarrhythmias, as well as a matured risk stratification algorithm capable of reliably identifying those patients at highest risk. This initiative has been a major determinant of reducing HCM-related mortality to a low rate of 0.5%/year. In such a heterogeneous heart disease as HCM, no perfect risk stratification strategy is possible, and available approaches differ in terms of sensitivity and specificity for identifying patients with SD risk. Major cardiovascular societies, American Heart Association/American College of Cardiology in the USA and European Society of Cardiology in Europe have promoted different risk stratification guidelines creating the potential for judging SD risk in a given HCM patient differently based on commitment to a particular societal guideline or country of residence. In this review, we provide a critical but balanced assessment of these two divergent SD prevention strategies with regard to their respective strengths and weaknesses, as a guide to clinicians directly engaged in this important management issue.
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MESH Headings
- Humans
- Risk Assessment
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Defibrillators, Implantable/adverse effects
- Tachycardia, Ventricular/etiology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Risk Factors
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Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Paolo Spirito
- Divisione di Cardiologia, Ospedali Galliera, Genoa, Italy
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
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Maron BA, Kleiner DE, Arons E, Wertheim BM, Sharma NS, Haley KJ, Samokhin AO, Rowin EJ, Maron MS, Rosing DR, Maron BJ. Evidence of Advanced Pulmonary Vascular Remodeling in Obstructive Hypertrophic Cardiomyopathy With Pulmonary Hypertension. Chest 2023; 163:678-686. [PMID: 36243062 PMCID: PMC9993337 DOI: 10.1016/j.chest.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Elevated mean pulmonary artery pressure (mPAP) is common in patients with hypertrophic cardiomyopathy (HCM) and heart failure symptoms. However, dynamic left ventricular (LV) outflow tract obstruction may confound interpretation of pulmonary hypertension (PH) pathophysiologic features in HCM when relying on resting invasive hemodynamic data alone. RESEARCH QUESTION Do structural changes to the lung vasculature clarify PH pathophysiologic features in patients with HCM with progressive heart failure? STUDY DESIGN AND METHODS Clinical data and ultrarare lung autopsy specimens were acquired retrospectively from the National Institutes of Health (1975-1992). Patients were included based on the availability of lung tissue and recorded mPAP. Discarded tissue from rejected lung donors served as control specimens. Histomorphology was performed on pulmonary arterioles and veins. Comparisons were calculated using the Student t test and Mann-Whitney U test; Pearson correlation was used to assess association between morphometric measurements and HCM cardiac and hemodynamic measurements. RESULTS The HCM cohort (n = 7; mean ± SD age, 43 ± 18 years; 71% men) showed maximum mean ± SD LV wall thickness of 25 ± 2.8 mm, mean ± SD outflow tract gradient of 90 ± 30 mm Hg, median mPAP of 25 mm Hg (interquartile range [IQR], 6 mm Hg), median pulmonary artery wedge pressure (PAWP) of 16 mm Hg (IQR, 4 mm Hg), and median pulmonary vascular resistance of 1.8 Wood units (WU; IQR, 2.4 WU). Compared with control samples (n = 5), patients with HCM showed greater indexed pulmonary arterial hypertrophy (20.7 ± 7.2% vs 49.7 ± 12%; P < .001) and arterial wall fibrosis (11.5 ± 3.4 mm vs 21.0 ± 4.7 mm; P < .0001), which correlated with mPAP (r = 0.84; P = .018), PAWP (r = 0.74; P = .05), and LV outflow tract gradient (r = 0.78; P = .035). Compared with control samples, pulmonary vein thickness was increased by 2.9-fold (P = .008) in the HCM group, which correlated with mPAP (r = 0.81; P = .03) and LV outflow tract gradient (r = 0.83; P = .02). INTERPRETATION To the best of our knowledge, these data demonstrate for the first time that in patients with obstructive HCM, heart failure is associated with pathogenic pulmonary vascular remodeling even when mPAP is elevated only mildly. These observations clarify PH pathophysiologic features in HCM, with future implications for clinical strategies that mitigate outflow tract obstruction.
