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Kumar SS, Mondal S, Banerjee S. Ebstein's Anomaly of the Tricuspid Valve, Mitral Valve Prolapse and Left Ventricular Non-Compaction: A Triple Trouble. Heart Lung Circ 2024; 33:e21-e23. [PMID: 38341315 DOI: 10.1016/j.hlc.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/16/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Swasthi S Kumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
| | - Sudipta Mondal
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
| | - Saurav Banerjee
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
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2
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Ma YT, Wang LJ, Zhao XY, Zheng Y, Sha LH, Zhao XX. Can left ventricular entropy by cardiac magnetic resonance late gadolinium enhancement be a prognostic predictor in patients with left ventricular non-compaction? Diagn Interv Radiol 2023; 29:682-690. [PMID: 36995015 PMCID: PMC10679546 DOI: 10.4274/dir.2023.221859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/31/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Left ventricular non-compaction (LVNC) is considered rare; however, the use of cardiac magnetic resonance (CMR) has shown that its incidence is not uncommon, and its clinical presentation remains variable, with an uncertain prognosis. Risk stratification of major adverse cardiac events (MACE) in patients with LVNC remains complex. Therefore, this study aims to determine whether tissue heterogeneity from late gadolinium enhancement-derived entropy is associated with MACE in patients with LVNC. METHODS This study was registered in the Clinical Trial Registry (CTR2200062045). Consecutive patients who underwent CMR imaging and were diagnosed with LVNC were followed up for MACE, which was defined by heart failure, arrhythmias, systemic embolism, and cardiac death. The patients were divided into MACE and non-MACE groups. The CMR parameters included left ventricular (LV) entropy, LV ejection fraction (LVEF), LV end-diastolic volume, LV end-systolic volume (LVESV), and LV mass (LVM). RESULTS Eighty-six patients (age: 45.48 ± 16.64 years; female: 62.7%; LVEF: 42.58 ± 17.20%) were followed up for a median of 18 months and experienced 30 MACE events (34.9%). The MACE group showed higher LV entropy, LVESV, and LVM and lower LVEF than the non-MACE group. LV entropy [hazard ratio (HR): 1.710, 95% confidence interval (CI): 1.078-2.714, P = 0.023] and LVEF (HR: 0.961, 95% CI: 0.936-0.988, P = 0.004) were independent predictors of MACE (P <0.050) according to the Cox regression analysis. Receiver operating characteristic curve analysis revealed that the area under the curve of LV entropy was 0.789 (95% CI: 0.687-0.869, P < 0.001), LVEF was 0.804 (95% CI: 0.699-0.878, P < 0.001), and the combined model of LV entropy and LVEF was 0.845 (95% CI: 0.751-0.914, P < 0.050). CONCLUSION LGE-derived LV entropy and LVEF are independent risk indicators of MACE in patients with LVNC. The combination of the two factors was more conducive to improving the prediction of MACE.
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Affiliation(s)
- Yun-Ting Ma
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lu-Jing Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Ying Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yue Zheng
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li-Hui Sha
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xin-Xiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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3
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Grebur K, Gregor Z, Kiss AR, Horváth M, Mester B, Czimbalmos C, Tóth A, Szabó L, Dohy Z, Vágó H, Merkely B, Szűcs A. Different methods, different results? Threshold-based versus conventional contouring techniques in clinical practice. Int J Cardiol 2023; 381:128-134. [PMID: 36965638 DOI: 10.1016/j.ijcard.2023.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND The quantitative differences of left and right ventricular (LV, RV) parameters of using different cardiac MRI (CMR) post-processing techniques and their clinical impact are less studied. We aimed to assess the differences and their clinical impact between the conventional contouring (CC) and the threshold-based (TB) methods using 70% and 50% thresholds in different hypertrabeculated conditions. METHODS This retrospective study included 30 dilated cardiomyopathy, 30 left ventricular non-compaction (LVNC), 30 arrhythmogenic cardiomyopathy patients, 30 healthy athletes and 30 healthy volunteers. All participants underwent CMR imaging on 1.5 T. Cine sequences were used to derive measures of the cardiac volumes, function, total muscle mass (TMi) and trabeculae and papillary muscle mass (TPMi) using CC and TB segmentation methods. RESULTS Comparing the CC and the 70% and 50% threshold TB methods, the LV and RV volumes were significantly lower, the ejection fraction (EF) and the TMi were significantly higher with the TB methods. Between the two threshold setups, only TPMi was significantly higher with the 70% threshold. Regarding the clinical benefits, the LVNC was the only group in whom all the diagnostic and therapeutic decisions and risk stratification were influenced using the TB method. Diagnostic changes occurred in three-quarters of the population, and all the cardiomyopathy groups were affected regarding the decision-making about pharmaco- and device therapy. CONCLUSIONS Using the TB method, only TPMi was significantly higher with the 70% threshold than the 50% setup, and both of them differed significantly from the CC technique, with relevant clinical impacts in all patient groups.
