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Fahmy AS, Rowin EJ, Jaafar N, Chan RH, Rodriguez J, Nakamori S, Ngo LH, Pradella S, Zocchi C, Olivotto I, Manning WJ, Maron M, Nezafat R. Radiomics of Late Gadolinium Enhancement Reveals Prognostic Value of Myocardial Scar Heterogeneity in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2024; 17:16-27. [PMID: 37354155 DOI: 10.1016/j.jcmg.2023.05.003] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) scar burden by cardiac magnetic resonance is a major risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, there is currently limited data on the incremental prognostic value of integrating myocardial LGE radiomics (ie, shape and texture features) into SCD risk stratification models. OBJECTIVES The purpose of this study was to investigate the incremental prognostic value of myocardial LGE radiomics beyond current European Society of Cardiology (ESC) and American College of Cardiology (ACC)/American Heart Association (AHA) models for SCD risk prediction in HCM. METHODS A total of 1,229 HCM patients (62% men; age 52 ± 16 years) from 3 medical centers were included. Left ventricular myocardial radiomic features were calculated from LGE images. Principal component analysis was used to reduce the radiomic features and calculate 3 principal radiomics (PrinRads). Cox and logistic regression analyses were then used to evaluate the significance of the extracted PrinRads of LGE images, alone or in combination with ESC or ACC/AHA models, to predict SCD risk. The ACC/AHA risk markers include LGE burden using a dichotomized 15% threshold of LV scar. RESULTS SCD events occurred in 30 (2.4%) patients over a follow-up period of 49 ± 28 months. Risk prediction using PrinRads resulted in higher c-statistics than the ESC (0.69 vs 0.57; P = 0.02) and the ACC/AHA (0.69 vs 0.67; P = 0.75) models. Risk predictions were improved by combining the 3 PrinRads with ESC (0.73 vs 0.57; P < 0.01) or ACC/AHA (0.76 vs 0.67; P < 0.01) risk scores. The net reclassification index was improved by combining the PrinRads with ESC (0.25 [95% CI: 0.08-0.43]; P = 0.005) or ACC/AHA (0.05 [95% CI: -0.07 to 0.16]; P = 0.42) models. One PrinRad was a significant predictor of SCD risk (HR: 0.57 [95% CI: 0.39-0.84]; P = 0.01). LGE heterogeneity was a major component of PrinRads and a significant predictor of SCD risk (HR: 0.07 [95% CI: 0.01-0.75]; P = 0.03). CONCLUSIONS Myocardial LGE radiomics are strongly associated with SCD risk in HCM and provide incremental risk stratification beyond current ESC or AHA/ACC risk models. Our proof-of-concept study warrants further validation.
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Affiliation(s)
- Ahmed S Fahmy
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Narjes Jaafar
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond H Chan
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Rodriguez
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Shiro Nakamori
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Silvia Pradella
- Department of Radiology, University Hospital Careggi, Florence, Italy
| | - Chiara Zocchi
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Iacopo Olivotto
- Department of Radiology, University Hospital Careggi, Florence, Italy
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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Faisaluddin M, Ahmed A, Patel H, Thakkar S, Patel B, Balasubramanian S, Feitell SC, Shekar P, Rowin E, Maron M, Ganatra S, Dani SS. Surgical Outcomes of Septal Myectomy With and Without Mitral Valve Surgeries in Hypertrophic Cardiomyopathy: a National Propensity-Matched Analysis (2005 to 2020). Am J Cardiol 2023; 205:276-282. [PMID: 37619494 DOI: 10.1016/j.amjcard.2023.07.150] [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: 06/29/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
The management of concomitant mitral valve (MV) disease in patients with hypertrophic cardiomyopathy (HCM) remains controversial. The 2020 American Heart Association/American College of Cardiology HCM guidelines recommend that MV replacement (MVR) at the time of myectomy should not be performed for the sole purpose of relieving outflow obstruction. At the national level, limited data exist on the surgical outcomes of MV repair/replacement in patients with HCM who underwent septal myectomy (SM). Hospitalizations of patients with HCM who underwent SM between 2005 and 2020 were identified using International Classification of Diseases, Ninth and Tenth Revision codes (International Classification of Diseases, Ninth and Tenth Revision Clinical Modification/Procedure Coding System). The 3 comparison cohorts were SM alone, MV repair, and MVR with concomitant SM. After propensity matching, 2 cohorts, SM + MVR versus SM + MV repair, were studied for surgical outcomes. Demographic characteristics, baseline co-morbidities, procedural complications, inpatient mortality, length of stay, and cost of hospitalization were compared between the propensity-matched cohorts. A total of 16,797 SM procedures were identified from 2005 to 2020. Among them, 11,470 hospitalizations had SM alone (68.2%), SM + MVR was seen in 3,101 (18.4%), and SM + MV repair comprised 2,226 (13.2%). After propensity matching, the MVR and MV repair formed the matched cohorts of 1,857. There were no significant differences in the odds of cardiogenic shock (adjusted odds ratio [aOR] 0.88, 95% confidence interval [CI] 0.63 to 1.24, p = 0.49), mechanical circulatory support requirement (aOR 0.58, 95% CI 0.37 to 0.90, p = 0.015), stroke (aOR 1.27, 95% CI 0.81 to 1.99, p = 0.29), and major bleeding (aOR 0.52, 95% CI 0.34 to 0.79, p = 0.0026) between the comparison groups. MVR, compared with MV repair, was associated with a higher risk of procedural mortality (8.02% vs 3.18%, aOR 2.98, 95% CI 2.05 to 4.33, p <0.0001), complete heart block (16.36% vs 12.15%, aOR 1.76, 95% CI 1.44 to 2.12, p <0.0001), and the need for permanent pacemaker (16.39% vs 10.62%, aOR 1.83, 95% CI 1.41 to 2.38, p <0.0001). The total length of hospital stay and median hospitalization cost was higher in the MVR group. SM in HCM concomitant with MVR is associated with higher procedural mortality and in-hospital complication risk. These real-world data support the 2020 American Heart Association/American College of Cardiology guidelines that in patients who are candidates for surgical myectomy, MVR should not be performed as part of the operative strategy for relieving outflow obstruction in HCM.
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Affiliation(s)
- Mohammed Faisaluddin
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Harsh Patel
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, Illinois
| | | | - Bhavin Patel
- Department of Internal Medicine, Saint Joseph Mercy-Oakland, Pontiac, Michigan
| | - Senthil Balasubramanian
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, Illinois
| | - Scott C Feitell
- Division of Cardiovascular Medicine, Rochester General Hospital, Rochester, New York
| | - Prem Shekar
- Division of Cardiothoracic Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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Abdelfattah OM, Martinez M, Sayed A, ElRefaei M, Abushouk A, Hassan A, Masri A, Winters SL, Kapadia S, Maron B, Rowin EJ, Maron M. Abstract P556: Temporal and Global Trends of the Incidence of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: A Meta-Analysis. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p556] [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: 03/18/2023]
Abstract
Introduction:
Since hypertrophic cardiomyopathy(HCM) initial description, sudden cardiac death (SCD) has been the most feared complication of HCM.