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Affiliation(s)
- Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Elena Arons
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Bradley M Wertheim
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nirmal S Sharma
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kathleen J Haley
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Andriy O Samokhin
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA
| | - Douglas R Rosing
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA
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26
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Bokhari N, Madias C, Studley R, Quintana E, Bao C, Maron BJ, Maron MS, Rowin E. IS IDIOPATHIC LEFT BUNDLE BRANCH BLOCK IN HYPERTROPHIC CARDIOMYOPATHY A MARKER FOR ADVERSE OUTCOMES? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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27
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Saberi S, Abraham TP, Choudhury L, Owens AT, Tower-Rader A, Rader F, Pavia PG, Olivotto I, Coats C, Fifer MA, Solomon SD, Watkins H, Heitner S, Jacoby D, Kupfer S, Malik FI, Meng L, Wohltman A, Maron MS, Masri A. LONG-TERM EFFICACY AND SAFETY OF AFICAMTEN IN PATIENTS WITH SYMPTOMATIC OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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28
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Faisaluddin M, Agarwal S, Patel H, Thakkar S, Patel BA, Majithia A, Ganatra S, Maron MS, Rowin E, Dani SS. INCREASING INCIDENCE AND MORTALITY OF INFECTIOUS ENDOCARDITIS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: IMPLICATIONS FOR ANTIBIOTIC PROPHYLAXIS RECOMMENDATIONS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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29
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Maron BJ, Rowin EJ, Ambe SP, Maron MS. The Reply. Am J Med 2023; 136:e50. [PMID: 36796956 DOI: 10.1016/j.amjmed.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 02/16/2023]
Affiliation(s)
- Barry J Maron
- HCM Center at Lahey Hospital and Medical Center, Burlington, Mass.
| | - Ethan J Rowin
- HCM Center at Lahey Hospital and Medical Center, Burlington, Mass
| | - Shray P Ambe
- HCM Center at Lahey Hospital and Medical Center, Burlington, Mass
| | - Martin S Maron
- HCM Center at Lahey Hospital and Medical Center, Burlington, Mass
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30
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Faisaluddin M, Patel H, Thakkar S, Patel BA, Agarwal S, Majithia A, Shekar PS, Maron MS, Rowin E, Ganatra S, Dani SS. CARDIOVASCULAR OUTCOMES OF MITRAL VALVE REPAIR VERSUS MITRAL VALVE REPLACEMENT IN HYPERTROPHIC CARDIOMYOPATHY PATIENTS WHO UNDERWENT MYECTOMY: A NATIONAL INPATIENT SAMPLE ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Carrick R, Maron MS, Maron BJ, Madias C, Wu KC, Rowin E. USE OF ECG DEEP-LEARNING TO IDENTIFY HYPERTROPHIC CARDIOMYOPATHY PATIENTS WITH HIGH-RISK FEATURES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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32
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Bonaventura J, Rowin EJ, Maron MS, Maron BJ. Risks of the Athletic Field Revisited: Report of Unusual Occurrences of Cardiac Arrest and Sudden Death in Professional Soccer Players. Am J Med 2023; 136:315-321. [PMID: 36495934 DOI: 10.1016/j.amjmed.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sudden deaths in competitive athletes are highly visible but potentially preventable events that generate great interest amongst the cardiovascular community and general public. METHODS Internet searches were performed using a combination of keywords and operators to produce search results for sudden death or cardiac arrest on the field in professional soccer players. RESULTS We identified 35 male professional soccer players (mean age 26 ± 5 years) who experienced collapse and cardiac arrest on the field (most during matches) in Europe from December 2002 to February 2022 with 63% in the last 6 years. Twenty-five have died on the field or later in a hospital despite cardiopulmonary resuscitation. Of the 10 survivors, eight were implanted with cardioverter-defibrillators for secondary (n = 6) or primary (n = 2) prevention and returned to full competition; five of the 8 required successful device therapy during matches or training. CONCLUSIONS Cardiac arrest and sudden death can occur not uncommonly in professional athletes highly trained over decades and participating at an elite sports level. Our observations also underscore the importance of targeted preparticipation cardiovascular screening, and availability of external defibrillators on the playing field.