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Affiliation(s)
- Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Zsófia Gregor
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Márton Horváth
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Balázs Mester
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Csilla Czimbalmos
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Attila Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary; Department of Sports Medicine, Semmelweis University, Budapest, Városmajor utca, 68., Budapest 1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary; Department of Sports Medicine, Semmelweis University, Budapest, Városmajor utca, 68., Budapest 1122, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary.
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Dorobantu DM, Radulescu CR, Riding N, McClean G, de la Garza MS, Abuli-Lluch M, Duarte N, Adamuz MC, Ryding D, Perry D, McNally S, Stuart AG, Sitges M, Oxborough DL, Wilson M, Williams CA, Pieles GE. The use of 2-D speckle tracking echocardiography in assessing adolescent athletes with left ventricular hypertrabeculation meeting the criteria for left ventricular non-compaction cardiomyopathy. Int J Cardiol 2023; 371:500-7. [PMID: 36216087 DOI: 10.1016/j.ijcard.2022.09.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current echocardiographic criteria cannot accurately differentiate exercise induced left ventricular (LV) hypertrabeculation in athletes from LV non-compaction cardiomyopathy (LVNC). This study aims to evaluate the role of speckle tracking echocardiography (STE) in characterising LV myocardial mechanics in healthy adolescent athletes with and without LVNC echocardiographic criteria. METHODS Adolescent athletes evaluated at three sports academies between 2014 and 2019 were considered for this observational study. Those meeting the Jenni criteria for LVNC (end-systolic non-compacted/compacted myocardium ratio > 2 in any short axis segment) were considered LVNC+ and the rest LVNC-. Peak systolic LV longitudinal strain (Sl), circumferential strain (Sc), rotation (Rot), corresponding strain rates (SRl/c) and segmental values were calculated and compared using a non-inferiority approach. RESULTS A total of 417 participants were included, mean age 14.5 ± 1.7 years, of which 6.5% were LVNC+ (n = 27). None of the athletes showed any additional LVNC clinical criteria. All average Sl, SRl Sc, SRc and Rot values were no worse in the LVNC+ group compared to LVNC- (p values range 0.0003-0.06), apart from apical SRc (p = 0.2). All 54 segmental measurements (Sl/Sc SRl/SRc and Rot) had numerically comparable means in both LVNC+ and LVNC-, of which 69% were also statistically non-inferior. CONCLUSIONS Among healthy adolescent athletes, 6.5% met the echocardiographic criteria for LVNC, but showed normal LV STE parameters, in contrast to available data on paediatric LVNC describing abnormal myocardial function. STE could better characterise the myocardial mechanics of athletes with LV hypertrabeculation, thus allowing the transition from structural to functional LVNC diagnosis, especially in suspected physiological remodelling.
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5
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Sanna GD, Piga A, Parodi G, Sinagra G, Papadakis M, Pantazis A, Sharma S, Gati S, Finocchiaro G. The Electrocardiogram in the Diagnosis and Management of Patients With Left Ventricular Non-Compaction. Curr Heart Fail Rep 2022; 19:476-490. [PMID: 36227527 DOI: 10.1007/s11897-022-00580-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE REVIEW Left ventricular non-compaction (LVNC) is characterised by prominent left ventricular trabeculae and deep inter-trabecular recesses. Although considered a distinct cardiomyopathy, prominent trabeculations may also be found in other cardiomyopathies, in athletes or during pregnancy. Clinical presentation includes heart failure symptoms, systemic embolic events, arrhythmias and sudden cardiac death. Currently, LVNC diagnosis relies on imaging criteria, and clinicians face several challenges in the assessment of patients with prominent trabeculations. In this review, we summarise the available information on the role of the ECG in the diagnosis and management of LVNC. RECENT FINDINGS ECG abnormalities have been reported in 75-94% of adults and children with LVNC. The lack of specificity of these ECG abnormalities does not allow (in isolation) to diagnose the condition. However, when considered in a set of diagnostic criteria including family history, clinical information, and imaging features, the ECG may differentiate between physiological and pathological findings or may provide clues raising the possibility of specific underlying conditions. Finally, some ECG features in LVNC constitute ominous signs that require a stricter patient surveillance or specific therapeutic measures. The ECG remains a cornerstone in the diagnosis and management of patients with cardiomyopathies, including LVNC.
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Affiliation(s)
- Giuseppe D Sanna
- Cardiovascular Department, Sassari University Hospital, Sassari, Italy. .,Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy.
| | - Anna Piga
- Cardiovascular Department, Sassari University Hospital, Sassari, Italy
| | - Guido Parodi
- Cardiovascular Department, Sassari University Hospital, Sassari, Italy
| | | | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Antonis Pantazis
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Sabiha Gati
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK.,King's College London, London, UK
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Oztarhan K, Senturk B, Ucar O. Left ventricular non-compaction cardiomyopathy: restrictive subtype with MYH7 gene mutation. Cardiol Young 2022;:1-3. [PMID: 36217801 DOI: 10.1017/S1047951122002773] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Left ventricular non-compaction is a very rare, still unclassified congenital cardiomyopathy. Nine distinct subtypes of functional and anatomical left ventricular non-compaction have been identified. Studies on the prognosis and mortality of subtypes are ongoing. Our study presented the first restrictive subtype left ventricular non-compaction case with family history and MYH7 gene mutation.