Hypothesis:
Temporal, geographical, and age-related trends of SCD rates in HCM have drastically decreased over time.
Methods:
Databases were systematically searched to Nov 2021 for studies reporting on SCD event rates in HCM. Patients with SCD equivalents (appropriate ICD shocks and non-fatal SCD) were excluded. Random-e!ects model was utilized to pool study estimates calculating the overall incidence rates(IR) for each time-era, geographical region, and age-group. We analyzed 2 eras (before vs. after 2000, following implementation of ICD in HCM). Following 2000, 5-year intervals were used to reflect the temporal change in SCD.
Results:
98 studies(N=70,510patients and 431,407patient-years) met inclusion criteria. Overall rate of HCM SCD was 0.43%/year (95% CI: 0.37-0.50%; I2=75%; SCD events:1,938; person-years of follow-up: 408,715), with young patients(<18 years) demonstrating a>2-fold-risk for SCD vs. adults(18- 60years) (IR:1.09%; 95% CI: 0.69-1.73% vs. IR: 0.43%; 95% CI: 0.37-0.50%)(P-value for subgroup di!erences:<0.01). Contemporary SCD rates from 2015-present were 0.32%/year; significantly lower compared to 2000 or earlier (IR: 0.32%; 95% CI:0.20-0.52%, vs. IR: 0.73%; 95% CI:0.53-1.02%,respectively). Reported HCM-SCD rates 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 are low (0.32%/year) representing a 2-fold decrease compared to prior treatment eras, with young HCM patients at the highest risk. SCD risk stratification maturation and primary prevention ICD application are likely responsible for the notable decline in SCD trends. Moreover, worldwide geographical disparities in SCD was evident, underscoring the need to increase access to SCD prevention for all HCM patients.
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Kimmelstiel C, Everett KD, Jain P, Miyashita S, Botto R, Resor C, Rowin E, Maron M, Kapur NK. Transcatheter Mitral Intervention Relieves Dynamic Outflow Obstruction and Reduces Cardiac Workload in Hypertrophic Cardiomyopathy. Circ Heart Fail 2022; 15:e009171. [PMID: 35189689 DOI: 10.1161/circheartfailure.121.009171] [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: 11/16/2022]
Affiliation(s)
- Carey Kimmelstiel
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.).,Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA. (C.K., E.R., M.M.)
| | - Kay D Everett
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.)
| | - Pankaj Jain
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.)
| | - Satoshi Miyashita
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.)
| | - Richard Botto
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.)
| | - Charles Resor
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.)
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA. (C.K., E.R., M.M.)
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA. (C.K., E.R., M.M.)
| | - Navin K Kapur
- The Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, MA. (C.K., K.D.E., P.J., S.M., R.B., C.R., N.K.K.)
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Butzner M, Maron M, Sarocco P, Teng CC, Stanek E, Tan H, Robertson L. Healthcare resource utilization and cost of obstructive hypertrophic cardiomyopathy in a US population. Am Heart J Plus 2022; 13:100089. [PMID: 38560082 PMCID: PMC10978189 DOI: 10.1016/j.ahjo.2022.100089] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 04/04/2024]
Abstract
Background There are limited data evaluating all-cause and disease-related healthcare resource utilization (HCRU) and cost of care for patients with obstructive hypertrophic cardiomyopathy (oHCM). Methods This was a retrospective study using US longitudinal medical and pharmacy claims data during 2012-2020. Adults with ≥2 oHCM diagnoses were identified, with the first diagnosis date used as the index date. HCRU and costs of care were reported for the year preindex (baseline) and at 1- and 2-year follow-ups. Results We identified 1841 patients with oHCM (63 ± 15 years; 52% male). The mean number of hypertrophic cardiomyopathy (HCM)-related outpatient and cardiology visits increased from baseline to 1-year follow-up (2.3 vs. 7.8 and 0.6 vs. 2.2, respectively). At baseline, 8% of patients had ≥1 HCM-related inpatient hospitalization (mean 0.11 visits, 5.4 days length of stay), increasing to 27% postdiagnosis (mean 0.42 visits, 5.9 days length of stay). Total HCM-related costs increased from $5968 to $20,290 at 1-year follow-up, largely driven by inpatient hospitalization costs ($3889 vs. $14,369) and surgical costs ($2259 vs. $7217). The proportion with ≥1 HCM-related prescription increased from baseline (69%; mean fills 5.3) to 1-year follow-up (82%; mean fills 7.8). Pharmacy costs were generally low but also increased ($449 vs. $752). Conclusions This benchmark economic dataset for management and evaluation of patients with oHCM shows increased HCM-related costs over a 2-year period after oHCM diagnosis, driven by inpatient hospitalizations and surgical costs. Medication use was high, but costs were low, possibly reflecting use of generic multi-indication drugs for oHCM treatment.
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Affiliation(s)
- Michael Butzner
- Cytokinetics, Incorporated, Health Economics and Outcomes Research, South San Francisco, CA, USA
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Phil Sarocco
- Cytokinetics, Incorporated, Health Economics and Outcomes Research, South San Francisco, CA, USA
| | | | | | | | - Laura Robertson
- Cytokinetics, Incorporated, Clinical Research, South San Francisco, CA, USA
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Butzner M, Sarocco P, Maron M, Rowin E, Tan H, Teng CC, Stanek E, Robertson L. CLINICAL PROFILE OF OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY IN A NATIONWIDE PATIENT COHORT. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02072-6] [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: 10/21/2022]
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Mancio J, Pashakhanloo F, El-Rewaidy H, Jang J, Joshi G, Csecs I, Ngo L, Rowin E, Manning W, Maron M, Nezafat R. Machine learning phenotyping of scarred myocardium from cine in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:532-542. [PMID: 33779725 DOI: 10.1093/ehjci/jeab056] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) with late-gadolinium enhancement (LGE) is increasingly being used in hypertrophic cardiomyopathy (HCM) for diagnosis, risk stratification, and monitoring. However, recent data demonstrating brain gadolinium deposits have raised safety concerns. We developed and validated a machine-learning (ML) method that incorporates features extracted from cine to identify HCM patients without fibrosis in whom gadolinium can be avoided. METHODS AND RESULTS An XGBoost ML model was developed using regional wall thickness and thickening, and radiomic features of myocardial signal intensity, texture, size, and shape from cine. A CMR dataset containing 1099 HCM patients collected using 1.5T CMR scanners from different vendors and centres was used for model development (n=882) and validation (n=217). Among the 2613 radiomic features, we identified 7 features that provided best discrimination between +LGE and -LGE using 10-fold stratified cross-validation in the development cohort. Subsequently, an XGBoost model was developed using these radiomic features, regional wall thickness and thickening. In the independent validation cohort, the ML model yielded an area under the curve of 0.83 (95% CI: 0.77-0.89), sensitivity of 91%, specificity of 62%, F1-score of 77%, true negatives rate (TNR) of 34%, and negative predictive value (NPV) of 89%. Optimization for sensitivity provided sensitivity of 96%, F2-score of 83%, TNR of 19% and NPV of 91%; false negatives halved from 4% to 2%. CONCLUSION An ML model incorporating novel radiomic markers of myocardium from cine can rule-out myocardial fibrosis in one-third of HCM patients referred for CMR reducing unnecessary gadolinium administration.
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Affiliation(s)
- Jennifer Mancio
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Farhad Pashakhanloo
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Hossam El-Rewaidy
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Computer Science, Technical University of Munich, Arcisstraße 21, 80333 Munich, Germany
| | - Jihye Jang
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Computer Science, Technical University of Munich, Arcisstraße 21, 80333 Munich, Germany
| | - Gargi Joshi
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Ibolya Csecs
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Ethan Rowin
- HCM Institute, Division of Cardiology, Tufts Medical Centre, 860 Washington St Building, 6th Floor, Boston, MA 02111, USA
| | - Warren Manning
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Radiology, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Martin Maron
- HCM Institute, Division of Cardiology, Tufts Medical Centre, 860 Washington St Building, 6th Floor, Boston, MA 02111, USA
| | - Reza Nezafat
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Uretsky S, Bangash A, Rowin E, Horgan S, Hiramatsu S, Lasam G, Gillam LD, Maron M. Determinants of LV Dilatation in Patients With Hypertrophic Cardiomyopathy and Preserved Systolic Function: A CMR Study. JACC Cardiovasc Imaging 2020; 14:298-300. [PMID: 32828774 DOI: 10.1016/j.jcmg.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
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Pelliccia F, Alfieri O, Calabrò P, Cecchi F, Ferrazzi P, Gragnano F, Kaski JP, Limongelli G, Maron M, Rapezzi C, Seggewiss H, Yacoub MH, Olivotto I. Multidisciplinary evaluation and management of obstructive hypertrophic cardiomyopathy in 2020: Towards the HCM Heart Team. Int J Cardiol 2020; 304:86-92. [DOI: 10.1016/j.ijcard.2020.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/10/2020] [Indexed: 01/29/2023]
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Carrick R, Maron M, Wessler B, Maron B, Rowin E. NEW ONSET AF CAN BE PREDICTED WITH HIGH RELIABILITY IN HCM: A CLINICAL PREDICTIVE MODEL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31570-9] [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: 10/24/2022]
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Rowin E, Maron B, Wells SB, Burrows A, Firely C, Patel AR, Maron M. GLOBAL LONGITUDINAL STRAIN PREDICTS PROGRESSIVE HEART FAILURE IN NONOBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31542-4] [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: 10/24/2022]
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Kramer C, DiMarco JP, Kolm P, Ho C, Kwong RY, Desai MY, Desvigne-Nickens P, Dolman S, Appelbaum E, Friedrich M, Geller N, Jerosch-Herold M, Kim DY, Maron M, Schulz-Menger J, Piechnik S, Zhang C, Watkins H, Weintraub WS, Neubauer S. PREDICTORS OF CLINICALLY SIGNIFICANT ATRIAL FIBRILLATION IN THE NHLBI HYPERTROPHIC CARDIOMYOPATHY REGISTRY (HCMR). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31303-6] [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: 11/26/2022]
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Ghiselli L, Marchi A, Fumagalli C, Maurizi N, Oddo A, Pieri F, Girolami F, Rowin E, Mazzarotto F, Cicoira M, Ribichini F, Arretini A, Targetti M, Passantino S, Cecchi F, Marchionni N, Maron M, Mori F, Olivotto I. Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy. Eur J Prev Cardiol 2019; 27:1821-1831. [PMID: 31698967 DOI: 10.1177/2047487319886961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 11/17/2022]
Abstract
AIMS Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. METHODS We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. RESULTS Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83-11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females (p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39-0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66-2.24; p = 0.53). CONCLUSIONS Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.
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Affiliation(s)
- Luca Ghiselli
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.,Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Marchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Oddo
- Cardiology Department, Careggi University Hospital, Florence, Italy
| | - Francesco Pieri
- Cardiology Department, Careggi University Hospital, Florence, Italy
| | - Francesca Girolami
- Department of Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Francesco Mazzarotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | | | - Flavio Ribichini
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Anna Arretini
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Passantino
- Department of Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy
| | - Franco Cecchi
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milano, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Fabio Mori
- Cardiology Department, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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Affiliation(s)
- Martin Maron
- Hypertrophic Cardiomyopathy Center Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
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Dannock RJ, Pays O, Renaud PC, Maron M, Goldizen AW. Assessing blue wildebeests' vigilance, grouping and foraging responses to perceived predation risk using playback experiments. Behav Processes 2019; 164:252-259. [PMID: 31121214 DOI: 10.1016/j.beproc.2019.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/13/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
Two aspects of reactive antipredator behaviour are still unclear for ungulates. First, when there is a direct predation threat, how do prey balance antipredator and social vigilance to learn a predator's location and assess the risk? Second, how do an individual's group and environment affect its responses? We tested the responses of adult females in 101 groups of wildebeest to playbacks of lion roars or car noises in Etosha National Park, Namibia. We analysed how the times they spent in different types categories of vigilance, and their within-group density, were affected by the playbacks and how a range of social and environmental variables affected those responses. Females increased their antipredator vigilance but not their social vigilance, after lion roars but not car noises, suggesting that they mostly relied on their own vigilance rather than social information to try to find the source of the lion roars. Females' antipredator vigilance increased more when they were further from cover and with other prey species, suggesting that both circumstances increased their perception of risk. They 'bunched' more after lion roars than car noises and their bite rates decreased as they bunched. Animals' use of social information about threats is likely to be context-dependent.
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Affiliation(s)
- R J Dannock
- School of Biological Sciences, the University of Queensland, Brisbane, Qld 4072, Australia
| | - O Pays
- UMR CNRS 6554 LETG-Angers, Université d'Angers, 2 Bd Lavoisier, F-49045, Angers, France; LTSER France, CNRS, Hwange National Park, Bag 62, Dete, Zimbabwe
| | - P-C Renaud
- UMR CNRS 6554 LETG-Angers, Université d'Angers, 2 Bd Lavoisier, F-49045, Angers, France
| | - M Maron
- School of Earth and Environmental Sciences, the University of Queensland, Brisbane, Qld 4072, Australia
| | - A W Goldizen
- School of Biological Sciences, the University of Queensland, Brisbane, Qld 4072, Australia.