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Affiliation(s)
- Jiri Bonaventura
- Department of Cardiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Mass
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Mass
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Mass
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Mass
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Maron MS. Increased Long-Term Survival After Myectomy: Is the Pendulum Swinging Again in This 30-Year Debate? J Am Coll Cardiol 2023; 81:116-118. [PMID: 36631205 DOI: 10.1016/j.jacc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
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Navidi Z, Sun J, Chan RH, Hanneman K, Al-Arnawoot A, Munim A, Rakowski H, Maron MS, Woo A, Wang B, Tsang W. Interpretable machine learning for automated left ventricular scar quantification in hypertrophic cardiomyopathy patients. PLOS Digit Health 2023; 2:e0000159. [PMID: 36812626 PMCID: PMC9931226 DOI: 10.1371/journal.pdig.0000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/09/2022] [Indexed: 01/06/2023]
Abstract
Scar quantification on cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) images is important in risk stratifying patients with hypertrophic cardiomyopathy (HCM) due to the importance of scar burden in predicting clinical outcomes. We aimed to develop a machine learning (ML) model that contours left ventricular (LV) endo- and epicardial borders and quantifies CMR LGE images from HCM patients.We retrospectively studied 2557 unprocessed images from 307 HCM patients followed at the University Health Network (Canada) and Tufts Medical Center (USA). LGE images were manually segmented by two experts using two different software packages. Using 6SD LGE intensity cutoff as the gold standard, a 2-dimensional convolutional neural network (CNN) was trained on 80% and tested on the remaining 20% of the data. Model performance was evaluated using the Dice Similarity Coefficient (DSC), Bland-Altman, and Pearson's correlation. The 6SD model DSC scores were good to excellent at 0.91 ± 0.04, 0.83 ± 0.03, and 0.64 ± 0.09 for the LV endocardium, epicardium, and scar segmentation, respectively. The bias and limits of agreement for the percentage of LGE to LV mass were low (-0.53 ± 2.71%), and correlation high (r = 0.92). This fully automated interpretable ML algorithm allows rapid and accurate scar quantification from CMR LGE images. This program does not require manual image pre-processing, and was trained with multiple experts and software, increasing its generalizability.
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Affiliation(s)
- Zeinab Navidi
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Vector Institute, Toronto, Canada
| | - Jesse Sun
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Raymond H. Chan
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Kate Hanneman
- Department of Radiology, University Health Network, University of Toronto, Toronto, Canada
| | - Amna Al-Arnawoot
- Department of Radiology, University Health Network, University of Toronto, Toronto, Canada
| | | | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Martin S. Maron
- Division of Cardiology, Tufts Medical Center, Boston, United States of America
| | - Anna Woo
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Bo Wang
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Vector Institute, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Wendy Tsang
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- * E-mail:
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35
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Maron MS, Masri A, Choudhury L, Olivotto I, Saberi S, Wang A, Garcia-Pavia P, Lakdawala NK, Nagueh SF, Rader F, Tower-Rader A, Turer AT, Coats C, Fifer MA, Owens A, Solomon SD, Watkins H, Barriales-Villa R, Kramer CM, Wong TC, Paige SL, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Abraham T. Phase 2 Study of Aficamten in Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2023; 81:34-45. [PMID: 36599608 DOI: 10.1016/j.jacc.2022.10.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) obstruction is a major determinant of heart failure symptoms in obstructive hypertrophic cardiomyopathy (oHCM). Aficamten, a next-in-class cardiac myosin inhibitor, may lower gradients and improve symptoms in these patients. OBJECTIVES This study aims to evaluate the safety and efficacy of aficamten in patients with oHCM. METHODS Patients with oHCM and LVOT gradients ≥30 mm Hg at rest or ≥50 mm Hg with Valsalva were randomized 2:1 to receive aficamten (n = 28) or placebo (n = 13) in 2 dose-finding cohorts. Doses were titrated based on gradients and ejection fraction (EF). Safety and changes in gradient, EF, New York Heart Association functional class, and cardiac biomarkers were assessed over a 10-week treatment period and after a 2-week washout. RESULTS From baseline to 10 weeks, aficamten reduced gradients at rest (mean difference: -40 ± 27 mm Hg, and -43 ± 37 mm Hg in Cohorts 1 and 2, P = 0.0003 and P = 0.0004 vs placebo, respectively) and with Valsalva (-36 ± 27 mm Hg and -53 ± 44 mm Hg, P = 0.001 and <0.0001 vs placebo, respectively). There were modest reductions in EF (-6% ± 7.5% and -12% ± 5.9%, P = 0.007 and P < 0.0001 vs placebo, respectively). Symptomatic improvement in ≥1 New York Heart Association functional class was observed in 31% on placebo, and 43% and 64% on aficamten in Cohorts 1 and 2, respectively (nonsignificant). With aficamten, N-terminal pro-B-type natriuretic peptide was reduced (62% relative to placebo, P = 0.0002). There were no treatment interruptions and adverse events were similar between treatment arms. CONCLUSIONS Aficamten resulted in substantial reductions in LVOT gradients with most patients experiencing improvement in biomarkers and symptoms. These results highlight the potential of sarcomere-targeted therapy for treatment of oHCM.