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Bazoukis G, Tyrovolas K, Letsas KP, Vlachos K, Radford D, Chung CT, Liu T, Efremidis M, Tse G, Baranchuk A. Predictors of fatal arrhythmic events in patients with non-compaction cardiomyopathy: a systematic review. Heart Fail Rev 2022; 27:2067-2076. [PMID: 35776368 DOI: 10.1007/s10741-022-10257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 12/01/2022]
Abstract
Left ventricular non-compaction cardiomyopathy (LVNC) is a congenital heart disease with autosomal dominant inheritance. This review aims to summarize the existing data about the predictors of fatal arrhythmias in patients with LVNC. Medline and Cochrane library databases were searched from inception to November 2021 for articles on LVNC. The reference lists of the relevant research studies as well as the relevant review studies and meta-analyses were also searched. Clinical symptoms and electrocardiogram findings such as left bundle branch block are significantly associated with ventricular arrhythmias. Other non-invasive tools such as Holter monitoring, echocardiography, and cardiac magnetic resonance (CMR) can provide additional value for risk stratification. CMR-derived left and right ventricular ejection fraction, left ventricular end-diastolic diameter, late gadolinium enhancement, and non-compacted to compacted myocardium ratio are predictive of ventricular arrhythmias. An electrophysiological study can provide additional prognostic data in patients with LVNC who are at moderate risk of ventricular arrhythmias. Risk stratification of LVNC patients with no prior history of a fatal arrhythmic event remains challenging. Symptoms assessment, electrocardiogram, Holter monitoring, and cardiac imaging should be performed on every patient, while an electrophysiological study should be performed for moderate-risk patients. Large cohort studies are needed for the construction of score models for arrhythmic risk stratification purposes.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus. .,Department of Basic and Clinical Sciences, University of Nicosia Medical School, 2414, Nicosia, Cyprus.
| | | | | | | | - Danny Radford
- Kent and Medway Medical School, Canterbury, Kent, UK
| | | | - Tong Liu
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Collaboration, Hong Kong, China-UK, China.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Michael Efremidis
- Department of Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Kent, UK.,Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Collaboration, Hong Kong, China-UK, China
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, ON, Canada
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8
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Tu P, Sun H, Zhang X, Ran Q, He Y, Ran S. Diverse cardiac phenotypes among different carriers of the same MYH7 splicing variant allele (c.732+1G>A) from a family. BMC Med Genomics 2022; 15:36. [PMID: 35209905 PMCID: PMC8876400 DOI: 10.1186/s12920-022-01186-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/12/2021] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital heart defect. Gene defections have been found in patients with LVNC and their family members; and MYH7 is the most frequent gene associated with LVNC. Methods We performed a complete prenatal ultrasound and echocardiographic examination on a fetus with cardiac abnormality and a parent–child trio whole-exome sequencing to identify the potential genetic causes. When the genetic abnormality in MYH7 was identified in the fetus, we performed echocardiography and genetic screening on its high-risk relatives. Results Second trimester ultrasound and echocardiography showed several malformations in the fetus: Ebstein’s anomaly (EA), heart dilatation, perimembranous ventricle septal defects, mild seroperitoneum, and single umbilical artery. Heterozygous genotyping of a splicing variant allele (NM_00025.3: c.732+G>A) was identified in this fetus and her mother, not her father, indicating a maternal inheritance. Subsequently, direct sequencing confirmed the presence of this splicing variant among her grandmother (mother of mother), mother, older sister, and herself in a heterozygous manner. No PCR products were amplified by qRT-PCR for the RNA samples extracted from peripheral blood cells. In addition to this proband who was diagnosed with EA, her older sister and grandmother (mother of mother) were diagnosed with isolated asymptomatic LVCN, but her mother was just a carrier with no marked clinical manifestations after family screening. Conclusion The presence of MYH7 splicing variant c.732+G>A can be inherited maternally, and its cardiac phenotypes are different from one carrier to another.
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Affiliation(s)
- Peng Tu
- Department of Ultrasound, Chongqing Health Center for Women and Children, 120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Hairui Sun
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiaohang Zhang
- Department of Ultrasound, Chongqing Health Center for Women and Children, 120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Qian Ran
- Department of Ultrasound, Chongqing Health Center for Women and Children, 120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Yihua He
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Suzhen Ran
- Department of Ultrasound, Chongqing Health Center for Women and Children, 120 Longshan Road, Yubei District, Chongqing, 401147, China.