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Garnett ST, Butchart SHM, Baker GB, Bayraktarov E, Buchanan KL, Burbidge AA, Chauvenet ALM, Christidis L, Ehmke G, Grace M, Hoccom DG, Legge SM, Leiper I, Lindenmayer DB, Loyn RH, Maron M, McDonald P, Menkhorst P, Possingham HP, Radford J, Reside AE, Watson DM, Watson JEM, Wintle B, Woinarski JCZ, Geyle HM. Metrics of progress in the understanding and management of threats to Australian birds. Conserv Biol 2019; 33:456-468. [PMID: 30465331 DOI: 10.1111/cobi.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/14/2018] [Accepted: 08/03/2018] [Indexed: 06/09/2023]
Abstract
Although evidence-based approaches have become commonplace for determining the success of conservation measures for the management of threatened taxa, there are no standard metrics for assessing progress in research or management. We developed 5 metrics to meet this need for threatened taxa and to quantify the need for further action and effective alleviation of threats. These metrics (research need, research achievement, management need, management achievement, and percent threat reduction) can be aggregated to examine trends for an individual taxon or for threats across multiple taxa. We tested the utility of these metrics by applying them to Australian threatened birds, which appears to be the first time that progress in research and management of threats has been assessed for all threatened taxa in a faunal group at a continental scale. Some research has been conducted on nearly three-quarters of known threats to taxa, and there is a clear understanding of how to alleviate nearly half of the threats with the highest impact. Some management has been attempted on nearly half the threats. Management outcomes ranged from successful trials to complete mitigation of the threat, including for one-third of high-impact threats. Progress in both research and management tended to be greater for taxa that were monitored or occurred on oceanic islands. Predation by cats had the highest potential threat score. However, there has been some success reducing the impact of cat predation, so climate change (particularly drought), now poses the greatest threat to Australian threatened birds. Our results demonstrate the potential for the proposed metrics to encapsulate the major trends in research and management of both threats and threatened taxa and provide a basis for international comparisons of evidence-based conservation science.
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Affiliation(s)
- S T Garnett
- Threatened Species Recovery Hub, National Environmental Science Program, Research Institute for the Environment and Livelihoods, Charles Darwin University, Northern Territory, 0909, Australia
| | - S H M Butchart
- BirdLife International, David Attenborough Building, Pembroke Street, Cambridge, CB2 3QZ, U.K
- Department of Zoology, The University of Cambridge, Downing Street, Cambridge, CB2 3EJ, U.K
| | - G B Baker
- Institute for Marine and Antarctic Studies, The University of Tasmania, Hobart, Tasmania, 7005, Australia
| | - E Bayraktarov
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - K L Buchanan
- School of Life and Environmental Sciences, Deakin University, 75 Pigdons Road, Geelong, Victoria, 3216, Australia
| | - A A Burbidge
- 87 Rosedale Street, Floreat, Western Australia, 6014, Australia
| | - A L M Chauvenet
- School of Environment and Science & Environmental Futures Research Institute, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - L Christidis
- National Marine Science Centre, Southern Cross University, Lismore, New South Wales, 2480, Australia
| | - G Ehmke
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
- BirdLife Australia, Carlton, Victoria, 3053, Australia
| | - M Grace
- Department of Zoology, The University of Oxford, Oxford, OX1 3PS, U.K
| | - D G Hoccom
- Royal Society for the Protection of Birds, Bedfordshire, SG 19 2DL, U.K
| | - S M Legge
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
- Threatened Species Recovery Hub, National Environmental Science Program, Fenner School of Environment and Society, The Australian National University, Canberra, Australian Capital Territory, 2601, Australia
| | - I Leiper
- Threatened Species Recovery Hub, National Environmental Science Program, Research Institute for the Environment and Livelihoods, Charles Darwin University, Northern Territory, 0909, Australia
| | - D B Lindenmayer
- Threatened Species Recovery Hub, National Environmental Science Program, Fenner School of Environment and Society, The Australian National University, Canberra, Australian Capital Territory, 2601, Australia
| | - R H Loyn
- The Centre for Freshwater Ecosystems, School of Life Sciences, La Trobe University, Wodonga, Victoria, 3690, Australia
- Institute for Land, Water and Society, Charles Sturt University, Albury, New South Wales, 2640, Australia
- Eco Insights, Beechworth, Victoria, 3747, Australia
| | - M Maron
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
- School of Earth and Environmental Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - P McDonald
- Zoology, School of Environmental and Rural Science, University of New England, Armidale, New South Wales, 2351, Australia
| | - P Menkhorst
- Arthur Rylah Institute for Environmental Research, Department of Environment, Land, Water and Planning, Heidelberg, Victoria, 3084, Australia
| | - H P Possingham
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
- The Nature Conservancy, Arlington, VA, 22203-1606, U.S.A
| | - J Radford
- Department of Ecology, Environment and Evolution, La Trobe University, Bundoora, Victoria, 3086, Australia
- Research Centre for Future Landscapes, La Trobe University, Bundoora, Victoria, 3086, Australia
| | - A E Reside
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - D M Watson
- Institute for Land, Water and Society, Charles Sturt University, Albury, New South Wales, 2640, Australia
| | - J E M Watson
- Threatened Species Recovery Hub, National Environmental Science Program, Centre for Biodiversity and Conservation Science, The University of Queensland, St Lucia, Qld, 4072, Australia
- School of Earth and Environmental Sciences, The University of Queensland, St Lucia, 4072, Australia
- Wildlife Conservation Society, Bronx, NY, 10460-1068, U.S.A
| | - B Wintle
- School of Bioscience, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - J C Z Woinarski
- Threatened Species Recovery Hub, National Environmental Science Program, Research Institute for the Environment and Livelihoods, Charles Darwin University, Northern Territory, 0909, Australia
| | - H M Geyle
- Threatened Species Recovery Hub, National Environmental Science Program, Research Institute for the Environment and Livelihoods, Charles Darwin University, Northern Territory, 0909, Australia
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Romashko M, Maron M, Maron B, Udelson J, Testani JM, Rowin E. PREVALENCE, CLINICAL PROFILE, AND OUTCOME OF CARDIORENAL SYNDROME IN SYMPTOMATIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31369-5] [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: 11/25/2022]
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Fatima A, Maron M, Maron B, Rowin E. IDENTIFICATION OF CARDIAC AMYLOIDOSIS AMONG A COHORT OF HYPERTROPHIC CARDIOMYOPATHY PATIENTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31616-x] [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: 10/27/2022]
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Rahban Y, Zisa D, Davila C, Rowin E, Wells S, Maron M, Udelson J, Carroll C, Kapur N, Weintraub A, Wessler B, Kimmelstiel C. TCT-828 Clinical Outcomes Following Focal Ablation – a New Technique for the Performance of Alcohol Septal Ablation. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2070] [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: 10/28/2022]
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Neubauer S, Weintraub W, Appelbaum E, Desai M, Desvigne-Nickens P, Dimarco J, Dolman S, Ho C, Jerosch-Herold M, Kolm P, Kwong R, Maron M, Schulz-Menger J, Watkins H, Kramer C. P3165Baseline characteristics of the hypertrophic cardiomyopathy registry (n=2773). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Affiliation(s)
- S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - W Weintraub
- Medstar Research Institute, Washington, United States of America
| | - E Appelbaum
- Harvard Medical School, Boston, United States of America
| | - M Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Desvigne-Nickens
- National Institutes of Health, NHLBI, Bethesda, United States of America
| | - J Dimarco
- University of Virginia, Charlottesville, United States of America
| | - S Dolman
- Medstar Research Institute, Washington, United States of America
| | - C Ho
- Harvard Medical School, Boston, United States of America
| | | | - P Kolm
- Medstar Research Institute, Washington, United States of America
| | - R Kwong
- Harvard Medical School, Boston, United States of America
| | - M Maron
- Harvard Medical School, Boston, United States of America
| | | | - H Watkins
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - C Kramer
- University of Virginia, Charlottesville, United States of America
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Rowin E, Romashko M, Maron BJ, Rastegar H, Maron M. MASSIVE LV HYPERTROPHY IN HYPERTROPHIC CARDIOMYOPATHY IS A HIGH-RISK SUBGROUP, BUT IS ASSOCIATED WITH FAVORABLE OUTCOME WITH CONTEMPORARY TREATMENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31206-3] [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: 10/17/2022]