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Affiliation(s)
- Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - Ahmad Masri
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Sara Saberi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Andrew Wang
- Duke University Hospital, Durham, North Carolina, USA
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro de Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Florian Rader
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - Anjali Owens
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Timothy C Wong
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sharon L Paige
- Cytokinetics Incorporated, South San Francisco, California, USA
| | | | - Stuart Kupfer
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Lisa Meng
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Amy Wohltman
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Theodore Abraham
- University of California, San Francisco, San Francisco, California, USA
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Brignole M, Cecchi F, Anastasakis A, Crotti L, Deharo JC, Elliott PM, Fedorowski A, Kaski JP, Limongelli G, Maron MS, Olivotto I, Ommen SR, Parati G, Shen W, Ungar A, Wilde A. Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management. Int J Cardiol 2023; 370:330-337. [PMID: 36309161 DOI: 10.1016/j.ijcard.2022.10.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/09/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
Syncopal events in patients with hypertrophic cardiomyopathy (HCM) are of concern as they are a vital consideration in algorithms for risk stratification for sudden cardiac death (SCD) and ICD implantation. However, the cause of syncope is often under-investigated and/or unexplained. Current syncope guidelines do not provide a detailed definition of unexplained syncope. To address this important gap, an international panel of experts in the field of both syncope and HCM wrote a consensus document with the aim of providing practical guidance for the diagnosis and management of syncope in patients with HCM.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Risk Assessment
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Syncope/diagnosis
- Syncope/etiology
- Syncope/therapy
- Risk Factors
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Affiliation(s)
- Michele Brignole
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy.
| | - Franco Cecchi
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Kallithea, Greece
| | - Lia Crotti
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Jean Claude Deharo
- Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France; Aix Marseille Université, C2VN, Marseille, France.
| | - Perry M Elliott
- Institute of Cardiological Sciences, University College London, UK.
| | - Artur Fedorowski
- Dept. of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | - Juan Pablo Kaski
- Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital, London, UK.
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi VanvitellI", AO Dei Colli-Monaldi Hospital, Naples, Italy
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA, USA.
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Steve R Ommen
- Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, University of Milano Bicocca, Milan, Italy.
| | - Win Shen
- Mayo Clinic Arizona, Phoenix, AZ, USA.
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence andFlorence, Italy.
| | - Arthur Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische Centra, Amsterdam,location AMC, the Netherlands.
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Rowin EJ, Ruberg FL, Das G, Higgins D, Lipe WC, Bokhari N, Dehn M, Maron BJ, Maron MS. Identification of Transthyretin Cardiac Amyloidosis Among Patients Previously Diagnosed With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2022; 15:e014938. [PMID: 36448453 DOI: 10.1161/circimaging.122.014938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington MA (E.J.R., B.J.M., M.S.M.)
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA (F.L.R.)
| | - Gaurav Das
- CardioVascular Center, Tufts Medical Center, Boston MA (G.D., D.H., W.C.L., N.B., M.D.)
| | - Daniel Higgins
- CardioVascular Center, Tufts Medical Center, Boston MA (G.D., D.H., W.C.L., N.B., M.D.)
| | - Willard C Lipe
- CardioVascular Center, Tufts Medical Center, Boston MA (G.D., D.H., W.C.L., N.B., M.D.)
| | - Nadia Bokhari
- CardioVascular Center, Tufts Medical Center, Boston MA (G.D., D.H., W.C.L., N.B., M.D.)
| | - Monica Dehn
- CardioVascular Center, Tufts Medical Center, Boston MA (G.D., D.H., W.C.L., N.B., M.D.)
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington MA (E.J.R., B.J.M., M.S.M.).,CardioVascular Center, Tufts Medical Center, Boston MA (G.D., D.H., W.C.L., N.B., M.D.)
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington MA (E.J.R., B.J.M., M.S.M.)