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Rodríguez-de-Vera JM, Bernabé G, García JM, Saura D, González-Carrillo J. Left ventricular non-compaction cardiomyopathy automatic diagnosis using a deep learning approach. Comput Methods Programs Biomed 2022; 214:106548. [PMID: 34861618 DOI: 10.1016/j.cmpb.2021.106548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Left ventricular non-compaction (LVNC) is an uncommon cardiomyopathy characterised by a thick and spongy left ventricle wall caused by the high presence of trabeculae (hyper-trabeculation). Recently, the percentage of the trabecular volume to the total volume of the external wall of the left ventricle (VT%) has been proposed to diagnose this illness. METHODS This paper presents the use of a deep learning-based method to measure the (VT%) value and diagnose this rare cardiomyopathy. The population used in this research was composed of 277 patients suffering from hypertrophic cardiomyopathy. 134 patients only suffered hypertrophic cardiomyopathy, and 143 also suffered left ventricular non-compaction. Our deep learning solution is based on a 2D U-Net. This artificial neural network (ANN) was trained on short-axis magnetic resonance imaging to segment the left ventricle's internal cavity, external wall, and trabecular tissue. 5-fold cross-validation was performed to ensure the robustness of the results. The Dice coefficient of the three classes was computed as a measure of the precision of the segmentation. Based on this segmentation, the percentage of the trabecular volume (VT%) was computed. Two specialist cardiologists rated the segmentation produced by the neural network for 25 patients to evaluate the clinical validity of the outputs. The computed VT% was used to automatically diagnose the 277 patients depending on whether or not a given threshold was exceeded. A receiver operating characteristic analysis was also performed. RESULTS According to the cross-validation results, the average and standard deviation of the Dice coefficient for the internal cavity, external wall, and trabeculae were 0.96±0.00, 0.89±0.00, and 0.84±0.00, respectively. The cardiologists rated 99.5% of the evaluated segmentations as clinically valid for diagnosis, outperforming existing automatic traditional tools. The area under the ROC curve was 0.94 (95% confidence interval, 0.91-0.96). The accuracy, sensitivity, and specificity values of diagnosis using a threshold of 25% were 0.87, 0.93, and 0.80, respectively. CONCLUSIONS The U-Net neural network can achieve excellent results in the delineation of different cardiac structures of short-axis cardiac MRI. The high-quality segmentation allows for the correct measurement of left ventricular hyper-trabeculation and a definitive diagnosis of LVNC illness. Using this kind of solution could lead to more objective and faster analysis, reducing human error and time spent by cardiologists.
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Affiliation(s)
| | - Gregorio Bernabé
- Computer Engineering Department, University of Murcia, Murcia 30071 Spain.
| | - José M García
- Computer Engineering Department, University of Murcia, Murcia 30071 Spain
| | - Daniel Saura
- Hospital Virgen de la Arrixaca, Murcia 30080 Spain
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10
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Zhou D, Li S, Sirajuddin A, Wu W, Huang J, Sun X, Zhao S, Pu J, Lu M. CMR Characteristics, gene variants and long-term outcome in patients with left ventricular non-compaction cardiomyopathy. Insights Imaging 2021; 12:184. [PMID: 34894296 PMCID: PMC8665949 DOI: 10.1186/s13244-021-01130-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background As the paucity of data focusing on evaluating cardiac structure and function in patients with or without gene mutation, this study was sought to investigate the correlation between genotype and cardiac magnetic resonance (CMR) phenotype in patients with left ventricular non-compaction cardiomyopathy (LVNC) and to explore prognostic relevance in this cohort if possible. Methods Patients with LVNC who underwent CMR and targeted gene sequencing between 2006 and 2016 were retrospectively evaluated. Demographic data, clinical presentation, genetic analysis, CMR data and follow-up data of all participants were collected. Results Compared to negative genotype (G−) group, patients with positive genotype (G+) had larger left atrial volume (LAV), and carriers of multiple variants had lower left ventricular (LV) ejection fraction and cardiac index, increased LV fibrosis, larger LA volume, reduced LV global circumferential strain, LA reservoir strain and booster pump strain (all p < 0.05). LA volume was able to discriminate patients with G + (all p < 0.05), as well as those with multiple genetic mutation (all p < 0.01). During a median follow-up of 5.1 years, Kaplan–Meier survival analysis revealed worse primary endpoint-free survival among carriers of multiple variants compared to G− group. Conclusions CMR feature tracking is a remarkable tool to evaluate implication, genetics cascade screen and predict outcome in LVNC population. LA volume is a sensitive and robust indicator for genetic mutational condition, of which facilities to guide clinical management and intensity of follow-up for patients and their relatives. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01130-2.
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Affiliation(s)
- Di Zhou
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Shijie Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National, Institutes of Health (NIH), Bethesda, USA
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jinghan Huang
- The Heart-Lung Testing Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoxin Sun
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Department of Nuclear Medicine, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Jielin Pu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China. .,Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China.
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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11
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Rhee S, Paik DT, Yang JY, Nagelberg D, Williams I, Tian L, Roth R, Chandy M, Ban J, Belbachir N, Kim S, Zhang H, Phansalkar R, Wong KM, King DA, Valdez C, Winn VD, Morrison AJ, Wu JC, Red-Horse K. Endocardial/endothelial angiocrines regulate cardiomyocyte development and maturation and induce features of ventricular non-compaction. Eur Heart J 2021; 42:4264-4276. [PMID: 34279605 PMCID: PMC8560211 DOI: 10.1093/eurheartj/ehab298] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 04/21/2021] [Accepted: 05/15/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Non-compaction cardiomyopathy is a devastating genetic disease caused by insufficient consolidation of ventricular wall muscle that can result in inadequate cardiac performance. Despite being the third most common cardiomyopathy, the mechanisms underlying the disease, including the cell types involved, are poorly understood. We have previously shown that endothelial cell-specific deletion of the chromatin remodeller gene Ino80 results in defective coronary vessel development that leads to ventricular non-compaction in embryonic mouse hearts. We aimed to identify candidate angiocrines expressed by endocardial and endothelial cells (ECs) in wildtype and LVNC conditions in Tie2Cre;Ino80fl/fltransgenic embryonic mouse hearts, and test the effect of these candidates on cardiomyocyte proliferation and maturation. METHODS AND RESULTS We used single-cell RNA-sequencing to characterize endothelial and endocardial defects in Ino80-deficient hearts. We observed a pathological endocardial cell population in the non-compacted hearts and identified multiple dysregulated angiocrine factors that dramatically affected cardiomyocyte behaviour. We identified Col15a1 as a coronary vessel-secreted angiocrine factor, downregulated by Ino80-deficiency, that functioned to promote cardiomyocyte proliferation. Furthermore, mutant endocardial and endothelial cells up-regulated expression of secreted factors, such as Tgfbi, Igfbp3, Isg15, and Adm, which decreased cardiomyocyte proliferation and increased maturation. CONCLUSIONS These findings support a model where coronary endothelial cells normally promote myocardial compaction through secreted factors, but that endocardial and endothelial cells can secrete factors that contribute to non-compaction under pathological conditions.
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Affiliation(s)
- Siyeon Rhee
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - David T Paik
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Johnson Y Yang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Ian Williams
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lei Tian
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert Roth
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Mark Chandy
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jiyeon Ban
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Nadjet Belbachir
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Seokho Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Hao Zhang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ragini Phansalkar
- Department of Genetics, Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Ka Man Wong
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Devin A King
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Caroline Valdez
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Ashby J Morrison
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kristy Red-Horse
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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12
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Davlat M, Massin M, Rodriguez Castro J, Damry N. Association of left ventricular non-compaction with acute coronary syndrome. Acta Cardiol 2021; 77:465-466. [PMID: 34085591 DOI: 10.1080/00015385.2021.1897258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mina Davlat
- Division of Radiology, CHU Brugmann, Brussels, Belgium
| | - Martial Massin
- Division of Pediatric Cardiology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
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13
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Ross SB, Jones K, Blanch B, Puranik R, McGeechan K, Barratt A, Semsarian C. A systematic review and meta-analysis of the prevalence of left ventricular non-compaction in adults. Eur Heart J 2021; 41:1428-1436. [PMID: 31143950 DOI: 10.1093/eurheartj/ehz317] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/13/2018] [Accepted: 05/01/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS To assess the reported prevalence of left ventricular non-compaction (LVNC) in different adult cohorts, taking in to consideration the role of diagnostic criteria and imaging modalities used. METHODS AND RESULTS A systematic review and meta-analysis of studies reporting LVNC prevalence in adults. Studies were sourced from Pre-Medline, Medline, and Embase and assessed for eligibility according to inclusion criteria. Eligible studies provided a prevalence of LVNC in adult populations (≥12 years). Studies were assessed, and data extracted by two independent reviewers. Fifty-nine eligible studies documenting LVNC in 67 unique cohorts were included. The majority of studies were assessed as moderate or high risk of bias. The pooled prevalence estimates for LVNC were consistently higher amongst cohorts diagnosed on cardiac magnetic resonance (CMR) imaging (14.79%, n = 26; I2 = 99.45%) compared with echocardiogram (1.28%, n = 36; I2 = 98.17%). This finding was unchanged when analysis was restricted to studies at low or moderate risk of bias. The prevalence of LVNC varied between disease and population representative cohorts. Athletic cohorts demonstrated high pooled prevalence estimates on echocardiogram (3.16%, n = 5; I2 = 97.37%) and CMR imaging (27.29%, n = 2). CONCLUSION Left ventricular non-compaction in adult populations is a poorly defined entity which likely encompasses both physiological adaptation and pathological disease. There is a higher prevalence with the introduction of newer imaging technologies, specifically CMR imaging, which identify LVNC changes more readily. The clinical significance of these findings remains unclear; however, there is significant potential for overdiagnosis, overtreatment, and unnecessary follow-up.
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Affiliation(s)
- Samantha B Ross
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney 2050, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, New South Wales, Australia
| | - Katherine Jones
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney 2050, New South Wales, Australia
| | - Bianca Blanch
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney 2050, New South Wales, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney 2050, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, New South Wales, Australia.,Wiser Healthcare, Sydney 2050, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, New South Wales, Australia.,Wiser Healthcare, Sydney 2050, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney 2050, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney 2050, New South Wales, Australia.,Wiser Healthcare, Sydney 2050, New South Wales, Australia
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14
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Faber JW, D'Silva A, Christoffels VM, Jensen B. Lack of morphometric evidence for ventricular compaction in humans. J Cardiol 2021; 78:397-405. [PMID: 33840532 DOI: 10.1016/j.jjcc.2021.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
The remodeling of the compact wall by incorporation of trabecular myocardium, referred to as compaction, receives much attention because it is thought that its failure causes left ventricular non-compaction cardiomyopathy (LVNC). Although the notion of compaction is broadly accepted, the nature and strength of the evidence supporting this process is underexposed. Here, we review the literature that quantitatively investigated the development of the ventricular wall to understand the extent of compaction in humans, mice, and chickens. We queried PubMed using several search terms, screened 1127 records, and selected 56 publications containing quantitative data on ventricular growth. For humans, only 34 studies quantified wall development. The key premise of compaction, namely a reduction of the trabecular layer, was never documented. Instead, the trabecular layer grows slower than the compact wall in later development and this changes wall architecture. There were no reports of a sudden enlargement of the compact layer (from incorporated trabeculae), be it in thickness, area, or volume. Therefore, no evidence for compaction was found. Only in chickens, a sudden increase in compact myocardial thickness layer was reported coinciding with a decrease in trabecular thickness. In mice, morphometric and lineage tracing investigations have yielded conflicting results that allow for limited compaction to occur. In conclusion, compaction in human development is not supported while rapid intrinsic growth of the compact wall is supported in all species. If compaction takes place, it likely plays a much smaller role in determining wall architecture than intrinsic growth of the compact wall.
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Affiliation(s)
- Jaeike W Faber
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands.
| | - Andrew D'Silva
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands.
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15
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Evans E, McDonald M, Adamson DL, Khan JN. Cardiomyopathy in the peripartum period due to left ventricular non-compaction and association with Ebstein's anomaly: a case report. Eur Heart J Case Rep 2021; 5:ytab088. [PMID: 33768196 PMCID: PMC7983311 DOI: 10.1093/ehjcr/ytab088] [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: 10/09/2020] [Revised: 11/03/2020] [Accepted: 02/19/2021] [Indexed: 12/24/2022]
Abstract
Background Left ventricular non-compaction (LVNC) cardiomyopathy is a persistence of abnormal foetal myocardium and is a rare cause of cardiomyopathy in the peripartum period. Unlike other causes of peripartum cardiomyopathy which typically improve, LVNC has significant long-term personal and family implications and needs lifelong follow-up. Case summary We describe a unique case of a 30-year-old woman who developed cardiomyopathy in the peripartum period which was revealed on cardiovascular magnetic resonance imaging to be due to occult LVNC. Our patient also had Ebstein’s anomaly, which is a known LVNC association. Discussion Cardiomyopathy in the peripartum period can be a decompensation of previously asymptomatic subclinical cardiomyopathy. It is important to assess for LVNC in patients presenting with this. Cardiovascular magnetic resonance imaging is the gold-standard imaging modality and allows accurate diagnosis of LVNC, associated structural complications and rare associations such as Ebstein’s anomaly. Left ventricular non-compaction is irreversible and has implications for patients and their family members.
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Affiliation(s)
- Emily Evans
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Mandy McDonald
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Dawn L Adamson
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Jamal Nasir Khan
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
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16
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Femia G, Zhu D, Choudhary P, Ross SB, Muthurangu V, Richmond D, Celermajer DS, Semsarian C, Puranik R. Long term clinical outcomes associated with CMR quantified isolated left ventricular non-compaction in adults. Int J Cardiol 2021; 328:235-40. [PMID: 33309759 DOI: 10.1016/j.ijcard.2020.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Left ventricular non-compaction (LVNC) is a complex clinical condition with several diagnostic criteria but no diagnostic gold standard. We aimed to evaluate our thresholding technique in a group of patients with LVNC and assess the risk of major adverse cardiovascular and cerebrovascular events (MACCE). METHODS We retrospectively analyzed cardiac magnetic resonance (CMR) scans of patients with Petersen criteria LVNC and quantified noncompacted myocardial mass. We assessed the association of noncompacted myocardial mass, CMR derived LV volumetric parameters and late gadolinium enhancement (LGE) to MACCE including cardiac death, cardiac transplantation, sustained ventricular tachycardia/ventricular fibrillation (VT/VF) and ischemic stroke. Patients with known genetic mutations and cardiovascular disease were excluded. RESULTS 98 patients with LVNC were included (55 males,56.7%); 17(17.3%) patients had impaired LV function and five (5.1%) had LGE. Patients with impaired LV function had more end-systolic noncompacted mass (61.9 g±22.4 vs. 38.1 g±15.8, p < 0.001) and larger end-systolic noncompacted to total myocardial mass (44%±9 vs. 36%±12, p = 0.003). At 78 months follow-up [interquartile range(IQR) 66-90], MACCE occurred in 11(11.3%) patients; nine(81.8%) had impaired LV function and two(18.2%) had LGE. Impaired LV function and LV LGE were predictors of MACCE (HR = 35.6, 95% CI = 7.65-165.21, p < 0.001 and HR = 16.2, 95% CI = 4.54-57.84, p < 0.001) whereas noncompacted mass were not. CONCLUSION Noncompacted mass was not an independent predictor of major adverse events but in patients with impaired LV function and/or LV LGE, the risk of MACCE was high. These results highlight the importance of including LV volumetrics and scar in the assessment of patients with LV noncompaction.
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17
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Hirano M, Kimura K, Ishigaki T, Nojima M, Daimon M, Morita H, Takenaka K, Xu B, Sawada N, Hirokawa M, Komuro I, Morisaki T, Yotsuyanagi H, Kawamata T, Yokoyama K, Konuma T, Kato S, Yasui H, Nagamura-Inoue T, Uchimaru K, Takahashi S, Imai Y, Tojo A. High Prevalence of Left Ventricular Non-Compaction and Its Effect on Chemotherapy-Related Cardiac Dysfunction in Patients With Hematological Diseases. Circ J 2020; 84:1957-1964. [PMID: 33041289 DOI: 10.1253/circj.cj-20-0344] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recent progress in chemotherapy has prolonged the survival of patients with hematological diseases, but has also increased the number of patients with chemotherapy-related cardiac dysfunction (CTRCD). However, the causes of individual variations and risk factors for CTRCD have yet to be fully elucidated.Methods and Results:Consecutive echocardiograms of 371 patients were retrospectively evaluated for the presence of left ventricular (LV) non-compaction (LVNC). Individual LV ejection fraction (LVEF) outcome estimates were made using bivariate linear regression with log-transformed duration Akaike information criterion (AIC) model fitting. The prevalence of LVNC was 6-fold higher in patients with hematological diseases than in those with non-hematological diseases (12% vs. 2%; risk ratio 6.1; 95% confidence interval [CI] 2.0, 18.2). Among patients with hematological diseases, the ratio of myeloid diseases was significantly higher in the group with LVNC (P=0.031). Deterioration of LVEF was more severe in patients with than without LVNC (-14.4 percentage points/year [95% CI -21.0, -7.9] vs. -4.6 percentage points/year [95% CI -6.8, -2.4], respectively), even after multivariate adjustment for baseline LVEF, background disease distributions, cumulative anthracycline dose, and other baseline factors. CONCLUSIONS LVNC is relatively prevalent in patients with hematological diseases (particularly myeloid diseases) and can be one of the major risk factors for CTRCD. Detailed cardiac evaluations including LVNC are recommended for patients undergoing chemotherapy.
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Affiliation(s)
- Mitsuhito Hirano
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Koichi Kimura
- Department of Laboratory Medicine, The Institute of Medical Science, The University of Tokyo.,Department of General Medicine, The Institute of Medical Science, The University of Tokyo.,Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tomohiro Ishigaki
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo.,Department of Laboratory Medicine, The Institute of Medical Science, The University of Tokyo
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo
| | - Masao Daimon
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Laboratory Medicine, The University of Tokyo Hospital, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsu Takenaka
- Department of Laboratory Medicine, The University of Tokyo Hospital, The University of Tokyo
| | - Boqing Xu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Naoko Sawada
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Takayuki Morisaki
- Department of General Medicine, The Institute of Medical Science, The University of Tokyo
| | - Hiroshi Yotsuyanagi
- Department of General Medicine, The Institute of Medical Science, The University of Tokyo
| | - Toyotaka Kawamata
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Kazuaki Yokoyama
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Seiko Kato
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Hiroshi Yasui
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Tokiko Nagamura-Inoue
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo.,Department of Laboratory Medicine, The Institute of Medical Science, The University of Tokyo
| | - Kaoru Uchimaru
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Satoshi Takahashi
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Yoichi Imai
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
| | - Arinobu Tojo
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo
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18
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Vershinina T, Fomicheva Y, Muravyev A, Jorholt J, Kozyreva A, Kiselev A, Gordeev M, Vasichkina E, Segrushichev A, Pervunina T, Sjoberg G, Skyttner-Rahmani S, Sejersen T, Kostareva A. Genetic Spectrum of Left Ventricular Non-Compaction in Paediatric Patients. Cardiology 2020; 145:746-756. [PMID: 33049752 DOI: 10.1159/000510439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Left ventricular non-compaction (LVNC) represents a genetically heterogeneous cardiomyopathy which occurs in both children and adults. Its genetic spectrum overlaps with other types of cardiomyopathy. However, LVNC phenotypes in different age groups can have distinct genetic aetiologies. The aim of the study was to decipher the genetic spectrum of LVNC presented in childhood. Patient Group and Methods: Twenty patients under the age of 18 years diagnosed with LVNC were enrolled in the study. Target sequencing and whole-exome sequencing were performed using a panel of 108 cardiomyopathy-associated genes. Pathogenic, likely pathogenic, and variants of unknown significance found in genes highly expressed in cardiomyocytes were considered as variants of interest for further analysis. RESULTS The median age at presentation was 8.0 (0.1-17) years, with 6 patients presenting before 1 year of age. Twelve (60%) patients demonstrated reduced ejection fraction. Right ventricular (RV) dilation was registered in 6 (30%), often in combination with reduced RV contractility (25%). Almost half (45%) of the patients demonstrated biventricular involvement already at disease presentation. For pathogenic and likely pathogenic variants, the positive genotyping rate was 45%, and these variants were found mainly in non-contractile structural sarcomeric genes (ACTN2, MYPN, and TTN) or in metabolic and signal transduction genes (BRAF and TAZ). Likely pathogenic TAZ variants were detected in all 5 patients suspected of having Barth syndrome. No pathogenic or likely pathogenic variants were found in genes encoding for sarcomeric contractile proteins, but variants of unknown significance were detected in 3 out of 20 patients (MYH6, MYH7, and MYLK2). In 4 patients, variants of unknown significance in ion-channel genes were detected. CONCLUSION We detected a low burden of contractile sarcomeric variants in LVNC patients presenting below the age of 18 years, with the major number of variants residing in non-contractile structural sarcomeric genes. The identification of the variants in ion-channel and related genes not previously associated with LVNC in paediatric patients requires further examination of their functional role.
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Affiliation(s)
- Tatiana Vershinina
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Yulia Fomicheva
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Alexey Muravyev
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - John Jorholt
- Department of Women's and Children's Health and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Alexandra Kozyreva
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Artem Kiselev
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Michail Gordeev
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Elena Vasichkina
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | | | - Tatyana Pervunina
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Gunnar Sjoberg
- Department of Women's and Children's Health and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sanaz Skyttner-Rahmani
- Department of Women's and Children's Health and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Thomas Sejersen
- Department of Women's and Children's Health and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna Kostareva
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation, .,Department of Women's and Children's Health and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden,
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19
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Seitz A, Hinck A, Bekeredjian R, Sechtem U. Late diagnosis of Barth syndrome in a 39-year-old patient with non-compaction cardiomyopathy and neutropenia. ESC Heart Fail 2020; 7:697-701. [PMID: 31967729 PMCID: PMC7160505 DOI: 10.1002/ehf2.12588] [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: 08/20/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/07/2022] Open
Abstract
Barth syndrome is a rare X‐linked recessive disorder characterized by a broad spectrum of clinical features including cardiac and skeletal myopathy, neutropenia, exercise intolerance, and growth delay. Most affected patients are diagnosed during childhood, and mortality is highest in the first years of life. As a consequence, Barth syndrome is often considered a paediatric disease. Here, we report a case where the diagnosis was established in a 39‐year‐old patient with left ventricular non‐compaction and neutropenia. The clinical course of the patient presented here was relatively benign. This suggests that the prevalence of Barth syndrome in adults may be underestimated. Barth syndrome should be considered in the differential diagnosis of male patients with cardiomyopathy and neutropenia.
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Affiliation(s)
- Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Annely Hinck
- Department of Medicine-Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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20
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Bonamini R, Imazio M, Faletti R, Gatti M, Xhyheri B, Limone M, Longo F, Piga A. Prevalence and prognostic impact of left ventricular non-compaction in patients with thalassemia. Intern Emerg Med 2019; 14:1299-1306. [PMID: 31240580 DOI: 10.1007/s11739-019-02114-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
A high incidence of isolated left ventricular non-compaction (LVNC) has been reported in previous studies on smaller cohorts of patients with thalassemia by cardiac MRI but the clinical impact of the finding is unknown. This prospective cohort study evaluates the prevalence and clinical implication of the finding. Prospective cohort study with enrollment of all consecutive cases with thalassemia referred for cardiac MRI from September 2007 to November 2014. The presence of LVNC was assessed according to the Petersen method and the Jacquier method, with the proposed changes by Fazio, Grothoff, and Chiodi. A clinical follow-up was performed in all patients. We included 560 patients with thalassemia (473 with thalassemia major and 87 with thalassemia intermedia: mean age 31.9 ± 10.6 years, male/female = 250/310). A total number of 1683 MRI tests were performed. A diagnosis of LVNC was determined according to adopted MR criteria in 44 patients (7.9%). Patients with LVNC had a significantly lower ejection fraction (52.68 ± 5.17% vs. 56.90 ± 6.34%; p = 0.0005) and greater indexed LV ESV (48.16 ± 10.03 ml/m2 vs. 40.02 ± 10.06 ml/m2; p = 0.0022). After a mean follow-up time was 5.1 years, no significant change of MR parameters was detected as well as no clinical adverse events. LVNC is relatively frequent in patients with thalassemia. However, it is not associated with a worsening of LV function and adverse events after a long-term follow-up.
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Affiliation(s)
- Rodolfo Bonamini
- Department of Surgical Sciences, Radiology Unit, University of Torino, Turin, Italy
| | - Massimo Imazio
- University Cardiology, AOU Città Della Salute e Della Scienza Di Torino, Corso Bramante 88, 10126, Turin, Italy.
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Torino, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Torino, Turin, Italy
| | | | - Marco Limone
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
- Reference Centre for Hemoglobinopathies, AOU San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Filomena Longo
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
- Reference Centre for Hemoglobinopathies, AOU San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Antonio Piga
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
- Reference Centre for Hemoglobinopathies, AOU San Luigi Gonzaga Hospital, Orbassano, Italy
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21
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Karatza A, Mylonas KS, