1
|
Sun D, Schaff HV, Nishimura RA, Geske JB, Dearani JA, Ommen SR. In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy. Mayo Clin Proc Innov Qual Outcomes 2022; 7:45-50. [PMID: 36619178 PMCID: PMC9811196 DOI: 10.1016/j.mayocpiqo.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the in-hospital outcomes of acute ischemic stroke in patients with hypertrophic cardiomyopathy (HCM). Patients and Methods Using weighted discharge data from the National Inpatient Sample, we identified 5804 nonelective hospitalizations for ischemic stroke in adult patients with HCM between 2011 and 2017. For comparison, 58,179 hospitalizations for ischemic stroke in adult patients without HCM were selected as controls using the simple random sampling method. Results Compared with the patients without HCM, those with HCM had a higher prevalence of hyperlipidemia (62.4% vs 57.5%, respectively, P<.001) and chronic heart failure (25.4% vs 13.6%, respectively, P<.001) but a lower prevalence of diabetes (28.2% vs 34.9%, respectively, P<.001) and hypertension (42.9% vs 53.4%, respectively, P<.001). Atrial fibrillation was documented in 45.1% (n=2617) of the patients with HCM. However, only 28.0% (n=733) of these patients had long-term use of anticoagulants. The in-hospital death rate among the patients with HCM was 6.3% (n=368), which was significantly higher than that in the patients without HCM (4.1%, P<.001). Having HCM (odds ratio [OR], 1.35; P<.001), atrial fibrillation (OR, 2.08; P<.001), and chronic heart failure (OR, 1.65; P<.001) were significant predictors of in-hospital death. In patients with HCM who were discharged alive, 50.0% were transferred to skilled nursing facilities compared with 45.3% of those without HCM (P<.001). Conclusion The prognosis of acute ischemic stroke is worse in patients with HCM than in those without HCM. These findings emphasize the importance of aggressive treatment of predisposing factors for stroke in patients with HCM, especially atrial fibrillation.
Collapse
Affiliation(s)
- Daokun Sun
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Hartzell V. Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,Correspondence: Address to Hartzell V. Schaff, MD, Mayo Clinic, Mayo Foundation for Medical Education and Research, 200 First St SW. Rochester, MN 55905.
| | | | - Jeffrey B. Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Steve R. Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
2
|
Huang AL, MacNamara J, Link MS, Martinez M, Dearani JA, Cannon BC, Levine BD, Ackerman MJ. Asymptomatic Apical Hypertrophic Cardiomyopathy in an Elite Competitive Athlete. JACC Case Rep 2022; 6:101705. [PMID: 36704059 PMCID: PMC9871207 DOI: 10.1016/j.jaccas.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
A 17-year-old male elite athlete presented for evaluation after an abnormal pre-competitive college screening electrocardiogram. Subsequent evaluation revealed the presence of hypertrophic cardiomyopathy. He remained asymptomatic throughout four years of follow-up. Through shared decision making, he continued to play competitively and is now a professional athlete. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Athena L. Huang
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James MacNamara
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark S. Link
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | - Michael J. Ackerman
- Mayo Clinic, Rochester, Minnesota, USA,Address for correspondence: Dr Michael J. Ackerman, Mayo Clinic, Guggenheim Building, Room 501, 200 First Street SW, Rochester, Minnesota 55905, USA.
| |
Collapse
|
3
|
Miliou A, Antonopoulos AS, Kouris N, Lazaros G, Tsioufis K, Vlachopoulos C. Danon Cardiomyopathy: Specific Imaging Signs. JACC Case Rep 2022; 4:1496-1500. [PMID: 36444189 PMCID: PMC9700059 DOI: 10.1016/j.jaccas.2022.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 06/01/2023]
Abstract
Danon disease (DD) is a rare, X-linked genetic disorder caused by LAMP2 deficiency. Clinical phenotype involves early cardiomyopathy development along with pre-excitation, skeletal myopathy, retinopathy, and cognitive impairment. We highlight how a noninvasive diagnostic approach based on clinical and imaging red flags for DD can be employed to raise high clinical suspicion for DD, which was confirmed by genetic testing results. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Antigoni Miliou
- Address for correspondence: Dr Miliou Antigoni, Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, 99 Michalakopoulou Street, Athens 11527, Greece.
| | | | | | | | | | | |
Collapse
|
4
|
Bijsterveld NR, van der Crabben SN, Groenink M, Wilde A, Jørstad H. Accelerated Idioventricular Rhythm in a Young Athlete: Physiology or Pathology? JACC Case Rep 2022; 4:101657. [PMID: 36507292 PMCID: PMC9730148 DOI: 10.1016/j.jaccas.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
An accelerated idioventricular rhythm was seen on a routine preparticipation electrocardiogram of a 19-year-old healthy and symptom-free athlete. Family history was negative for cardiac disease. Additional investigations revealed a hypertrophic cardiomyopathy, confirmed with cardiac magnetic resonance imaging and genetic analysis. Accelerated idioventricular rhythm in young athletes warrants careful clinical evaluation. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Nick R. Bijsterveld
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands,Department of Cardiology, Flevoziekenhuis, Almere, the Netherlands,Address for correspondence: Dr Nick R. Bijsterveld, Department of Cardiology, Amsterdam UMC, Heart Centre, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | | | - Maarten Groenink
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands
| | - Harald Jørstad
- Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Sykes AV, Epstein E, Choubdar PA, Taub PR. 2 Cases of Elusive Left Ventricular Outflow Tract Gradient. JACC Case Rep 2022; 4:1404-1408. [PMID: 36388718 PMCID: PMC9663909 DOI: 10.1016/j.jaccas.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 06/16/2023]
Abstract
Patients with hypertrophic cardiomyopathy (HCM) typically have septal hypertrophy and left ventricular outflow tract gradient, usually present at rest with increase under certain hemodynamic conditions. We report 2 cases of HCM in which there was subtle septal hypertrophy; the gradient was detected only postprandially, highlighting the importance of considering postprandial imaging in patients with suspected HCM. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Alexandra Vaio Sykes
- Department of Internal Medicine, University of California-San Diego, San Diego, California, USA
| | - Elizabeth Epstein
- Department of Internal Medicine, University of California-San Diego, San Diego, California, USA
| | | | - Pam R. Taub
- Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| |
Collapse
|
6
|
Malik FI, Robertson LA, Armas DR, Robbie EP, Osmukhina A, Xu D, Li H, Solomon SD. A Phase 1 Dose-Escalation Study of the Cardiac Myosin Inhibitor Aficamten in Healthy Participants. JACC Basic Transl Sci 2022; 7:763-775. [PMID: 36061336 PMCID: PMC9436819 DOI: 10.1016/j.jacbts.2022.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
Certain genetic hypertrophic cardiomyopathies may result from hypercontractility of cardiac muscle, caused by pathogenic variants in genes encoding proteins of the cardiac sarcomere. Aficamten (formerly CK-3773274) is a small-molecule selective inhibitor of the cardiac myosin ATPase, which reduces the contractility of cardiomyocytes in vitro and decreases measures of ventricular contractility in animal studies. In this first-in-human, phase 1 study in healthy adults, aficamten was well tolerated; adverse events were generally mild and comparable in frequency to those seen with placebo. Aficamten demonstrated dose-proportional pharmacokinetics with a half-life of 75 to 85 hours. Pharmacodynamically active doses of aficamten decreased left ventricular ejection fraction from baseline in a concentration-dependent manner, informing the design of a phase 2 trial in patients with hypertrophic cardiomyopathy.
This phase 1, randomized, double-blind, placebo-controlled study of aficamten (formerly CK-3773274) in healthy adults identified a pharmacologically active range of doses and exposures. At doses that were pharmacologically active (single doses of ≤50 mg or daily dosing of ≤10 mg for 14 or 17 days), aficamten appeared to be safe and well tolerated. Adverse events were generally mild and no more frequent than with placebo. Pharmacokinetic assessments showed dose proportionality over the range of single doses administered, and pharmacokinetics were not affected by administration with food or in otherwise healthy individuals with a cytochrome P450 2D6 poor metabolizer phenotype. (A Single and Multiple Ascending Dose Study of CK-3773274 in Health Adult Subjects; NCT03767855)
Collapse
Key Words
- AE, adverse event
- AUC24, area under the plasma concentration–time curve from time 0 to 24 hours
- CV%,, percent coefficient of variation
- CYP, cytochrome P450
- CYP2D6-PM, cytochrome P450 2D6 poor metabolizer phenotype
- Cmax, maximum plasma drug concentration
- DLRC, Dose Level Review Committee
- ECG, electrocardiogram
- HCM, hypertrophic cardiomyopathy
- LV contractility
- LV, left ventricle
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- MAD, multiple ascending dose
- PD, pharmacodynamic
- PK, pharmacokinetic
- QTcF, QT interval corrected for heart rate using Fridericia’s formula
- SAD, single ascending dose
- TEAE, treatment-emergent adverse event
- aficamten
- cardiac myosin inhibitor
- hypertrophic cardiomyopathy
- phase 1
Collapse
Affiliation(s)
- Fady I Malik
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Laura A Robertson
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | | | - Edward P Robbie
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Anna Osmukhina
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Donghong Xu
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Hanbin Li
- Certara, Inc, Menlo Park, California, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Ge ZD, Boyd RM, Lantz C, Thorp EB, Forbess JM. Cardio-omentopexy requires a cardioprotective innate immune response to promote myocardial angiogenesis in mice. JTCVS Open 2022; 10:222-242. [PMID: 36004249 PMCID: PMC9390370 DOI: 10.1016/j.xjon.2022.02.027] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Abstract
Objective The pedicled greater omentum, when applied onto stressed hearts using omentopexy, has been shown to be protective in humans and animals. The mechanisms underlying cardioprotection using omentopexy remain elusive. This study examined whether macrophage-mediated angiogenesis accounts for the cardioprotective effect of omentopexy in mice. Methods C57BL/6 mice were subjected to minimally invasive transverse aortic constriction for 6 weeks and subsequent cardio-omentopexy for 8 weeks. Control mice underwent the same surgical procedures without aortic constriction or cardio-omentopexy. Results Transverse aortic constriction led to left ventricular concentric hypertrophy, reduced mitral E/A ratio, increased cardiomyocyte size, and myocardial fibrosis in the mice that underwent sham cardio-omentopexy surgery. The negative effects of transverse aortic constriction were prevented by cardio-omentopexy. Myocardial microvessel density was elevated in the mice that underwent aortic constriction and sham cardio-omentopexy surgery, and cardio-omentopexy further enhanced angiogenesis. Nanostring gene array analysis uncovered the activation of angiogenesis gene networks by cardio-omentopexy. Flow cytometric analysis revealed that cardio-omentopexy triggered the accumulation of cardiac MHCIIloLyve1+TimD4+ (Major histocompatibility complex class IIlow lymphatic vessel endothelial hyaluronan receptor 1+ T cell immunoglobulin and mucin domain conataining 4+) resident macrophages at the omental-cardiac interface. Intriguingly, the depletion of macrophages with clodronate-liposome resulted in the failure of cardio-omentopexy to protect the heart and promote angiogenesis. Conclusions Cardio-omentopexy protects the heart from pressure overload-elicited left ventricular hypertrophy and dysfunction by promoting myocardial angiogenesis. Cardiac MHCIIloLyve1+TimD4+ resident macrophages play a critical role in the cardioprotective effect and angiogenesis of cardio-omentopexy. Video Abstract
Collapse
Key Words
- AXL, AXL receptor tyrosine kinase
- Akt, protein kinase B
- CD45, lymphocyte common antigen
- CD64, cluster of differentiation 64
- COP, cardio-omentopexy
- Calm1, calmodulin 1
- Cdh5, cadherin 5
- Clodro, clodronate-liposomes
- Crk, proto-oncogene c-Crk
- Ctnnb1, catenin β1
- Ctnnd1, catenin delta 1
- Cybb, cytochrome B-245 beta chain
- Cyfip1, cytoplasmic FMR1 interacting protein 1
- ECM, extracellular matrix
- F4/80, F4/80 antigen
- HCM, hypertrophic cardiomyopathy
- HSP89aa1, heat shock protein 89aa1
- Hippo, hippocampal
- Itpr2, inositol 1,4,5-trisphosphate receptor type 2
- Kdr, kinase insert domain receptor
- Kras, kirsten rat sarcoma virus
- LV, left ventricle
- Ly6Clo, lymphocyte antigen-6Clow
- Ly6G, lymphocyte antigen 6 complex locus G6D
- Lyve1, lymphatic vessel endothelial hyaluronan receptor 1
- MHCIIlo, major histocompatibility complex class IIlow
- Ncf1, neutrophil cytosolic factor 1
- Nck2, NCK adaptor protein 2
- Nckap1H, NCK-associated protein 1H
- Nos3, nitric oxide synthase 3
- PBS, phosphate-buffered saline
- PDGF, platelet-derived growth factor
- PI3K, phosphoinositide-3-kinase
- Plcg1, phospholipase Cγ1
- Plcg2, 1-phosphatidylinositol-4,5-bisphosphate phosphodiesterase γ2
- Prkaca, protein kinase cAMP-activated catalytic subunit α
- Prkacb, protein kinase cAMP-activated catalytic subunit β
- Prkca, protein kinase Cα
- Ptk2, protein tyrosine kinase 2
- Ptk2b, protein tyrosine kinase 2β
- Rac1, Rac family small GTPase 1
- Rock2, Rho associated coiled-coil containing protein kinase 2
- Src, proto-oncogene tyrosine-protein kinase Src
- TAC, transverse aortic constriction
- TGF, transforming growth factor
- TimD4, T cell immunoglobulin and mucin domain conataining 4
- VEGF-A, vascular endothelial growth factor A
- Vav1, Vav guanine nucleotide exchange factor 1
- WGA, wheat germ agglutinin
- angiogenesis
- cardiac hypertrophy
- cardio-omentopexy
- iB4, biotinylated-isolectin B4
- mTOR, mammalian target of rapamycin
- macrophages
Collapse
Affiliation(s)
- Zhi-Dong Ge
- The Heart Center and Cardiovascular-Thoracic Surgery, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Riley M. Boyd
- The Heart Center and Cardiovascular-Thoracic Surgery, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Connor Lantz
- The Heart Center and Cardiovascular-Thoracic Surgery, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Edward B. Thorp
- The Heart Center and Cardiovascular-Thoracic Surgery, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Joseph M. Forbess
- Department of Surgery, University of Maryland School of Medicine and The Children's Heart Program, University of Maryland Children's Hospital, Baltimore, Md
| |
Collapse
|
8
|
Cai K, Wang F, Lu JQ, Shen AN, Zhao SM, Zang WD, Gui YH, Zhao JY. Nicotinamide Mononucleotide Alleviates Cardiomyopathy Phenotypes Caused by Short-Chain Enoyl-Coa Hydratase 1 Deficiency. JACC Basic Transl Sci 2022; 7:348-362. [PMID: 35540099 PMCID: PMC9079797 DOI: 10.1016/j.jacbts.2021.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
ECHS1 hydrates medium- and short-chain enoyl CoAs and catalyzes the oxidation of fatty acids and branched-chain amino acids. The mechanism driving ECHS1 deficiency–associated cardiomyopathy was investigated using conventional biochemistry and molecular biology methods, including immunoprecipitation and polymerase chain reaction. Echs1 heterogeneous knockout mice displayed cardiac dysfunction as evaluated by echocardiography. ECHS1 deficiency causes cardiomyopathy by enhancing p300-mediated H3K9ac. ECHS1 deficiency–induced cardiomyopathy can be prevented using an intervention approach targeting H3K9ac.
Short-chain enoyl-CoA hydratase 1 (ECHS1) deficiency plays a role in cardiomyopathy. Whether ECHS1 deficiency causes or is only associated with cardiomyopathy remains unclear. By using Echs1 heterogeneous knockout (Echs1+/-) mice, we found that ECHS1 deficiency caused cardiac dysfunction, as evidenced by diffuse myocardial fibrosis and upregulated fibrosis-related genes. Mechanistically, ECHS1 interacts with the p300 nuclear localization sequence, preventing its nuclear translocation in fibroblasts. ECHS1 deficiency promotes p300 nuclear translocation, leading to increased H3K9 acetylation, a known risk factor for cardiomyopathy. Nicotinamide mononucleotide–mediated acetylation targeting suppressed ECHS1 deficiency–induced cardiomyopathy phenotypes in Echs1+/- mice. Thus, enhancing p300-mediated H3K9ac is a potential interventional approach for preventing ECHS1 deficiency–induced cardiomyopathy.
Collapse
Key Words
- ANP, atrial natriuretic peptide
- BCAA, branched-chain amino acid
- BNP, brain natriuretic peptide
- DCM, dilated cardiomyopathy
- ECHS1, short-chain enoyl-CoA hydratase 1
- FA, fatty acid
- HCM, hypertrophic cardiomyopathy
- HFF, human foreskin fibroblast
- IVSd, interventricular septum in end-diastole
- IVSs, interventricular septum in end-systole
- LVEF, left ventricular ejection fraction
- LVFS, left ventricular fractional shortening
- LVIDd, left ventricular internal dimension in end-diastole
- LVIDs, left ventricular internal dimension in end-systole
- LVPWd, left ventricular posterior wall in end-diastole
- LVPWs, left ventricular posterior wall in end-systole
- NMN, nicotinamide mononucleotide
- acetylation of H3K9
- cardiomyopathy
- enoyl-CoA hydratase 1
- nicotinamide mononucleotide
- p300
- α-SMA, smooth muscle actin-α
Collapse
Affiliation(s)
- Ke Cai
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Feng Wang
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Jia-Quan Lu
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - An-Na Shen
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Shi-Min Zhao
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China.,Key Laboratory of Reproduction Regulation of NPFPC, Fudan University, Shanghai, China
| | - Wei-Dong Zang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yong-Hao Gui
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China
| | - Jian-Yuan Zhao
- NHC Key Laboratory of Neonatal Diseases, Cardiovascular Center, Children's Hospital of Fudan University, State Key Laboratory of Genetic Engineering, and School of Life Sciences, Fudan University, Shanghai, China.,School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
9
|
Chan F, Lockie T, Monserrat L, Moon JC, Captur G. Subclinical Hypertrophic Cardiomyopathy in Elite Athletes: Knowledge Gaps Persist. JACC Case Rep 2022; 4:94-98. [PMID: 35106492 PMCID: PMC8784716 DOI: 10.1016/j.jaccas.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/07/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022]
Abstract
Subclinical hypertrophic cardiomyopathy (HCM) is a phenotypic entity that has emerged from the increased use of cardiovascular magnetic resonance imaging in the evaluation and family screening of patients with HCM. We describe the case of a competitive athlete with a sarcomere gene mutation and family history of HCM who was found to exhibit the subclinical HCM phenotype on cardiovascular magnetic resonance imaging in the absence of left ventricular hypertrophy. We discuss the clinical uncertainties in her management. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Fiona Chan
- The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom
| | - Tim Lockie
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom
- The Royal Free Hospital, Cardiology Department, Pond Street, Hampstead, London, United Kingdom
| | | | - James C. Moon
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, United Kingdom
| | - Gabriella Captur
- The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom
- UCL MRC Unit for Lifelong Health and Ageing, University College London, Fitzrovia, London, United Kingdom
| |
Collapse
|
10
|
Abstract
The primary etiology of a diverse range of cardiomyopathies is now understood to be genetic, creating a new paradigm for targeting treatments on the basis of the underlying molecular cause. This review provides a genetic and etiologic context for the traditional clinical classifications of cardiomyopathy, including molecular subtypes that may exhibit differential responses to existing or emerging treatments. The authors describe several emerging cardiomyopathy treatments, including gene therapy, direct targeting of myofilament function, protein quality control, metabolism, and others. The authors discuss advantages and disadvantages of these approaches and indicate areas of high potential for short- and longer term efficacy.
Collapse
Key Words
- AAV, adeno-associated virus
- ACM, arrhythmogenic cardiomyopathy
- ARVC, arrhythmogenic right ventricular cardiomyopathy
- ATPase, adenosine triphosphatase
- DCM, dilated cardiomyopathy
- DMD, Duchenne muscular dystrophy
- DNA, DNA
- DSP, desmoplakin
- FDA, U.S. Food and Drug Administration
- GRT, gene replacement therapy
- GST, gene silencing therapy
- HCM, hypertrophic cardiomyopathy
- HR, homologous recombination
- LNP, lipid nanoparticle
- LVOT, left ventricular outflow tract
- RNA, RNA
- TTR, transthyretin
- arrhythmogenic cardiomyopathy
- dilated cardiomyopathy
- genetics
- hypertrophic cardiomyopathy
- therapeutics
Collapse
Affiliation(s)
- Adam S. Helms
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea D. Thompson
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sharlene M. Day
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Dai Z, Iguchi N, Takamisawa I, Takayama M, Nanasato M, Kanisawa M, Mizuno N, Miyazaki S, Isobe M. Alcohol septal ablation markedly reduces energy loss in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: A four-dimensional flow cardiac magnetic resonance study. Int J Cardiol Heart Vasc 2021; 37:100886. [PMID: 34692989 PMCID: PMC8515238 DOI: 10.1016/j.ijcha.2021.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
Background Functional follow-up modalities of hypertrophic cardiomyopathy (HCM) with left ventricular (LV) outflow tract obstruction (LVOTO) subjected to alcohol septal ablation (ASA) are limited. Methods This retrospective cohort study included patients of HCM with LVOTO who underwent ASA and four-dimensional (4D) flow cardiac magnetic resonance imaging (MRI) both before and after ASA. We analyzed energy loss in one cardiac cycle within the three-chamber plane of the LV and aortic root, and compared between pre- and post-ASA measurements. Results Of the 26 included patients, 10 (39%) were male, and median age was 71 (interquartile range 58–78) years. ASA significantly reduced not only LVOT pressure gradient (70 [19–50] to 9 [3–16], P < 0.001), but also energy loss during one cardiac cycle within the three-chamber plane of the LV and aortic root (80 [65–99] to 56 [45–70], P < 0.001). A linear association was observed between the reductions of energy loss and pressure gradient (R2 = 0.58, P < 0.001). Conclusions ASA significantly reduced energy loss within the LV and aortic root as quantified by 4D flow MRI, reflecting the decreased cardiac workload. This approach is a promising candidate for serial functional follow-up in patients undergoing ASA.
Collapse
Key Words
- 4D flow MRI
- 4D, four-dimensional
- ASA, alcohol septal ablation
- Alcohol septal ablation
- Energy loss
- HCM, hypertrophic cardiomyopathy
- Hypertrophic cardiomyopathy
- LV, left ventricle/left ventricular
- LVOT, left ventricular outflow tract
- LVOTO, left ventricular outflow tract obstruction
- Left ventricular outflow tract obstruction
- MRI, magnetic resonance imaging
- NYHA, New York Heart Association
- ROI, region of interest
- TTE, transthoracic echocardiography
Collapse
Affiliation(s)
- Zhehao Dai
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan.,Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan.,Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Mitsuru Kanisawa
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Naokazu Mizuno
- Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Shohei Miyazaki
- Cardio Flow Design Inc., 22-3 Ichibancho, Chiyoda-ku, Tokyo 102-0082, Japan
| | - Mitsuaki Isobe
- Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| |
Collapse
|
12
|
Sousa-Nunes F, Dias A, Ribeiro J, Fontes-Carvalho R. A Pleasant Surprise in the Face of ST-Segment Elevation. JACC Case Rep 2021; 3:1384-6. [PMID: 34505078 DOI: 10.1016/j.jaccas.2021.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
ST-segment elevation is a dreadful finding in the emergency department because it is often associated with myocardial infarction and demands a prompt and definitive treatment. However, the clinical and echocardiographic assessment of a patient with electrocardiographic changes trumps any electrocardiology expert and should always lead to a clinical decision. (Level of Difficulty: Intermediate.).
Collapse
|
13
|
Howell SJ, Nazer B. Thick Heart, Wide QRS, Broad Differential. JACC Case Rep 2021; 3:1363-1366. [PMID: 34505071 PMCID: PMC8414416 DOI: 10.1016/j.jaccas.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/03/2022]
Abstract
Routine electrocardiogram in a middle-aged man with left ventricular hypertrophy showed sinus rhythm, a short PR interval, and delta wave, confirming ventricular pre-excitation. Pre-excitation was fixed after a premature atrial complex and in atrial fibrillation, features diagnostic of a fasciculo-ventricular pathway. Genetic testing confirmed a diagnosis of hypertrophic cardiomyopathy. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Stacey J Howell
- University of California-San Francisco, San Francisco, California, USA
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
14
|
Weich HSV, John TJ, Joubert L, Moses J, Herbst P, Doubell A. Dynamic Left Ventricular Outflow Tract Obstruction Post-Transcatheter Aortic Valve Replacement. JACC Case Rep 2021; 3:871-4. [PMID: 34317644 DOI: 10.1016/j.jaccas.2021.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. (Level of Difficulty: Advanced.).
Collapse
|
15
|
Kantor PF, Casarez TW, Bar-Cohen Y. Hypertrophic Cardiomyopathy in Adolescence: Application of Guidelines. JACC Case Rep 2021; 3:10-15. [PMID: 34317460 PMCID: PMC8305668 DOI: 10.1016/j.jaccas.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
We present the course and management of an adolescent male with hypertrophic cardiomyopathy. The importance of family history, early screening, accurate evaluation of hypertrophy, and risk stratification for eligibility for a defibrillator in hypertrophic cardiomyopathy are emphasized. Learning points are seen in the light of new guidelines. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Paul F Kantor
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Timothy W Casarez
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Pediatric Cardiology Medical Associates, Encino, California, USA
| | - Yaniv Bar-Cohen
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
16
|
Toyoda S, Ida K, Kitagawa Y, Kamijima T, Saito I, Nishino S, Sakuma M, Ohki G, Naito S, Inoue T. Pacemaker Treatment for Apical Hypertrophic Cardiomyopathy in the Setting of an Apical Ventricular Aneurysm. JACC Case Rep 2021; 3:1150-1155. [PMID: 34471902 PMCID: PMC8314128 DOI: 10.1016/j.jaccas.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
We describe the case of a patient with apical hypertrophic cardiomyopathy with concomitant apical aneurysm. We measured the aneurysmal cavity pressure using the pressure guidewire system. The patient underwent implantable cardioverter-defibrillator treatment successfully to reduce the pressure gradient between the aneurysmal cavity and the true left ventricle. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Keitaro Ida
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yoshiyuki Kitagawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toru Kamijima
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Ikuta Saito
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Setsu Nishino
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Gaku Ohki
- Department of Cardiology, Yuki Hospital, Yuki, Ibaraki, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| |
Collapse
|
17
|
Saleem M, Balla S, Amin MS, Farid S, Caccamo M, Sokos G, Bianco CM. Hereditary Apolipoprotein A-I-Associated Cardiac Amyloidosis: Importance of Endomyocardial Biopsy When Suspicion Remains High. JACC Case Rep 2021; 3:1032-7. [PMID: 34317679 DOI: 10.1016/j.jaccas.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
Cardiac amyloidosis has recently garnered substantial attention. Although the advent of noninvasive diagnostic algorithms revolutionized diagnosis, endomyocardial biopsy may still be considered in select cases to determine the amyloidosis subtype definitively. We report a case of a patients with a known mutation causing hereditary apolipoprotein A-I–associated cardiac amyloidosis. (Level of Difficulty: Advanced.)
Collapse
|
18
|
Caniato F, Andrei V, Bernardo P, Agostini C, Cappelli F, Stefano PL, Olivotto I, Pieroni M, Bolognese L, Di Mario C. Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy Plus Apical Ballooning: Management With VA-ECMO and Myectomy. JACC Case Rep 2021; 3:433-437. [PMID: 34317552 PMCID: PMC8311032 DOI: 10.1016/j.jaccas.2020.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/14/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 04/28/2023]
Abstract
A patient with known obstructive hypertrophic cardiomyopathy developed worsening left ventricular outflow tract obstruction, severe mitral regurgitation, and apical ballooning leading to cardiogenic shock, a combination in which treatment of each component could worsen the others. Emergency veno-arterial extracorporeal membrane oxygenation, levosimendan, and noradrenaline transiently restored adequate systemic perfusion and gas exchange. Surgical myectomy offered a more definitive solution. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- AF, atrial fibrillation
- CS, cardiogenic shock
- EF, ejection fraction
- HCM, hypertrophic cardiomyopathy
- HF, heart failure
- LVOTO, left ventricular outflow tract obstruction
- MR, mitral regurgitation
- SAM, systolic anterior movement
- TTE, transthoracic echocardiography
- VA-ECMO, veno-arterial extracorporeal membrane oxygenation
- acute heart failure
- cardiac assist devices
- cardiomyopathy
- inotropes
Collapse
Affiliation(s)
- Flavia Caniato
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
- Address for correspondence: Dr. Flavia Caniato, Cardiac Intensive Care Unit, Careggi University Hospital, Largo G. Alessandro Brambilla, 3, 50134 Florence, Italy.
| | - Valentina Andrei
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Pasquale Bernardo
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Cecilia Agostini
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | | | | | - Carlo Di Mario
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
19
|
de Feria AE, Lin KY, Day SM. Applying Shared Decision Making to Sports Participation for a Patient With Hypertrophic Cardiomyopathy. JACC Case Rep 2021; 3:6-9. [PMID: 34317459 PMCID: PMC8305623 DOI: 10.1016/j.jaccas.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
A patient with hypertrophic cardiomyopathy and a cardio-defibrillator implanted for primary prevention would like to compete on the ski team at his school. This case illustrates how a shared decision-making approach can be applied when counseling patients with hypertrophic cardiomyopathy about exercise and sports participation. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Alejandro E. de Feria
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Cardiovascular Division, Children’s Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimberly Y. Lin
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Cardiovascular Division, Children’s Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharlene M. Day
- Address for correspondence: Dr. Sharlene Day, University of Pennsylvania, 3400 Civic Center Boulevard, Smilow 11-102, Philadelphia, Pennsylvania 19104, USA. @sday_hcm
| |
Collapse
|
20
|
Kiamanesh O, Rankin K, Billia F, Badiwala MV. Left Ventricular Assist Device With a Left Atrial Inflow Cannula for Hypertrophic Cardiomyopathy. JACC Case Rep 2020; 2:2090-2094. [PMID: 34317114 PMCID: PMC8299761 DOI: 10.1016/j.jaccas.2020.10.006] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 10/26/2022]
Abstract
Patients with restrictive or hypertrophic cardiomyopathy (HCM) are often ineligible for a left ventricular assist device (LVAD) due to the risk of suction events with a small left ventricular cavity size and left ventricular inflow cannula. We describe an alternative LVAD configuration using a left atrial inflow cannula as a bridge to transplantation in an adult with HCM. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Omid Kiamanesh
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Rankin
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mitesh V Badiwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Stämpfli SF, De Boeck BW, Cuculi F, Kobza R. Thebesian Veins Draining to the Left Ventricle, Mimicking Left Ventricular Noncompaction. JACC Case Rep 2020; 2:2085-2089. [PMID: 34317113 PMCID: PMC8299769 DOI: 10.1016/j.jaccas.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 06/13/2023]
Abstract
Left ventricular noncompaction cardiomyopathy (LVNC) was diagnosed in a 59-year-old woman, based on echocardiography. Later, diagnostic criteria were also found positive by cardiac magnetic resonance (CMR). However, coronary angiography revealed thebesian veins were causing the noncompacted appearance. The complementary role of CMR and echocardiography criteria, including flow assessment in the recesses, is discussed. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Simon F. Stämpfli
- Address for correspondence: Dr. Simon F. Stämpfli, Outpatient Clinic and Echocardiography, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse, CH-6000 Lucerne, Switzerland. @simonstaempfli
| | | | | | | |
Collapse
|
22
|
Abstract
The human genome contains approximately 4 million variants, whose population frequencies vary according to the ethnic backgrounds. Genetic diversity of humans in part determines interindividual variability in susceptibility to diseases, response to therapy, and the clinical outcomes. Genetic variants exert a gradient of biological and clinical effect sizes. In general, variants with the largest effect sizes are responsible for the single-gene disorders, whereas those with moderate and modest effect sizes are responsible for oligogenic and polygenic diseases, respectively. A phenotype is the consequence of nonlinear stochastic interactions among multiple genetic and nongenetic determinants. Discerning pathogenicity of the genetic variants, identified through genetic testing, in the clinical phenotype is challenging and requires complementary expertise in human molecular genetics and clinical medicine.
Genetic variants are major determinants of susceptibility to disease, response to therapy, and clinical outcomes. Advances in the short-read sequencing technologies, despite some shortcomings, have enabled identification of the vast majority of the genetic variants in each genome. The major challenge is in identifying the pathogenic variants in cardiovascular diseases. The yield of the genetic testing has been limited because of technological shortcomings and our incomplete understanding of the genetic basis of cardiovascular disorders. To advance the field, a shift to long-read sequencing platforms is necessary. In addition, to discern the pathogenic variants, genetic diseases should be considered as a continuum and the genetic variants as probabilistic factors with a gradient of effect sizes. Moreover, disease-specific physician-scientists with expertise in the clinical medicine and molecular genetics are best equipped to discern functional and clinical significance of the genetic variants. The changes would be expected to enhance clinical utilities of the genetic discoveries.
Collapse
Affiliation(s)
- Ali J Marian
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas
| |
Collapse
|
23
|
Shin ES, Chon MK, Jun EJ, Park YH, Lee SH, Kim JS, Shin DH, Lee SY, Cho MS, Lee SW, Reinthaler M, Park JW, Nam GB, Lederman RJ, Won Y, Kim JH. Septal Reduction Using Transvenous Intramyocardial Cerclage Radiofrequency Ablation: Preclinical Feasibility. ACTA ACUST UNITED AC 2020; 5:988-998. [PMID: 33145462 PMCID: PMC7591824 DOI: 10.1016/j.jacbts.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023]
Abstract
Surgical myectomy is morbid and transcoronary alcohol septal ablation can result in geographic miss or occasional nontarget injury. We developed a transvenous intraseptal radiofrequency ablation technique (cerclage ablation method) to overcome the shortcomings of surgical myectomy and alcohol septal ablation. We delivered dedicated intraseptal radiofrequency ablation catheter into the ventricular septum through the coronary sinus and a septal vein. The ablated volume of myocardium was larger at higher electrode temperatures and using an irrigated-ablation mode in vitro. Cerclage ablation was successful in all in vivo attempts and induced a focal regional wall motion abnormality at later follow-up. This study presents in vivo evidence of the feasibility, effectiveness, and safety of cerclage ablation method to debulk interventricular septal myocardium.
Debulking of left ventricular septal mass is typically accomplished using surgical myectomy, which is morbid, or using transcoronary alcohol septal ablation, which can result in geographic miss and occasional catastrophic nontarget coronary injury. The authors developed and tested operational parameters in vitro and vivo for a device to accomplish transvenous intraseptal radiofrequency ablation to reduce ventricular septal mass using a technique derived from mitral cerclage, which the authors call cerclage ablation. Cerclage ablation appeared feasible in vitro and safe and effective in vivo. Cerclage ablation is an attractive new approach to debulk the interventricular septum in obstructive hypertrophic cardiomyopathy. These data support clinical investigation.
Collapse
Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
| | - Min-Ku Chon
- Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Eun Jung Jun
- Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
| | - Yong-Hyun Park
- Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Sang-Hyun Lee
- Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Jeong-Su Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Dong-Hun Shin
- Department of Pathology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Soo-Yong Lee
- Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Min Soo Cho
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Markus Reinthaler
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Jai-Wun Park
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Gi-Byung Nam
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yonghyun Won
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, Seoul, Republic of Korea
| | - June-Hong Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| |
Collapse
|
24
|
Peigh G, Wasserlauf J, Choudhury L, Knight BP, Kim S. From 100 to 0: Endocardial Radiofrequency Ablation of Septal Hypertrophy for Management of Hypertrophic Cardiomyopathy. JACC Case Rep 2020; 2:1173-1177. [PMID: 34317442 PMCID: PMC8311700 DOI: 10.1016/j.jaccas.2020.05.042] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 06/13/2023]
Abstract
Septal reduction techniques can reduce morbidity and mortality in patients with hypertrophic cardiomyopathy. In a patient with hypertrophic cardiomyopathy who was a poor candidate for surgical myectomy and alcohol septal ablation, endocardial radiofrequency ablation of septal hypertrophy provided durable reduction in left ventricular outflow tract gradients and symptomatic improvement. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
| | | | | | | | - Susan Kim
- Address for correspondence: Dr. Susan Kim, Division of Cardiology, Northwestern Memorial Hospital, 251 E. Huron Street, Room 8-340, Chicago, Illinois 60611.
| |
Collapse
|
25
|
Feng Z, Philipson D, Uzzell JP, Stein-Merlob A, Yang EH, Middlekauff HR, Lau RP, Fishbein GA, Bradfield JS, Ajijola OA. A Case of Ventricular Tachycardia Caused by a Rare Cardiac Mesenchymal Hamartoma. JACC Case Rep 2020; 2:1049-1055. [PMID: 34317413 PMCID: PMC8302110 DOI: 10.1016/j.jaccas.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 06/13/2023]
Abstract
The presentation of a cardiac hamartoma, an exceedingly rare and histologically benign cardiac tumor, can be variable. We describe a case of refractory ventricular tachycardia in a patient with a cardiac mass failing multiple pharmacologic and procedural interventions, ultimately treated by cardiac transplantation and diagnosed with a mesenchymal cardiac hamartoma. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Zekun Feng
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
| | - Daniel Philipson
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
| | - Jamar P. Uzzell
- UCLA Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California
| | - Ashley Stein-Merlob
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
| | - Eric H. Yang
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Holly R. Middlekauff
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
| | - Ryan P. Lau
- UCLA Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California
| | - Gregory A. Fishbein
- UCLA Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California
| | - Jason S. Bradfield
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Olujimi A. Ajijola
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, California
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| |
Collapse
|
26
|
Husaini M, Baker JN, Cresci S, Bach R, LaRue SJ. Recurrent Takotsubo Cardiomyopathy in a Patient With Hypertrophic Cardiomyopathy Leading to Cardiogenic Shock Requiring VA-ECMO. JACC Case Rep 2020; 2:1014-8. [PMID: 34317404 DOI: 10.1016/j.jaccas.2020.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/16/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Abstract
Providing hemodynamic support for patients with hypertrophic cardiomyopathy and cardiogenic shock can be challenging because inotropic medications worsen intraventricular obstruction, and the effect of appropriate mechanical support remains undefined. We report a patient with hypertrophic cardiomyopathy in shock because of takotsubo cardiomyopathy requiring venoarterial extracorporeal membrane oxygenation and septal reduction for full recovery. (Level of Difficulty: Advanced.).
Collapse
|
27
|
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. The disease is characterized by marked variability in morphological expression and natural history, ranging from asymptomatic to heart failure or sudden cardiac death. Left ventricular hypertrophy and abnormal ventricular configuration result in dynamic left ventricular outflow obstruction in most patients. The goal of pharmacological therapy in HCM is to alleviate the symptoms, and it includes pharmacotherapies and septal reduction therapies. In this review, we summarize the relevant clinical issues and treatment options of HCM.
Collapse
Affiliation(s)
- Murillo de Oliveira Antunes
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Universidade São Francisco (USF), Bragança Paulista, São Paulo, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
28
|
Gi WT, Sedaghat-Hamedani F, Shirvani Samani O, Kayvanpour E, Herpel E, Arif R, Riffel J, Mereles D, Katus HA, Meder B. Cardiac Myxoma in a Patient With Hypertrophic Cardiomyopathy. JACC Case Rep 2020; 2:378-383. [PMID: 34317246 PMCID: PMC8311620 DOI: 10.1016/j.jaccas.2019.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 12/01/2022]
Abstract
We report a rare case of concomitant hypertrophic cardiomyopathy and cardiac myxoma without LEOPARD syndrome. Additionally, 6 similar cases were systemically reviewed, and the characteristics of this first-ever studied patient group were summarized. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Weng-Tein Gi
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Farbod Sedaghat-Hamedani
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Omid Shirvani Samani
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Elham Kayvanpour
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Esther Herpel
- Institute of Pathology Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Derliz Mereles
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Hugo A Katus
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Benjamin Meder
- Department of Medicine III, Institute for Cardiomyopathy, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany.,Department of Genetics, Stanford University, Stanford, California
| |
Collapse
|
29
|
Gi WT, Amr A, Sedaghat-Hamedani F, Kayvanpour E, Mohr I, Meder M, Shirvani Samani O, Fluhr H, Katus HA, Meder B. Two Hearts at Risk: Emergency Alcohol Septal Ablation in a Pregnant Woman With Decompensated HOCM. JACC Case Rep 2020; 2:139-144. [PMID: 34316982 PMCID: PMC8301529 DOI: 10.1016/j.jaccas.2019.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 06/13/2023]
Abstract
Hypertrophic obstructive cardiomyopathy (HOCM) increases the risk for mother and fetus during pregnancy. Alcohol septal ablation (ASA) is an established procedure in nonpregnant patients with HOCM. In this report, we present a case of a 29-year-old woman in her 29th gestational week with decompensated HOCM undergoing a successful ASA. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Weng-Tein Gi
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Ali Amr
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Farbod Sedaghat-Hamedani
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Elham Kayvanpour
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Isabell Mohr
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Manuela Meder
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Omid Shirvani Samani
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Herbert Fluhr
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hugo A. Katus
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Benjamin Meder
- Institute for Cardiomyopathy, Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
- Department of Genetics, Stanford University, Stanford, California
| |
Collapse
|
30
|
Pfeffer TJ, Schlothauer S, Pietzsch S, Schaufelberger M, Auber B, Ricke-Hoch M, List M, Berliner D, Abou Moulig V, König T, Arany Z, Sliwa K, Bauersachs J, Hilfiker-Kleiner D. Increased Cancer Prevalence in Peripartum Cardiomyopathy. JACC CardioOncol 2019; 1:196-205. [PMID: 34396183 PMCID: PMC8352111 DOI: 10.1016/j.jaccao.2019.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 06/14/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
Objectives This study was designed to analyze the prevalence and potential genetic basis of cancer and heart failure in peripartum cardiomyopathy (PPCM). Background PPCM manifests as heart failure late in pregnancy or postpartum in women without previous heart disease. Methods Clinical history and cancer prevalence were evaluated in a cohort of 236 PPCM patients from Germany and Sweden. Exome sequencing assessed variants in 133 genes associated with cancer predisposition syndromes (CPS) and in 115 genes associated with dilated/hypertrophic cardiomyopathy (DCM/HCM) in 14 PPCM patients with a history of cancer, and in 6 PPCM patients without a history of cancer. Results The prevalence of cancer was 16-fold higher (8.9%, 21 of 236 patients) in PPCM patients compared to age-matched women (German cancer registry, Robert-Koch-Institute: 0.59%; p < 0.001). Cancer before PPCM occurred in 12 of 21 patients of whom 11 obtained cardiotoxic cancer therapies. Of those, 17% fully recovered cardiac function by 7 ± 2 months of follow-up compared to 55% of PPCM patients without cancer (p = 0.015). Cancer occurred after PPCM in 10 of 21 patients; 80% had left ventricular ejection fraction of ≥50% after cancer therapy. Whole-exome sequencing in 14 PPCM patients with cancer revealed that 43% (6 of 14 patients) carried likely pathogenic (Class IV) or pathogenic (Class V) gene variants associated with DCM/HCM in CPT2, DSP, MYH7, TTN, and/or with CPS in ATM, ERCC5, NBN, RECQL4, and SLX4. All CPS variants affected DNA damage response genes. Conclusions Cardiotoxic cancer therapy before PPCM is associated with delayed full recovery. The high cancer prevalence in PPCM is linked to likely pathogenic/pathogenic gene variants associated with DCM/HCM and/or CPS/DNA damage response-related cancer risk. This may warrant genetic testing and screening for heart failure in pregnant women with a cancer history and screening for cancer in PPCM patients.
Collapse
Key Words
- ATM, ataxia telangiectasia mutated
- BMBF, Bundesministerium für Bildung und Forschung
- BRCA1, breast cancer 1
- CPS, cancer predisposition syndrome
- DCM, dilated cardiomyopathy
- DDR, DNA damage response
- DFG, Deutsche Forschungsgesellschaft
- ERCC5, excision repair cross-complementing rodent repair deficiency
- FANCA, Fanconi anemia, complementation group
- FKRP, fukutin-related protein
- HCM, hypertrophic cardiomyopathy
- HTX, heart transplantation
- LVAD, left ventricular assist device
- LVEF, left ventricular ejection fraction
- PPCM, peripartum cardiomyopathy
- RECQL4, ATP-dependent DNA helicase Q4
- RYR1, ryanodine receptor 1
- SLX4, structure-specific endonuclease subunit SLX4
- TXNRD2, thioredoxin reductase 2
- VUS, variants of unknown significance
- cancer
- cardiotoxicity
- genetics
- peripartum cardiomyopathy
- whole-exome sequencing
Collapse
Affiliation(s)
- Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stella Schlothauer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stefan Pietzsch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Manuel List
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Valeska Abou Moulig
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tobias König
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Zolt Arany
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
31
|
Nafissi NA, Fudim M, Milano CA, Rosenberg PB, DeVore AD, Agarwal R. A Case of Rare Inherited Restrictive Cardiomyopathy With Severe Biatrial Enlargement. JACC Case Rep 2019; 1:588-591. [PMID: 34316885 PMCID: PMC8288754 DOI: 10.1016/j.jaccas.2019.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 11/05/2022]
Abstract
We describe a case of inherited restrictive cardiomyopathy in a patient presenting with severe biatrial enlargement. We review the evaluation and management of restrictive cardiomyopathy with a focus on genetic etiologies. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Navid A Nafissi
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Carmelo A Milano
- Division of Cardiothoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Paul B Rosenberg
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina
| | - Adam D DeVore
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Richa Agarwal
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina
| |
Collapse
|
32
|
Coppini R, Ferrantini C, Pioner JM, Santini L, Wang ZJ, Palandri C, Scardigli M, Vitale G, Sacconi L, Stefàno P, Flink L, Riedy K, Pavone FS, Cerbai E, Poggesi C, Mugelli A, Bueno-Orovio A, Olivotto I, Sherrid MV. Electrophysiological and Contractile Effects of Disopyramide in Patients With Obstructive Hypertrophic Cardiomyopathy: A Translational Study. JACC Basic Transl Sci 2019; 4:795-813. [PMID: 31998849 PMCID: PMC6978554 DOI: 10.1016/j.jacbts.2019.06.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/26/2023]
Abstract
In patients with HCM and symptomatic LVOT-obstruction, first treatment with disopyramide leads to a marked reduction of LVOT gradients, with a slight decrease of resting ejection fraction and a modest increase of corrected QT interval, highlighting high efficacy and safety. In single cardiomyocytes and intact trabeculae from surgical samples of patients with obstructive HCM, in vitro treatment with 5 μmol/l disopyramide lowered force and Ca2+ transients while reducing action potential duration and the rate of arrhythmic afterdepolarizations. These effects are mediated by the combined inhibition of peak and late Na+ currents, L-type Ca2+ current, delayed-rectifier K+ current, and ryanodine receptors. In addition to the negative inotropic effect of disopyramide, in vitro results suggest additional antiarrhythmic actions.
Disopyramide is effective and safe in patients with obstructive hypertrophic cardiomyopathy. However, its cellular and molecular mechanisms of action are unknown. We tested disopyramide in cardiomyocytes from the septum of surgical myectomy patients: disopyramide inhibits multiple ion channels, leading to lower Ca transients and force, and shortens action potentials, thus reducing cellular arrhythmias. The electrophysiological profile of disopyramide explains the efficient reduction of outflow gradients but also the limited prolongation of the QT interval and the absence of arrhythmic side effects observed in 39 disopyramide-treated patients. In conclusion, our results support the idea that disopyramide is safe for outpatient use in obstructive patients.
Collapse
Key Words
- AP, action potential
- DAD, delayed afterdepolarization
- EAD, early afterdepolarization
- ECG, electrocardiography
- HCM, hypertrophic cardiomyopathy
- ICa-L, L-type Ca current
- IK, delayed-rectifier K current
- INaL, late Na current
- LVOT, left ventricular outflow tract
- NCX, Na+/Ca2+ exchanger
- QT interval
- RyR, ryanodine receptor
- SR, sarcoplasmic reticulum
- action potentials
- arrhythmias
- diastolic dysfunction
- hERG, human ether-à-go-go-related gene
- hypertrophic cardiomyopathy
- pCa, Ca activation level
- safety
Collapse
Affiliation(s)
| | - Cecilia Ferrantini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Josè Manuel Pioner
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Santini
- Department NeuroFarBa, University of Florence, Florence, Italy
| | - Zhinuo J Wang
- Department of Computer Sciences, University of Oxford, Oxford, United Kingdom
| | - Chiara Palandri
- Department NeuroFarBa, University of Florence, Florence, Italy
| | - Marina Scardigli
- European Laboratory for Nonlinear Spectroscopy (LENS), University of Florence, Sesto Fiorentino, Italy and National Institute of Optics, National Research Council, Florence, Italy
| | - Giulia Vitale
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Leonardo Sacconi
- European Laboratory for Nonlinear Spectroscopy (LENS), University of Florence, Sesto Fiorentino, Italy and National Institute of Optics, National Research Council, Florence, Italy
| | - Pierluigi Stefàno
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Laura Flink
- Division of Cardiology, San Francisco Veterans Affairs Medical Center and University of California-San Francisco, San Francisco, California
| | - Katherine Riedy
- Hypertrophic Cardiomyopathy Program, New York University Langone Health, New York, New York
| | - Francesco Saverio Pavone
- European Laboratory for Nonlinear Spectroscopy (LENS), University of Florence, Sesto Fiorentino, Italy and National Institute of Optics, National Research Council, Florence, Italy
| | | | - Corrado Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, New York University Langone Health, New York, New York
| |
Collapse
|
33
|
Minegishi S, Kato S, Takase-Minegishi K, Horita N, Azushima K, Wakui H, Ishigami T, Kosuge M, Kimura K, Tamura K. Native T1 time and extracellular volume fraction in differentiation of normal myocardium from non-ischemic dilated and hypertrophic cardiomyopathy myocardium: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2019; 25:100422. [PMID: 31517037 PMCID: PMC6737306 DOI: 10.1016/j.ijcha.2019.100422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/02/2019] [Indexed: 11/02/2022]
Abstract
Background Both native T1 time and extracellular volume (ECV) fraction have been shown to be important measures for the detection of myocardial fibrosis. However, ECV determination requires the administration of an intravenous contrast agent, whereas native T1 mapping can be performed without a contrast agent. Methods Here, we conducted a meta-analysis of myocardial native T1 data obtained for non-ischemic cardiomyopathy (NIC) patients and controls. A literature review included studies that applied T1 mapping using modified Look-Locker inversion recovery to measure myocardial fibrosis, and the results were validated by comparing datasets for dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) patients and healthy controls (HCs). Results We identified 16 eligible studies. Pooled mean differences (MDs) and 95% confidence intervals (CIs) were estimated as follows. Native T1 at 1.5-T, DCM vs. HC: MD = 45.26 (95% CI: 30.92-59.59); HCM vs. HC: MD = 47.09 (95% CI: 32.42-61.76). Native T1 at 3.0-T, DCM vs. HC: MD = 82.52 (95% CI: 47.60-117.44); HCM vs. HC: MD = 115.87 (95% CI: 50.71-181.04). ECV at 1.5-T, DCM vs. HC: MD = 4.26 (95% CI: 3.06-5.46); HCM vs. HC: MD = 1.49 (95% CI: -1.45-4.43). ECV at 3.0-T, DCM vs. HC: MD = 8.40 (95% CI: 2.94-13.86); HCM vs. HC: MD = 8.02 (95% CI: 5.45-1-0.59). Conclusion In conclusion, native T1 values were significantly different between NIC patients and controls. Native T1 mapping may be a useful noninvasive method to detect diffuse myocardial fibrosis in NIC patients.
Collapse
Key Words
- CI, confidence interval
- CMR, cardiac magnetic resonance
- DCM, dilated cardiomyopathy
- Dilated cardiomyopathy
- ECV, extracellular volume
- Extracellular volume fraction
- HC, healthy control
- HCM, hypertrophic cardiomyopathy
- Hypertrophic cardiomyopathy
- LGE-MRI, late gadolinium-enhanced magnetic resonance imaging
- MD, mean difference
- MINORS, Methodological Index for Non-Randomized Studies
- MOLLI, modified Look-Locker inversion recovery
- Meta-analysis
- NIC, non-ischemic cardiomyopathy
- Native T1 mapping
- SCD, sudden cardiac death
- SD, standard deviation
- Systematic review
Collapse
Affiliation(s)
- Shintaro Minegishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoaki Ishigami
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masami Kosuge
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
34
|
Sewanan LR, Schwan J, Kluger J, Park J, Jacoby DL, Qyang Y, Campbell SG. Extracellular Matrix From Hypertrophic Myocardium Provokes Impaired Twitch Dynamics in Healthy Cardiomyocytes. JACC Basic Transl Sci 2019; 4:495-505. [PMID: 31468004 PMCID: PMC6712054 DOI: 10.1016/j.jacbts.2019.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/16/2022]
Abstract
The goal of this study was to examine the effects of diseased extracellular matrix on the behavior of healthy heart cells. Myocardium was harvested from a genetically engineered miniature pig carrying the hypertrophic cardiomyopathy mutation MYH7 R403Q and from a wild-type littermate. Engineered heart tissues were created by seeding healthy human induced pluripotent stem cell–derived cardiomyocytes onto thin strips of decellularized porcine myocardium. Engineered heart tissues made from the extracellular matrix of hypertrophic cardiomyopathy hearts exhibit increased stiffness, impaired relaxation, and increased force development. This suggests that diseased extracellular matrix can provoke abnormal contractile behavior in otherwise healthy cardiomyocytes.
Hypertrophic cardiomyopathy (HCM) is often caused by single sarcomeric gene mutations that affect muscle contraction. Pharmacological correction of mutation effects prevents but does not reverse disease in mouse models. Suspecting that diseased extracellular matrix is to blame, we obtained myocardium from a miniature swine model of HCM, decellularized thin slices of the tissue, and re-seeded them with healthy human induced pluripotent stem cell–derived cardiomyocytes. Compared with cardiomyocytes grown on healthy extracellular matrix, those grown on the diseased matrix exhibited prolonged contractions and poor relaxation. This outcome suggests that extracellular matrix abnormalities must be addressed in therapies targeting established HCM.
Collapse
Key Words
- CM, cardiomyocyte
- ECM, extracellular matrix
- EHT, engineered heart tissue
- H&E, hematoxylin and eosin
- HCM, hypertrophic cardiomyopathy
- MTR, Masson trichrome
- MUT, minipig carrying MYH7 R403Q mutation
- MYH7 mutation
- RT50, time from peak tension to 50% relaxation
- SR, Sirius red
- TTP, time to peak tension
- WT, wild-type
- cDNA, complementary deoxyribonucleic acid
- diastolic dysfunction
- engineered heart tissue
- fibrosis
- hypertrophic cardiomyopathy
- iPSC, induced pluripotent stem cell
- iPSC-derived cardiomyocyte
Collapse
Affiliation(s)
- Lorenzo R Sewanan
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Jonas Schwan
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Jonathan Kluger
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Jinkyu Park
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, Connecticut
| | - Daniel L Jacoby
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yibing Qyang
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Stem Cell Center, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut.,Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, Connecticut
| | - Stuart G Campbell
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
35
|
German DM, Mitalipov S, Mishra A, Kaul S. Therapeutic Genome Editing in Cardiovascular Diseases. JACC Basic Transl Sci 2019; 4:122-31. [PMID: 30847427 DOI: 10.1016/j.jacbts.2018.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 11/22/2022]
Abstract
A variety of genetic cardiovascular diseases may one day be curable using gene editing technology. Germline genome editing and correction promises to permanently remove monogenic cardiovascular disorders from the offspring and subsequent generations of affected families. Although technically feasible and likely to be ready for implementation in humans in the near future, this approach remains ethically controversial. Although currently beset by several technical challenges, and not yet past small animal models, somatic genome editing may also be useful for a variety of cardiovascular disorders. It potentially avoids ethical concerns about permanent editing of the germline and allows treatment of already diseased individuals. If technical challenges of Cas9-gRNA delivery (viral vector immune response, nonviral vector delivery) can be worked out, then CRISPR-Cas9 may have a significant place in the treatment of a wide variety of disorders in which partial or complete gene knockout is desired. However, CRISPR may not work for gene correction in the human heart because of low rates of homology directed repair. Off-target effects also remain a concern, although, thus far, small animal studies have been reassuring. Some of the therapies mentioned in this review may be ready for small clinical trials in the near future.
Collapse
|
36
|
Yang KC, Breitbart A, De Lange WJ, Hofsteen P, Futakuchi-Tsuchida A, Xu J, Schopf C, Razumova MV, Jiao A, Boucek R, Pabon L, Reinecke H, Kim DH, Ralphe JC, Regnier M, Murry CE. Novel Adult-Onset Systolic Cardiomyopathy Due to MYH7 E848G Mutation in Patient-Derived Induced Pluripotent Stem Cells. JACC Basic Transl Sci 2018; 3:728-740. [PMID: 30623132 PMCID: PMC6314962 DOI: 10.1016/j.jacbts.2018.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 12/15/2022]
Abstract
A novel myosin heavy chain 7 mutation (E848G) identified in a familial cardiomyopathy was studied in patient-specific induced pluripotent stem cell-derived cardiomyocytes. The cardiomyopathic human induced pluripotent stem cell-derived cardiomyocytes exhibited reduced contractile function as single cells and engineered heart tissues, and genome-edited isogenic cells confirmed the pathogenic nature of the E848G mutation. Reduced contractility may result from impaired interaction between myosin heavy chain 7 and cardiac myosin binding protein C.
Collapse
Key Words
- Ad-GFP, green fluorescent protein–encoding adenovirus
- DCM, dilated cardiomyopathy
- EHT, engineered heart tissue
- FCM, familial cardiomyopathy
- HCM, hypertrophic cardiomyopathy
- KO, knockout
- MOI, multiplicity of infections
- MYH, myosin heavy chain
- WT, wild-type
- cMyBP-C, cardiac myosin-binding protein C
- disease-modeling
- engineered heart tissue
- genetic cardiomyopathy
- hiPSC-CM, human induced pluripotent stem cell–derived cardiomyocyte
- iPSC-CM, induced pluripotent stem cell–derived cardiomyocyte
- induced pluripotent stem cells
Collapse
Affiliation(s)
- Kai-Chun Yang
- Department of Medicine/Cardiology, University of Washington, Seattle, Washington
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Astrid Breitbart
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Willem J. De Lange
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter Hofsteen
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Akiko Futakuchi-Tsuchida
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Joy Xu
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Cody Schopf
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Maria V. Razumova
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Alex Jiao
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Robert Boucek
- Department of Pediatrics, Seattle’s Children’s Hospital and the University of Washington, Seattle, Washington
| | - Lil Pabon
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Hans Reinecke
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Deok-Ho Kim
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - J. Carter Ralphe
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Regnier
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Charles E. Murry
- Department of Medicine/Cardiology, University of Washington, Seattle, Washington
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| |
Collapse
|
37
|
Abstract
Precision medicine strives to delineate disease using multiple data sources-from genomics to digital health metrics-in order to be more precise and accurate in our diagnoses, definitions, and treatments of disease subtypes. By defining disease at a deeper level, we can treat patients based on an understanding of the molecular underpinnings of their presentations, rather than grouping patients into broad categories with one-size-fits-all treatments. In this review, the authors examine how precision medicine, specifically that surrounding genetic testing and genetic therapeutics, has begun to make strides in both common and rare cardiovascular diseases in the clinic and the laboratory, and how these advances are beginning to enable us to more effectively define risk, diagnose disease, and deliver therapeutics for each individual patient.
Collapse
Key Words
- CAD, coronary artery disease
- CF, cystic fibrosis
- CHD, coronary heart disease
- CML, chronic myelogenous leukemia
- CRS, conventional risk score
- CVD, cardiovascular disease
- CaM, calmodulin
- DCM, dilated cardiomyopathy
- DMD, Duchenne muscular dystrophy
- FH, familial hypercholesterolemia
- GRS, genomic risk score
- HCM, hypertrophic cardiomyopathy
- HDR, homology directed repair
- IVF, in vitro fertilization
- LDL-C, low-density lipoprotein cholesterol
- LQTS, long QT syndrome
- NGS, next-generation sequencing
- PGD, preimplantation genetic diagnosis
- SNP, single nucleotide polymorphism
- genome sequencing
- genomics
- iPSC, induced pluripotent stem cells
- precision medicine
- ssODN, single-stranded oligodeoxynucleotide
- targeted therapeutics
Collapse
Affiliation(s)
| | - Euan A. Ashley
- Department of Genetics, Stanford University, Stanford, California
- Department of Medicine, Stanford University, Stanford, California
- Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California
| |
Collapse
|
38
|
Abstract
Heart failure (HF) is the end-stage of all heart disease and arguably constitutes the greatest unmet therapeutic need in cardiovascular medicine today. Classic epidemiological studies have established clinical risk factors for HF, but the cause remains poorly understood in many cases. Biochemical analyses of small case-control series and animal models have described a plethora of molecular characteristics of HF, but a single unifying pathogenic theory is lacking. Heart failure appears to result not only from cardiac overload or injury but also from a complex interplay among genetic, neurohormonal, metabolic, inflammatory, and other biochemical factors acting on the heart. Recent development of robust, high-throughput tools in molecular biology provides opportunity for deep molecular characterization of population-representative cohorts and HF cases (molecular epidemiology), including genome sequencing, profiling of myocardial gene expression and chromatin modifications, plasma composition of proteins and metabolites, and microbiomes. The integration of such detailed information holds promise for improving understanding of HF pathophysiology in humans, identification of therapeutic targets, and definition of disease subgroups beyond the current classification based on ejection fraction which may benefit from improved individual tailoring of therapy. Challenges include: 1) the need for large cohorts with deep, uniform phenotyping; 2) access to the relevant tissues, ideally with repeated sampling to capture dynamic processes; and 3) analytical issues related to integration and analysis of complex datasets. International research consortia have formed to address these challenges and combine datasets, and cohorts with up to 1 million participants are being collected. This paper describes the molecular epidemiology of HF and provides an overview of methods and tissue types and examples of published and ongoing efforts to systematically evaluate molecular determinants of HF in human populations.
Collapse
Affiliation(s)
- J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts
| |
Collapse
|
39
|
Rodriguez-Gonzalez M, Castellano-Martinez A, Grujic B, Prieto-Heredia MA. Disopyramide as rescue treatment in a critically ill infant with obstructive hypertrophic cardiomyopathy refractory to beta blockers. J Cardiol Cases 2017; 15:209-213. [PMID: 30279782 DOI: 10.1016/j.jccase.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/15/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 11/15/2022] Open
Abstract
Hypertrophic obstructive cardiomyopathy (HOCM) is the most common known cause of sudden death in children beyond infancy and in young athletes. Cases reported indicate that steroid-induced HOCM is usually a benign disorder. The normalization of cardiac morphological changes and clinical signs observed after the discontinuation of steroid therapy indicates that the effects on cardiac muscle are dose-dependent and reversible. However, the management of patients with symptomatic-HOCM presenting in infancy represents a major challenge because left ventricular outflow tract obstruction is a major risk factor associated with increased mortality in pediatric patients. We report a critically ill infant with steroid-induced HOCM resistant to beta-blockers who was successfully treated with disopyramide without relevant adverse events. Adult guidelines and pediatric experts suggest pharmacological therapy with beta-blockers or verapamil as the first- and second-line approach. However, these drugs are not always an option, especially in critical patients, hence, alternative therapeutic options are required. For these cases, disopyramide could be an alternative drug in spite of the little evidence on its safety and efficacy in pediatric patients. Our experience supports this cause, and the need for prospective studies on its use in the management of hypertrophic cardiomyopathy in children. <Learning objective: Patients with symptomatic-HOCM resistant to first-line therapy with beta-blockers represent a challenge and are often referred for advanced care. In children, many authors suggest that disopyramide in combination with beta-blockers could be a useful adjunct therapy option in these cases, resulting in decrease of left ventricular outflow tract obstruction, symptoms, and survival improvement, without significant pro-arrhythmia mortality.>.
Collapse
Affiliation(s)
| | | | - Branislava Grujic
- Pediatric Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | | |
Collapse
|
40
|
El Bouchikhi I, Belhassan K, Moufid FZ, Iraqui Houssaini M, Bouguenouch L, Samri I, Atmani S, Ouldim K. Noonan syndrome-causing genes: Molecular update and an assessment of the mutation rate. Int J Pediatr Adolesc Med 2016; 3:133-142. [PMID: 30805484 PMCID: PMC6372459 DOI: 10.1016/j.ijpam.2016.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/14/2016] [Indexed: 12/16/2022]
Abstract
Noonan syndrome is a common autosomal dominant disorder characterized by short stature, congenital heart disease and facial dysmorphia with an incidence of 1/1000 to 2500 live births. Up to now, several genes have been proven to be involved in the disturbance of the transduction signal through the RAS-MAP Kinase pathway and the manifestation of Noonan syndrome. The first gene described was PTPN11, followed by SOS1, RAF1, KRAS, BRAF, NRAS, MAP2K1, and RIT1, and recently SOS2, LZTR1, and A2ML1, among others. Progressively, the physiopathology and molecular etiology of most signs of Noonan syndrome have been demonstrated, and inheritance patterns as well as genetic counseling have been established. In this review, we summarize the data concerning clinical features frequently observed in Noonan syndrome, and then, we describe the molecular etiology as well as the physiopathology of most Noonan syndrome-causing genes. In the second part of this review, we assess the mutational rate of Noonan syndrome-causing genes reported up to now in most screening studies. This review should give clinicians as well as geneticists a full view of the molecular aspects of Noonan syndrome and the authentic prevalence of the mutational events of its causing-genes. It will also facilitate laying the groundwork for future molecular diagnosis research, and the development of novel treatment strategies.
Collapse
Key Words
- CDC25, cell division cycle 25
- CHD, congenital heart defects
- CR, conserved region
- CRD, cysteine-rich domain
- GAP, GTPase activating protein
- GDP, guanosine-DiPhosphate
- GEF, guanine exchange factor
- GH, growth hormone
- GTP, guanosine-TriPhosphate
- HCM, hypertrophic cardiomyopathy
- IGF-1, insulin-like growth factor I
- MAP kinase signaling pathways
- Molecular etiology
- Mutation rate
- Noonan syndrome
- PTPN11
- RAS family
- RBD, RAS binding domain
- REM, RAS exchange motif
Collapse
Affiliation(s)
- Ihssane El Bouchikhi
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco.,Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, B.P. 2202, Route d'Imouzzer, Fez 30000, Morocco
| | - Khadija Belhassan
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Fatima Zohra Moufid
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco.,Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, B.P. 2202, Route d'Imouzzer, Fez 30000, Morocco
| | - Mohammed Iraqui Houssaini
- Laboratory of Microbial Biotechnology, Faculty of Sciences and Techniques, University of Sidi Mohammed Ben Abdellah, B.P. 2202, Route d'Imouzzer, Fez 30000, Morocco
| | - Laila Bouguenouch
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Imane Samri
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Samir Atmani
- Medico-Surgical Unit of Cardio-pediatrics, Department of Pediatrics, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| | - Karim Ouldim
- Medical Genetics and Oncogenetics Laboratory, HASSAN II University Hospital, BP 1835, Atlas, Fez 30000, Morocco
| |
Collapse
|
41
|
Viola HM, Johnstone VPA, Cserne Szappanos H, Richman TR, Tsoutsman T, Filipovska A, Semsarian C, Seidman JG, Seidman CE, Hool LC. The Role of the L-Type Ca 2+ Channel in Altered Metabolic Activity in a Murine Model of Hypertrophic Cardiomyopathy. JACC Basic Transl Sci 2016; 1:61-72. [PMID: 30167506 PMCID: PMC6113168 DOI: 10.1016/j.jacbts.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/31/2015] [Indexed: 01/08/2023]
Abstract
Heterozygous mice (αMHC403/+) expressing the human disease-causing mutation Arg403Gln exhibit cardinal features of hypertrophic cardiomyopathy (HCM) including hypertrophy, myocyte disarray, and increased myocardial fibrosis. Treatment of αMHC403/+mice with the L-type calcium channel (ICa-L) antagonist diltiazem has been shown to decrease left ventricular anterior wall thickness, cardiac myocyte hypertrophy, disarray, and fibrosis. However, the role of the ICa-L in the development of HCM is not known. In addition to maintaining cardiac excitation and contraction in myocytes, the ICa-L also regulates mitochondrial function through transmission of movement of ICa-L via cytoskeletal proteins to mitochondrial voltage-dependent anion channel. Here, the authors investigated the role of ICa-L in regulating mitochondrial function in αMHC403/+mice. Whole-cell patch clamp studies showed that ICa-L current inactivation kinetics were significantly increased in αMHC403/+cardiac myocytes, but that current density and channel expression were similar to wild-type cardiac myocytes. Activation of ICa-L caused a significantly greater increase in mitochondrial membrane potential and metabolic activity in αMHC403/+. These increases were attenuated with ICa-L antagonists and following F-actin or β-tubulin depolymerization. The authors observed increased levels of fibroblast growth factor-21 in αMHC403/+mice, and altered mitochondrial DNA copy number consistent with altered mitochondrial activity and the development of cardiomyopathy. These studies suggest that the Arg403Gln mutation leads to altered functional communication between ICa-L and mitochondria that is associated with increased metabolic activity, which may contribute to the development of cardiomyopathy. ICa-L antagonists may be effective in reducing the cardiomyopathy in HCM by altering metabolic activity. Heterozygous mice (αMHC403/+) expressing the human hypertrophic cardiomyopathy (HCM) disease causing mutation Arg403Gln exhibit cardinal features of HCM. This study investigated the role of L-type Ca2+ channel (ICa-L) in regulating mitochondrial function in Arg403Gln (αMHC403/+) mice. Activation of ICa-L in αMHC403/+mice caused a significantly greater increase in mitochondrial membrane potential and metabolic activity when compared to wild-type mice. Increases in mitochondrial membrane potential and metabolic activity were attenuated with ICa-L antagonists and when F-actin or β-tubulin were depolymerized. ICa-L antagonists may be effective in reducing the cardiomyopathy in HCM by altering metabolic activity.
Collapse
Affiliation(s)
- Helena M Viola
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
| | - Victoria P A Johnstone
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
| | - Henrietta Cserne Szappanos
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
| | - Tara R Richman
- The Harry Perkins Institute for Medical Research, The University of Western Australia, Crawley, Australia
| | - Tatiana Tsoutsman
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Aleksandra Filipovska
- The Harry Perkins Institute for Medical Research, The University of Western Australia, Crawley, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | - Livia C Hool
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| |
Collapse
|
42
|
Mizusawa Y. Recent advances in genetic testing and counseling for inherited arrhythmias. J Arrhythm 2016; 32:389-397. [PMID: 27761163 PMCID: PMC5063262 DOI: 10.1016/j.joa.2015.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 12/19/2022] Open
Abstract
Inherited arrhythmias, such as cardiomyopathies and cardiac ion channelopathies, along with coronary heart disease (CHD) are three most common disorders that predispose adults to sudden cardiac death. In the last three decades, causal genes in inherited arrhythmias have been successfully identified. At the same time, it has become evident that the genetic architectures are more complex than previously known. Recent advancements in DNA sequencing technology (next generation sequencing) have enabled us to study such complex genetic traits. This article discusses indications for genetic testing of patients with inherited arrhythmias. Further, it describes the benefits and challenges that we face in the era of next generation sequencing. Finally, it briefly discusses genetic counseling, in which a multidisciplinary approach is required due to the increased complexity of the genetic information related to inherited arrhythmias.
Collapse
Key Words
- ARVD/C, arrhythmogenic right ventricular dysplasia/cardiomyopathy
- BrS, Brugada syndrome
- CHD, coronary heart disease
- CPVT, catecholaminergic polymorphic ventricular tachycardia
- Cardiac ion channelopathies
- Cardiomyopathies
- DCM, dilated cardiomyopathy
- GWAS, genome wide association study
- Genetic counseling
- Genetic testing
- HCM, hypertrophic cardiomyopathy
- HF, heart failure
- ICD, implantable cardioverter defibrillator
- Inherited arrhythmias
- LQTS, long QT syndrome
- NGS, next generation sequencing
- SCD, sudden cardiac death
- VA, ventricular arrhythmia
- VF, ventricular fibrillation
- WES, whole exome sequencing
Collapse
Affiliation(s)
- Yuka Mizusawa
- Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Room K2-115, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| |
Collapse
|
43
|
Sun PY, Bois JP, Sheldon SH, Asirvatham SJ. Nonobstructive septal hypertrophy in a young adult provoking recurrent polymorphic ventricular tachycardia successfully treated with transaortic and transventricular septal myectomy: A case report. HeartRhythm Case Rep 2015; 1:300-4. [PMID: 28491572 DOI: 10.1016/j.hrcr.2015.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
44
|
Nakajima K, Miyamoto K, Matsuyama TA, Noda T, Ishibashi-Ueda H, Kusano K. Pathology after combined epicardial and endocardial ablation for ventricular tachycardia in a postmortem heart with hypertrophic cardiomyopathy. HeartRhythm Case Rep 2015; 1:310-314. [PMID: 28491574 PMCID: PMC5419512 DOI: 10.1016/j.hrcr.2015.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Taka-Aki Matsuyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|