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38
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Maron BA, Wang RS, Shevtsov S, Drakos SG, Arons E, Wever-Pinzon O, Huggins GS, Samokhin AO, Oldham WM, Aguib Y, Yacoub MH, Rowin EJ, Maron BJ, Maron MS, Loscalzo J. Author Correction: Individualized interactomes for network-based precision medicine in hypertrophic cardiomyopathy with implications for other clinical pathophenotypes. Nat Commun 2022; 13:7026. [PMID: 36396654 PMCID: PMC9672304 DOI: 10.1038/s41467-022-34834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abdelfattah OM, Martinez M, Sayed A, ElRefaei M, Abushouk AI, Hassan A, Masri A, Winters SL, Kapadia SR, Maron BJ, Rowin E, Maron MS. Temporal and Global Trends of the Incidence of Sudden Cardiac Death in Hypertrophic Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:1417-1427. [PMID: 36424010 DOI: 10.1016/j.jacep.2022.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Since the initial clinical description of hypertrophic cardiomyopathy (HCM) over 60 years ago, sudden cardiac death (SCD) has been the most visible and feared complication of HCM. OBJECTIVES This study sought to characterize the temporal, geographic, and age-related trends of reported SCD rates in adult HCM patients. METHODS Electronic databases were systematically searched up to November 2021 for studies reporting on SCD event rates in HCM patients. Patients with SCD equivalents (appropriate implantable cardioverter-defibrillator [ICD] shocks and nonfatal cardiac arrests) were not included. A random-effects model was used to pool study estimates calculating the overall incidence rates (IR) for each time-era, geographic region, and age group. We analyzed 2 periods (before vs after 2000, following clinical implementation of ICD in HCM). Following 2000, 5-year intervals were used to demonstrate the temporal change in SCD rates. RESULTS A total of 98 studies (N = 70,510 patients and 431,407 patient-years) met our inclusion criteria. The overall rate of HCM SCD was 0.43%/y (95% CI: 0.37-0.50%/y; I2 = 75%; SCD events: 1,938; person-years of follow-up: 408,715), with young patients (<18 years of age) demonstrating a >2-fold-risk for sudden death vs adult patients 18-60 years of age (IR: 1.09%; 95% CI: 0.69%-1.73% vs IR: 0.43%; 95% CI: 0.37%-0.50%) (P value for subgroup differences <0.01). Contemporary SCD rates from 2015 to present were 0.32%/y and significantly lower compared with 2000 or earlier (IR: 0.32%; 95% CI: 0.20%-0.52% vs IR: 0.73%; 95% CI: 0.53%-1.02%, respectively). Reported SCD rates for HCM were lowest in North America (IR: 0.28%; 95% CI: 0.18%-0.43%,) and highest in Asia (IR: 0.67%; 95% CI: 0.54%-0.84%). CONCLUSIONS Contemporary HCM-related SCD rates are low (0.32%/y) representing a 2-fold decrease compared with prior treatment eras. Young HCM patients are at the highest risk. The maturation of SCD risk stratification strategies and the application of primary prevention ICD to HCM are likely responsible for the notable decline over time in SCD events. In addition, worldwide geographic disparities in SCD rates were evident, underscoring the need to increase access to SCD prevention treatment for all HCM patients.
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Affiliation(s)
- Omar M Abdelfattah
- Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Matthew Martinez
- Shannon T. Mast Center for Hypertrophic Cardiomyopathy, Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ahmed Hassan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ahmad Masri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Stephen L Winters
- Section of Electrophysiology, Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
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Bataiosu R, Scolari FL, Brahmbhatt D, Hoss S, Chow C, Cooper C, Tsoi M, Rowin E, Maron MS, Billia F, Ralph-Edwards A, Rakowski H, Adler A. Left atrial remodelling after septal myectomy is associated with a reduced 5-year risk of atrial fibrillation in hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial diameter (LAD) is an established predictor of atrial fibrillation (AF) and adverse outcomes in hypertrophic cardiomyopathy (HCM). However, the impact of LAD remodelling after surgical myectomy on the development of late onset AF is still poorly understood.
Purpose
To investigate the association between LAD remodelling and new occurrence of AF in the first five years after surgical myectomy in a large patient population with HCM.
Methods
1177 HCM patients without a history of AF, subjected to surgical myectomy at two referral centres between 2001 and 2020 were retrospectively reviewed. Paired echocardiographic studies before and shortly after surgical myectomy were available in 894 (76%) patients and 889 (75%) patients had complete LAD measurements, defined as the anteroposterior diameter at end-systole from parasternal long axis view. LAD was considered normal when ≤40mm. Late onset AF was determined as AF documented between one month and 5 years follow up after myectomy. Patients were grouped as having normal LAD pre- and post-myectomy (group 1), enlarged pre-myectomy LAD but normal post-myectomy LAD (group 2), and those with enlarged LAD post-myectomy (group 3). Cox proportional hazards models were applied to evaluate the impact of LAD on late onset AF.
Results
Late onset AF was detected in 63 (7%) patients, 56% male, with an incidence of 1%/year. Patients with AF were older (56±13 vs. 52±14 years, p=0.03), had a larger post-surgery LAD (44±7 vs. 41±6 mm, p<0.001) and a lower left ventricular ejection fraction (58±6 vs. 61±6%, p=0.002) compared to patients without AF. Postoperative left ventricular maximal wall thickness (14±4 mm vs. 15±4mm, p=0.53), left ventricular outflow tract obstruction (6% vs. 8%, p=0.49) or moderate/severe mitral regurgitation (13% vs. 9%, p=0.29) were similar between patients with and without late onset AF. Among the 227 patients in group 1, late onset AF occurred in only 5 (3%), in comparison to 8 (5%) of 182 patients in group 2, and in 36 (10%) of the 480 patients in group 3 (p=0.006). Using group 1 as reference, the hazard ratio for developing AF was 2.1 (95% CI 0.7–6.5, p=0.15) for patients in group 2 and 3.5 (95% CI 1.4–9.4, p=0.005) for patients in group 3.
Conclusion
In our study we were able to show that the overall post-myectomy 5-year risk for developing AF was 1%/year. Normal LAD and reverse LAD remodelling correlated with a lower risk for developing late onset AF, whereas a higher risk was associated with enlarged post-myectomy LAD. These results highlight the possible clinical benefit of LAD remodelling after myectomy in reducing late onset AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bataiosu
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - F L Scolari
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - D Brahmbhatt
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - S Hoss
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - C Chow
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - C Cooper
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - M Tsoi
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - E Rowin
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - M S Maron
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - F Billia
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - A Ralph-Edwards
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - H Rakowski
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - A Adler
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
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41
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Maron BA, Wang RS, Carnethon MR, Rowin EJ, Loscalzo J, Maron BJ, Maron MS. What Causes Hypertrophic Cardiomyopathy? Am J Cardiol 2022; 179:74-82. [PMID: 35843734 DOI: 10.1016/j.amjcard.2022.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 01/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a global and relatively common cause of patient morbidity and mortality and is among the first reported monogenic cardiac diseases. For 30 years, the basic etiology of HCM has been attributed largely to variants in individual genes encoding cardiac sarcomere proteins, with the implication that HCM is fundamentally a genetic disease. However, data from clinical and network medicine analyses, as well as contemporary genetic studies show that single gene variants do not fully explain the broad and diverse HCM clinical spectrum. These transformative advances place a new focus on possible novel interactions between acquired disease determinants and genetic context to produce complex HCM phenotypes, also offering a measure of caution against overemphasizing monogenics as the principal cause of this disease. These new perspectives in which HCM is not a uniformly genetic disease but likely explained by multifactorial etiology will also unavoidably impact how HCM is viewed by patients and families in the clinical practicing community going forward, including relevance to genetic counseling and access to healthcare insurance and psychosocial wellness.
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Affiliation(s)
- Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine and Harvard Medical School, Boston, Massachusetts.
| | - Rui-Sheng Wang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mercedes R Carnethon
- Division of Pulmonology and Critical Care, Feinberg School of Medicine, Chicago, Illinois
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Joseph Loscalzo
- Division of Cardiovascular Medicine, Department of Medicine and Harvard Medical School, Boston, Massachusetts
| | - Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Rowin EJ, Cooper C, Carrick RT, Tsoi M, Maron BJ, Maron MS. Ventricular Septal Myectomy Decreases Long-Term Risk for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 179:70-73. [PMID: 35835601 PMCID: PMC10028409 DOI: 10.1016/j.amjcard.2022.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/01/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) and is an important cause of morbidity and embolic stroke. The impact of outflow obstruction and the influence of surgical septal myectomy on the development of new-onset AF has not been well described. Consecutive patients with HCM without previous AF were followed for 5.0 ± 3.6 years for new-onset AF, including 717 with obstruction who did not undergo surgical myectomy (outflow gradients ≥30 mm Hg at rest or after provocation), 555 with nonobstructive HCM (outflow gradients <30 mm Hg), and 503 who underwent surgical myectomy. Patients with obstructive HCM who did not undergo myectomy had a 1.5-fold increased risk for new-onset AF compared with nonobstructive HCM (26% vs 16% at 10 years, hazard ratio = 0.69, p = 0.02). Patients who underwent myectomy had more advanced heart failure (95% vs 18% New York Heart Association class III, p <0.001) and had larger left atrium dimension (42 ± 7 vs 41 ± 7 mm; p <0.01) as compared with patients with obstructive HCM who did not undergo myectomy. However, after myectomy, the risk of new-onset AF was significantly lower than nonoperated obstructive (17% vs 26% at 10 years, p = 0.04) and no different from the risk of AF in patients with nonobstructive HC (hazard ratio 0.95, p = 0.81). In conclusion, patients with HCM with outflow obstruction are at a higher risk for AF compared with patients with nonobstructive HCM. However, after surgical myectomy, the risk for new-onset AF is substantially reduced. In addition to the known benefits of myectomy to permanently relieve outflow tract obstruction and mitral regurgitation, reverse heart failure symptoms, and increase longevity, myectomy is now shown to decrease susceptibility to AF in HCM.
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Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Craig Cooper
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Richard T Carrick
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Melissa Tsoi
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington, Massachusetts
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43
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Maron BJ, Maron MS, Sherrid MV, Ommen SR, Rowin EJ. Personalized Treatment Strategies Effective in Hypertrophic Cardiomyopathy Do Not Rely on Genomics in 2022: A Different Tale of Precision Medicine. Am J Cardiol 2022; 183:150-152. [PMID: 36114018 DOI: 10.1016/j.amjcard.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Barry J Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Division of Cardiology. New York University Langone Health, New York, New York
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ethan J Rowin
- HCM Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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44
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Maron BJ, Dearani JA, Smedira NG, Schaff HV, Wang S, Rastegar H, Ralph-Edwards A, Ferrazzi P, Swistel D, Shemin RJ, Quintana E, Bannon PG, Shekar PS, Desai M, Roberts WC, Lever HM, Adler A, Rakowski H, Spirito P, Nishimura RA, Ommen SR, Sherrid MV, Rowin EJ, Maron MS. Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel. Am J Cardiol 2022; 180:124-139. [PMID: 35965115 DOI: 10.1016/j.amjcard.2022.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on >50 years experience, surgery reliably reverses disabling heart failure by permanently abolishing mechanical outflow impedance and mitral regurgitation, with normalization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increasing significantly in number over the most recent 15 years. Performed in experienced multidisciplinary institutions, perioperative mortality for myectomy has declined to 0.6%, becoming one of the safest currently performed open-heart procedures. Extended myectomy relieves symptoms in >90% of patients by ≥ 1 NYHA functional class, returning most to normal daily activity, and also with a long-term survival benefit; concomitant Cox-Maze procedure can reduce the number of atrial fibrillation episodes. Surgery, preferably performed in high volume clinical environments, continues to flourish as a guideline-based and preferred high benefit: low treatment risk option for adults and children with drug refractory disabling symptoms from obstruction, despite prior challenges: higher operative mortality/skepticism in 1960s/1970s; dual-chamber pacing in 1990s, alcohol ablation in 2000s, and now introduction of strong negative inotropic drugs potentially useful for symptom management.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA.
| | | | | | | | | | | | | | | | | | | | | | | | - Prem S Shekar
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA
| | | | - William C Roberts
- Department of Pathology and Medicine; Baylor UniversityMedical Center, Dallas Texas
| | | | - Arnon Adler
- Toronto General Hospital, Toronto Ontario, Canada
| | | | | | | | | | | | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, MA
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Rowin EJ, Maron MS. Refining Endpoint Measures in Clinical Trials for Hypertrophic Cardiomyopathy: The Emerging Role of Patient-Reported Outcomes. JACC Heart Fail 2022; 10:540-542. [PMID: 35902156 DOI: 10.1016/j.jchf.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Rowin EJ, Maron MS. Cardiovascular magnetic resonance for screening in hypertrophic cardiomyopathy: the new family plan. Eur Heart J Cardiovasc Imaging 2022; 23:1155-1156. [PMID: 35796102 DOI: 10.1093/ehjci/jeac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Lahey Medical Center and Hospital, 67 South Bedford Street, Suite 302W, Burlington, MA 01805, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Lahey Medical Center and Hospital, 67 South Bedford Street, Suite 302W, Burlington, MA 01805, USA
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47
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Butzner M, Sarocco P, Maron MS, Rowin E, Teng CC, Stanek E, Tan H, Robertson LA. Characteristics of Patients With Obstructive Hypertrophic Cardiomyopathy in Real-World Community-Based Cardiovascular Practices. Am J Cardiol 2022; 174:120-125. [PMID: 35473784 DOI: 10.1016/j.amjcard.2022.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/19/2022]
Abstract
The clinical profile of patients with obstructive hypertrophic cardiomyopathy (oHC) is not well characterized, with little evidence outside selected referral populations. Using longitudinal medical claims data from a United States nationwide database, we retrospectively identified adults who were newly diagnosed with oHC. Clinical characteristics were compared from 1 year before diagnosis and at the 2-year follow-up. Patients (N = 1,841) with oHC (age 63 ± 15 years; 52% were male) with geographic representation across the United States were identified. Most patients received care within community-based cardiovascular practices and 7% at referral hypertrophic cardiomyopathy (HC) centers. Baseline diagnostic procedures included electrocardiogram (66%), echocardiogram (51%), magnetic resonance imaging (4%), and HC genetic testing (0.7%). Baseline co-morbidities were hypertension (59%), coronary artery disease (30%), diabetes (19%), and atrial fibrillation (19%). For all HC-related medications, use significantly increased after diagnosis. During follow-up, 144 patients (8%) received an implantable cardioverter-defibrillator for sudden death prevention, 99 underwent septal myectomy (5%), and 24 underwent alcohol septal ablation (1%). By the 1-year follow-up, 2% of patients had sudden cardiac arrest and 26% had atrial fibrillation, and heart failure increased from 16% to 27%. In conclusion, in a community-based population of patients with oHC, patients' age at diagnosis of oHC was older than reported for referral populations and patients had a significant co-morbidity burden. Cardiovascular medication use was appropriate, but the rate of guideline-supported surgical procedures was low.
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Affiliation(s)
- Michael Butzner
- Cytokinetics, Incorporated, Health Economics and Outcomes Research, South San Francisco, California.
| | - Phil Sarocco
- Cytokinetics, Incorporated, Health Economics and Outcomes Research, South San Francisco, California
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center at Lahey Hospital, Burlington, Massachusetts
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center at Lahey Hospital, Burlington, Massachusetts
| | | | | | | | - Laura A Robertson
- Clinical Research, Cytokinetics, Incorporated, South San Francisco, California
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Fahmy AS, Rowin EJ, Arafati A, Al-Otaibi T, Maron MS, Nezafat R. Radiomics and deep learning for myocardial scar screening in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2022; 24:40. [PMID: 35761339 PMCID: PMC9235098 DOI: 10.1186/s12968-022-00869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial scar burden quantified using late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR), has important prognostic value in hypertrophic cardiomyopathy (HCM). However, nearly 50% of HCM patients have no scar but undergo repeated gadolinium-based CMR over their life span. We sought to develop an artificial intelligence (AI)-based screening model using radiomics and deep learning (DL) features extracted from balanced steady state free precession (bSSFP) cine sequences to identify HCM patients without scar. METHODS We evaluated three AI-based screening models using bSSFP cine image features extracted by radiomics, DL, or combined DL-Radiomics. Images for 759 HCM patients (50 ± 16 years, 66% men) in a multi-center/vendor study were used to develop and test model performance. An external dataset of 100 HCM patients (53 ± 14 years, 70% men) was used to assess model generalizability. Model performance was evaluated using area-under-receiver-operating curve (AUC). RESULTS The DL-Radiomics model demonstrated higher AUC compared to DL and Radiomics in the internal (0.83 vs 0.77, p = 0.006 and 0.78, p = 0.05; n = 159) and external (0.74 vs 0.64, p = 0.006 and 0.71, p = 0.27; n = 100) datasets. The DL-Radiomics model correctly identified 43% and 28% of patients without scar in the internal and external datasets compared to 42% and 16% by Radiomics model and 42% and 23% by DL model, respectively. CONCLUSIONS A DL-Radiomics AI model using bSSFP cine images outperforms DL or Radiomics models alone as a scar screening tool prior to gadolinium administration. Despite its potential, the clinical utility of the model remains limited and further investigation is needed to improve the accuracy and generalizability.
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Affiliation(s)
- Ahmed S. Fahmy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Ethan J. Rowin
- Cardiovascular Center, Tufts Medical Center, Boston, USA
| | - Arghavan Arafati
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Talal Al-Otaibi
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | | | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
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Maron MS, Lanuario EL, Rowin EJ, Maron BJ. Global Dissemination and Implementation of Contemporary Management Principles for Hypertrophic Cardiomyopathy and Role of the International HCM Summit. Am J Cardiol 2022; 172:146-149. [PMID: 35569881 DOI: 10.1016/j.amjcard.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Martin S Maron
- HCM Center, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | | | - Ethan J Rowin
- HCM Center, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Barry J Maron
- HCM Center, Lahey Hospital & Medical Center, Burlington, Massachusetts..
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Maron BJ, Maron MS. Reflections on Six Decades of Hypertrophic Cardiomyopathy From Eugene Braunwald. Am J Cardiol 2022; 172:150-153. [PMID: 35569882 DOI: 10.1016/j.amjcard.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/01/2022]
Abstract
On October 16 to 18, 2021, the 3-day 7th International Summit of Hypertrophic Cardiomyopathy was held virtually with almost 700 registrants and faculty from 40 countries and 42 states (Drs. Martin and Barry Maron, Directors). This meeting, the largest for this disease, was an opportunity to engage on a wide variety of topics with insights relevant to hypertrophic cardiomyopathy provided by 47 lectures, debates, and comprehensive discussions from 36 distinguished international speakers, including Dr. Eugene Braunwald.
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