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Rowin E, Maron BJ, Chokshi A, Kannappan M, Arkun K, Rastegar H, Maron M. OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY WITH MILD PHENOTYPE: A NOVEL SUBGROUP OF PATIENTS AMENABLE TO SURGICAL MYECTOMY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31433-5] [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: 11/15/2022]
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Rowin E, Maron BJ, Abt P, Kiernan M, Vest A, Costantino F, Maron M, DeNofrio D. THE IMPACT OF ADVANCED THERAPIES IN IMPROVING SURVIVAL TO HEART TRANSPLANT IN HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wells SB, Rowin E, Boll G, Rastegar H, Maron M, Maron BJ. PREVALENCE AND CLINICAL FEATURES OF NONRESPONDERS TO SURGICAL MYECTOMY WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31202-6] [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: 11/29/2022]
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Tirpaeck L, Grewal V, Katsikeris F, Khan E, Turk A, Montfort JH, Maron M. CARDIAC AMYLOID-LVOTO-OSIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32920-6] [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: 11/24/2022]
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Adalsteinsdottir B, Palsson R, Desnick RJ, Gardarsdottir M, Teekakirikul P, Maron M, Appelbaum E, Neisius U, Maron BJ, Burke MA, Chen B, Pagant S, Madsen CV, Danielsen R, Arngrimsson R, Feldt-Rasmussen U, Seidman JG, Seidman CE, Gunnarsson GT. Fabry Disease in Families With Hypertrophic Cardiomyopathy: Clinical Manifestations in the Classic and Later-Onset Phenotypes. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001639. [PMID: 28798024 DOI: 10.1161/circgenetics.116.001639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/07/2016] [Accepted: 06/15/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The screening of Icelandic patients clinically diagnosed with hypertrophic cardiomyopathy resulted in identification of 8 individuals from 2 families with X-linked Fabry disease (FD) caused by GLA(α-galactosidase A gene) mutations encoding p.D322E (family A) or p.I232T (family B). METHODS AND RESULTS Familial screening of at-risk relatives identified mutations in 16 family A members (8 men and 8 heterozygotes) and 25 family B members (10 men and 15 heterozygotes). Clinical assessments, α-galactosidase A (α-GalA) activities, glycosphingolipid substrate levels, and in vitro mutation expression were used to categorize p.D322E as a classic FD mutation and p.I232T as a later-onset FD mutation. In vitro expression revealed that p.D322E and p.I232T had α-GalA activities of 1.4% and 14.9% of the mean wild-type activity, respectively. Family A men had markedly decreased α-GalA activity and childhood-onset classic manifestations, except for angiokeratoma and cornea verticillata. Family B men had residual α-GalA activity and developed FD manifestations in adulthood. Despite these differences, all family A and family B men >30 years of age had left ventricular hypertrophy, which was mainly asymmetrical, and had similar late gadolinium enhancement patterns. Ischemic stroke and severe white matter lesions were more frequent among family A men, but neither family A nor family B men had overt renal disease. Family A and family B heterozygotes had less severe or no clinical manifestations. CONCLUSIONS Men with classic or later-onset FD caused by GLA missense mutations developed prominent and similar cardiovascular disease at similar ages, despite markedly different α-GalA activities.
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Affiliation(s)
- Berglind Adalsteinsdottir
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.).
| | - Runolfur Palsson
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Robert J Desnick
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Marianna Gardarsdottir
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Polakit Teekakirikul
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Martin Maron
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Evan Appelbaum
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Ulf Neisius
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Barry J Maron
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Michael A Burke
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Brenden Chen
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Silvere Pagant
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Christoffer V Madsen
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Ragnar Danielsen
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Reynir Arngrimsson
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Ulla Feldt-Rasmussen
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Jonathan G Seidman
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Christine E Seidman
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
| | - Gunnar Th Gunnarsson
- From the Faculty of Medicine, University of Iceland, Reykjavik, Iceland (B.A., R.P., R.A., G.T.G.); Division of Cardiology (B.A., R.D.), Department of Genetics (R.A.), Division of Nephrology (R.P.), and Department of Radiology (M.G.), Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Department of Cardiology, Haukeland University Hospital, Bergen, Norway (B.A.); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.D., B.C., S.P.); Department of Genetics, Harvard Medical School, Boston, MA (P.T., M.A.B., J.G.S., C.E.S.); Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A., U.N.); Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (M.M., B.J.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.B., C.E.S.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (M.A.B.); Department of Medical Endocrinology, Rigshospitalet and University of Copenhagen, Denmark (C.V.M., U.F.-R.); Howard Hughes Medical Institute, Boston, MA (C.E.S.); and Department of Medicine, Akureyri Hospital, Iceland (G.T.G.)
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Abt P, Rowin EJ, Maron B, Kiernan M, Vest A, Constantino F, Maron M, DeNofrio D. Heart Transplantation for Hypertrophic Cardiomyopathy: The Tufts Experience. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.049] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Miller C, Maron M, Maron B, Rowin E, Estes N, Link M. ANTIARRHYTHMIC MEDICATIONS FOR ATRIAL FIBRILLATION APPEAR REASONABLY SAFE IN HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33757-9] [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: 12/01/2022]
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Kato S, Bellm S, Roujol S, Jang J, Basha T, Berg S, Kissinger KV, Goddu B, Maron M, Manning WJ, Nezafat R. Diffuse Myocardial Fibrosis detected by Multi-slice T1 Mapping using Slice Interleaved T1 (STONE) Sequence in Patients with Hypertrophic Cardiomyopathy. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032287 DOI: 10.1186/1532-429x-18-s1-p238] [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: 11/10/2022] Open
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Kato S, Nakamori S, Bellm S, Jang J, Basha T, Maron M, Manning WJ, Nezafat R. Myocardial Native T1 Time in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 118:1057-62. [PMID: 27567135 DOI: 10.1016/j.amjcard.2016.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 01/07/2023]
Abstract
In hypertrophic cardiomyopathy (HC), there are significant variations in left ventricular (LV) wall thickness and fibrosis, which necessitates a volumetric coverage. Slice-interleaved T1 (STONE) mapping sequence allows for the assessment of native T1 time with complete coverage of LV myocardium. The aims of this study were to evaluate spatial heterogeneity of native T1 time in patients with HC. Twenty-nine patients with HC (55 ± 16 years) and 15 healthy adult control subjects (46 ± 19 years) were studied. Native T1 mapping was performed using STONE sequence which enables acquisition of 5 slices in the short-axis plane within a 90 seconds free-breathing scan. We measured LV native T1 time and maximum LV wall thickness in each 16 segments from 3 slices (basal, midventricular and apical slice). Late gadolinium enhanced (LGE) magnetic resonance imaging was acquired to assess the presence of myocardial enhancement. In patients with HC, LV native T1 time was significantly elevated compared with healthy controls, regardless of the presence or absence of LGE (mean native T1 time; LGE positive segments from HC, 1,141 ± 46 ms; LGE negative segments from HC, 1,114 ± 56 ms; segments from healthy controls, 1,065 ± 35 ms, p <0.001). Elevation of native T1 time was defined as >1,135 ms, which was +2SD of native T1 time by STONE sequence in healthy controls. A total of 120 of 405 (30%) LGE negative segments from patients with HC showed elevated native T1 time. Prevalence of segments with elevated native T1 time for basal, midventricular, and apical slice was 29%, 25%, 38%, respectively. Significant correlation was found between LV wall thickness and LV native T1 time (y = 0.029 × -22.6, p <0.001 by Spearman's correlation coefficient). In conclusion, substantial number of segments without LGE showed elevation of native T1 time, and whole-heart T1 mapping revealed heterogeneity of myocardial native T1 time in patients with HC.
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Abstract
A central topic for conservation science is evaluating how human activities influence global species diversity. Humanity exacerbates extinction rates. But by what mechanisms does humanity drive the emergence of new species? We review human-mediated speciation, compare speciation and known extinctions, and discuss the challenges of using net species diversity as a conservation objective. Humans drive rapid evolution through relocation, domestication, hunting and novel ecosystem creation-and emerging technologies could eventually provide additional mechanisms. The number of species relocated, domesticated and hunted during the Holocene is of comparable magnitude to the number of observed extinctions. While instances of human-mediated speciation are known, the overall effect these mechanisms have upon speciation rates has not yet been quantified. We also explore the importance of anthropogenic influence upon divergence in microorganisms. Even if human activities resulted in no net loss of species diversity by balancing speciation and extinction rates, this would probably be deemed unacceptable. We discuss why, based upon 'no net loss' conservation literature-considering phylogenetic diversity and other metrics, risk aversion, taboo trade-offs and spatial heterogeneity. We conclude that evaluating speciation alongside extinction could result in more nuanced understanding of biosphere trends, clarifying what it is we actually value about biodiversity.
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Affiliation(s)
- J W Bull
- Department of Food and Resource Economics and Center for Macroecology, Evolution and Climate, University of Copenhagen, Rolighedsvej 23, 1958 Copenhagen, Denmark
| | - M Maron
- School of Geography, Planning and Environmental Management, The University of Queensland, Brisbane, Queensland 4072, Australia
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Maurer MS, Ginns J, Maron B, Olivotto I, Lesser J, Gruner C, Crean A, Rakowski H, Rowin E, Lombardi M, Spirito P, Biagini E, Autore C, Manning W, Tomberli B, Maron M, Chan R. THE MYOCARDIAL CONTRACTION FRACTION (MCF) IS ASSOCIATED WITH NYHA CLASS AS WELL AS DELAYED ENHANCEMENT BY CARDIAC MRI IN HYPERTROPHIC CARDIOMYOPATHY AND PREDICTS SUDDEN CARDIAC DEATH. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31509-1] [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: 10/22/2022]
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Warner PJ, Cronkright AA, Dolan N, Maron M, Huggins GS. Carriers of Variants of Unknown Significance Have Intermediate Hypertrophic Cardiomyopathy Phenotypes. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maron BJ, Casey S, Garberich R, Rowin EJ, Maron M. ASSESSMENT OF EUROPEAN SOCIETY OF CARDIOLOGY SUDDEN CARDIAC DEATH RISK MODEL FOR HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60359-x] [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: 11/25/2022]
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Chan RH, Maron BJ, Olivotto I, Assenza GE, Haas TS, Lesser JR, Gruner C, Crean A, Rakowski H, Udelson JE, Rowin EJ, Lombardi M, Cecchi F, Tomberli B, Spirito P, Formisano F, Biagini E, Rapezzi C, De Cecco CN, Autore C, Hong SN, Gibson MC, Manning WJ, Appelbaum E, Maron M. Late gadolinium enhancement score (LGE-Score) for prediction of extensive late gadolinium enhancement in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328576 DOI: 10.1186/1532-429x-17-s1-q59] [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: 12/02/2022] Open
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Caselli S, Maron M, Moral JAU, Pandian N, Maron B, Pelliccia A. LEFT VENTRICULAR HYPERTROPHY IN ATHLETES: THE “GRAY-ZONE” REVISITED. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60842-1] [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: 11/29/2022]
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Gruner C, Chan R, Appelbaum E, Rowin E, Care M, Williams L, Gibson M, Lesser J, Haas T, Udelson J, Manning W, Tomberli B, Olivotto I, Maron B, Crean A, Maron M, Rakowski H. LACK OF PHENOTYPIC DIFFERENCES BY CMRI IN THE TWO MOST COMMON SARCOMERE PROTEIN GENE MUTATIONS IN HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61222-x] [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: 10/27/2022]
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Rowin E, Maron M. Noncontrast T1 values do not correlate to clinically relevant variables in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559595 DOI: 10.1186/1532-429x-15-s1-p106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rowin E, Maron M. The necessity for full ventricular coverage with noncontrast T1 mapping in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2013; 15 Suppl 1:E1-124, M1-14, O1-114, P1-300, T1-11, W-39. [PMID: 23452865 PMCID: PMC3559292 DOI: 10.1186/1532-429x-15-s1-e1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chan RH, Hong S, Haas TS, Feeney K, Lesser J, Gibson MC, Manning WJ, Maron BJ, Maron M, Appelbaum E. Characterization of patients with massive hypertrophic cardiomyopathy using contrast-enhanced magnetic resonance imaging: does contrast provide additional information? J Cardiovasc Magn Reson 2012. [PMCID: PMC3304824 DOI: 10.1186/1532-429x-14-s1-o99] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chan RH, Maron M, Hong S, Haas TS, Lesser J, Gibson CM, Manning WJ, Maron BJ, Appelbaum E. Late gadolinium enhancement is compatible with advanced age in hypertrophic cardiomyopathy: implications for risk stratification of sudden death. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305255 DOI: 10.1186/1532-429x-14-s1-p156] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Caselli S, Pelliccia A, Maron M, Santini D, Puccio D, Marcantonio A, Pandian NG, De Castro S. Differentiation of hypertrophic cardiomyopathy from other forms of left ventricular hypertrophy by means of three-dimensional echocardiography. Am J Cardiol 2008; 102:616-20. [PMID: 18721523 DOI: 10.1016/j.amjcard.2008.04.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 04/09/2008] [Accepted: 04/09/2008] [Indexed: 11/24/2022]
Abstract
In clinical practice, differential diagnosis among different forms of left ventricular (LV) hypertrophy is not always easy, and hypertrophic cardiomyopathy (HC) can be misdiagnosed. In this study, it was hypothesized that a 3-dimensional echocardiographically derived index of LV regional mass distribution could be useful in differentiating HC from other forms of LV hypertrophy. Sixty-eight subjects underwent 2- and 3-dimensional echocardiography; of these, 20 were healthy volunteers, 18 were top-level athletes, 15 had essential hypertension, and 15 had HC. In off-line analysis, a 12-segment model was generated for segmental mass measurement. A mass dispersion index (MDI) was calculated as the average of the SDs of segmental mass values at the basal, middle, and apical layers. The ratio of ventricular septal thickness to posterior wall thickness was also calculated using 2-dimensional echocardiography. Patients with HC had significantly higher MDI values (1.75 +/- 0.43) than healthy volunteers (0.39 +/- 0.13) (p <0.0001), athletes (0.49 +/- 0.12) (p <0.0001), and patients with hypertension (0.38 +/- 0.10) (p <0.0001). The ratio of ventricular septal thickness to posterior wall thickness was significantly higher in patients with HC (1.31 +/- 0.23) than normal subjects (1.04 +/- 0.05) (p <0.0001), highly trained athletes (1.03 +/- 0.06) (p = 0.001), and patients with hypertension (1.06 +/- 0.06) (p = 0.002). However, receiver-operating characteristic analysis showed a higher sensitivity for MDI (93.3% for the cut-off value of 1.13) than the ratio of ventricular septal thickness to posterior wall thickness (66.7% for the cut-off value of 1.20), with excellent specificity for both (100%) in identifying patients with HC. In conclusion, the 3-dimensional echocardiographically derived MDI could be considered a useful and reliable additional tool in differentiating HC from other forms of LV hypertrophy.
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De Castro S, Caselli S, Maron M, Pelliccia A, Cavarretta E, Maddukuri P, Cartoni D, Di Angelantonio E, Kuvin JT, Patel AR, Pandian NG. Left ventricular remodelling index (LVRI) in various pathophysiological conditions: a real-time three-dimensional echocardiographic study. Heart 2006; 93:205-9. [PMID: 16914482 PMCID: PMC1861397 DOI: 10.1136/hrt.2006.093997] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [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] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Various studies have reported a close correlation between real-time three-dimensional echocardiography (RT3DE) and cine magnetic resonance imaging studies for the assessment of cardiac volumes and mass. OBJECTIVE The aim of our study was to evaluate changes in left ventricular volumes and mass in subjects with different pathophysiological conditions. A ratio between left ventricular mass and end-diastolic volume (LVRI), detected by RT3DE, was used to describe various patterns of left ventricular remodelling. METHODS RT3DE was performed to calculate left ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV), ejection fraction (LVEF) and mass in 220 selected subjects. Of these, 152 were healthy volunteers, 19 top-level rowers, 23 patients with dilated cardiomyopathy and 26 patients with hypertrophic cardiomyopathy. Off-line analysis was performed by two independent operators by tracing manual endocardial and epicardial borders of the left ventricle through eight cutting planes. Inter- and intra-observer variability were calculated. RESULTS Despite the increase in LV volume and mass in the rowers, LVRI remained unchanged compared with control subjects (p = 0.455), while significantly lower values were found patients with dilated cardiomyopathy (p<0.001) and significantly higher values in patients with hypertrophic cardiomyopathy (p<0.001). There was inter- and intra-observer variability. CONCLUSION The LVRI may serve as a simple and useful indicator of left ventricular adaptation to physiological and pathological conditions.
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Affiliation(s)
- Stefano De Castro
- Department of Cardiovascular, Respiratory and Morphological Sciences, La Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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Nakhoul F, Ramadan R, Maron M, Abassi Z. Post-splenectomy pseudohyperkalemia in a patient with chronic idiopathic myelofibrosis and thrombocytosis. Clin Nephrol 2005; 64:243-6. [PMID: 16175953 DOI: 10.5414/cnp64243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Vaiva G, Maron M, Chapoy V, Thomas P, Codaccioni X, Goudemand M. [Value of a consultation center and crisis intervention in addressing psychiatric disorders in the perinatal period]. Encephale 2002; 28:71-6. [PMID: 11963346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The Psychiatry department of the University Hospital Centre of Lille has developed, over the last 10 years, a treatment network for psychiatric disorders during pregnancy or in the post-partum period. There are liaison consultations in the maternity department, screening and management of psychopathological disorders in the perinatal period, training of midwives, support of patients seeking genetic counselling, collaboration with teams providing "medically-assisted procreation", etc. For severe disorders of the post-partum period (severe depression, serious alteration of mother-child interaction, puerperal psychosis), the Psychiatry department has a specialized unit where 3 "mother-child" groups can be admitted. This unit is particularly effective if the patients and their family understand this healthcare system and stick to it to a certain extent. Even if improvements are always possible, cases in which situations occur as an emergency, are when dysfunctions are most frequently seen. On 7th December 1998, a Crisis Intervention Unit (CIU) was created with 15 short-term beds, for stays up to 72 hours. The CIU was opened in the Psychiatry department, close to the main Accident and Emergency department, with 2 aims: firstly to provide a setting and resources for a number of emergency psychiatric situations, and secondly to provide a place and time for crisis situations which we admit to the unit, with a view to facilitating interaction and to propose in certain cases a process of crisis intervention, which later continues on an outpatient basis. After being open for a year, the CIU has proved to be an improvement to all of the healthcare services which are available. It should be noted that the situations which need highly specialized resources in such a short time, are those which cause the most acute problems. This is at times when the emergency services network, with its internal logic, require another network based on a different logic, that the interface problems are at their most acute. The situations reported here, which require a fluid interface between the emergency services and the "mother-child" networks, are examples. We report 3 clinical situations, which illustrate 3 possibilities of action: the first, in which 2 successive stays in the CIU allowed an admission to the "mother-child" unit in satisfactory conditions, the second, in which overall management was based on hospitalization in the Obstetrics department and several visits to our Unit, and the last one, in which the whole medico-psycho-social approach was set up after a single stay of 3 days. Since the opening of Crisis Intervention Unit, around 1,000 patients have been treated there; 37 were women with difficulties with their pregnancy, 17 of whom required direct intervention by the "mother-child" team. The contexts were: 5 prenatal depressions, 4 post-partum depressions, 3 cases of hyperemesis gravidarum, 5 rejections of pregnancy and/or situations at risk of infanticide. The almost constant suicidal risk should be noted, or even attempted suicide, at the time of admission to the CIU. The other 20 women had psychopathological disorders linked to sterility, medically-assisted pregnancy, termination of pregnancy or pregnancy in women suffering from long-term somatic illnesses (insulin-dependent diabetes, lupus, etc.). When a psychopathological episode occurs during pregnancy, it is essential to preserve the developing relationship with the child in an intermediate place, in a healthcare perspective and to prevent any future impairment of the quality of the mother-child relationship by the psychiatric disorder. The Crisis Intervention Unit is not an emergency "mother-child" unit. Other French experiences have been reported, an example being mother-baby hospitalization in a crisis centre. The aim of our interventions is not the same, and our local context, together with the availability of a healthcare network on different floors, which is specific and close-by, allows this approach. Also, the contribution of Liaison Psychiatry in emergency situations should not be minimized. It is necessary to work in collaboration with the obstetricians. In fact, the chance to work with us was given by asking for a hospitalization in the Obstetric unit, during the prepartum period of pregnancies with a psychiatric risk. This way of proceeding allows somatic monitoring in hospital to be performed, whenever the risk run by the mother and/or the child requires it. This "analogue" procedure, however preventative it may be, does not always allow specific treatment of the psychiatric disorders to be given, despite liaison psychiatry interventions. Our interventions are not a specialized "mother-child" unit, or a substitute for Liaison Psychiatry, but they are specifically aimed at the context of the crisis. Obviously, it is precisely this dimension of the crisis which makes the other types of management temporarily unsuitable. This new working framework, with the simple possibility of admitting women and interacting with them in a crisis situation, with the aid of the competence of "mother-child" teams, most often seems to allow an alternative to hospitalization in the Psychiatry department, at the same time keeping up quality management of problems linked to the pregnancy or post-partum period. The specificity of the CIU, with its project of taking the special psychiatric vulnerability of pregnancy into account, makes sure that the psychopathological aspects of the crisis situation and the physiological aspects of adaptation reactions to the perinatal period are not neglected, but that are respected by this type of interaction/intervention.
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Affiliation(s)
- G Vaiva
- Service de Psychiatrie Générale, CHRU de Lille, Clinique Fontan, 6, rue du Professeur Laguesse, 59037 Lille
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Hodak E, Lapidoth M, Kohn K, David D, Brautbar B, Kfir K, Narinski N, Safirman S, Maron M, Klein K. Mycosis fungoides: HLA class II associations among Ashkenazi and non-Ashkenazi Jewish patients. Br J Dermatol 2001; 145:974-80. [PMID: 11899152 DOI: 10.1046/j.1365-2133.2001.04496.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND An immunogenetic mechanism has been suggested to play a role in the pathogenesis of mycosis fungoides (MF). While results of studies on HLA class I associations haveproved inconsistent, two previous studies showed that certain HLA class II alleles were significantly increased among North American caucasian patients with MF: HLA-DRB1*11 and DQB1*03. OBJECTIVES To investigate the possible HLA class I and class II associations with MF among Jewish patients. METHODS The patient group comprised 68 Jewish patients with MF: 38 Ashkenazi and 30 non-Ashkenazi. The control group comprised 252 healthy Jewish volunteers: 132 Ashkenazi and 120 non-Ashkenazi. Tissue typing for HLA class I (A and B) was performed using the National Institutes of Health microlymphocytotoxicity technique. DNA-based low-medium resolution analysis for DRB1* and DQB1* alleles was performed using polymerase chain reaction (PCR) amplification with sequence-specific primers. For those alleles found to have significantly increased frequency, high-resolution analysis was done by means of PCR sequence-specific oligotyping. RESULTS The allele frequency of HLA-DRB1*11 was found to be significantly increased but only among Ashkenazi patients with MF (30% vs. 19% in the controls; P = 0.034). High-resolution analysis for DRB1*11, not previously performed, suggested that its greater frequency is due to the increased number of Ashkenazi MF patients with the DRB1*1104 allele (P corrected = 0.036). Analysed together, DQB1*03 alleles (DQB1*0301-0304) had a significantly greater frequency in MF as a group as compared with controls (47% vs. 33%, P = 0.003). DQB1*0301 was demonstrated to be the specific allele associated with MF in Jewish patients (allele frequency of 36% vs. 23% in controls; P corrected = 0.0068), which was not the case for North American caucasian patients with MF. No greater frequencies of any of the HLA class I A or B antigens were found. CONCLUSIONS Our findings further demonstrate the 'universality' of MF HLA class II susceptibility alleles, i.e. HLA-DRB1*11 and HLA-DQB1*03, suggesting that HLA polymorphism is likely to be important in the pathogenesis of MF in Jewish patients, as it is in North American caucasian patients. Not previously reported is our finding that HLA-DRB1*1104 is the specific allele more prevalent among patients with MF. Our study also underscores some differences in HLA profiles between non-Jewish and Jewish patients with MF and between Ashkenazi and non-Ashkenazi Jewish patients, indicating the possibility of diverse HLA disease associations in populations with different genetic backgrounds. Our study provides further evidence for the lack of association between HLA class I and MF.
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Affiliation(s)
- E Hodak
- Department of Dermatology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tiqva, Israel.
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Abstract
BACKGROUND Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse effect to neuroleptic drugs. METHODS We report on 2 cases where NMS dramatically improved with carbamazepine. Incidental removal and reapplication of carbamazepine attests to its effectiveness for this condition. RESULTS A 34-year-old woman treated for a major depressive disorder experienced NMS with a phenothiazine. Her condition dramatically improved in 8 hours after she was administered carbamazepine. Since carbamazepine was discontinued, NMS recurred in 10 hours and remitted anew within less than 24 hours after reintroduction. A 31-year-old woman experiencing a schizoaffective disorder displayed NMS with aphenothiazine and a butyrophenone. NMS completely resolved within 8 hours after she was administered carbamazepine. NMS recurred within 12 hours after carbamazepine discontinuation. CONCLUSIONS These data thus account for a cause-effect relationship between carbamazepine administration and NMS relief, and argue against the neuroleptic withdrawal to be responsible by itself for NMS relief.
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Affiliation(s)
- P Thomas
- Department of Psychiatry, School of Medicine, Centre Hospitalier Regional et Universitaire, University of Lille, France
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Thomas P, Roche J, Maron M, Cotencin O, Vaiva G, Goudemand M. Severe extrapyramidal symptoms with fluvoxamine despite neuroleptics withdrawal. Eur Psychiatry 1996; 11:273. [DOI: 10.1016/0924-9338(96)82337-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/1996] [Accepted: 05/21/1996] [Indexed: 10/18/2022] Open
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Abstract
Using single photon emission computerized tomography (SPECT) with a 99mTc-HMPAO perfusion technique, we studied the regional cerebral blood flow (rCBF) of 42 drug-free inpatients suffering from Major Depression' (n = 21) or dysthymia with the super-imposed diagnosis of a major depressive episode (n = 21). The patients with Major Depression had a significantly lower frontal and posterior rCBF ratio than those with Double Depression. Left frontal region indices showed a slight overlap between the two groups. There was no correlation between the severity of the illness and the rCBF indices. Different qualitative cerebral dysfunctions may be implicated in these two affective disorder sub-types.
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Affiliation(s)
- P Thomas
- Department of General Psychiatry, CHRU, Lille, France
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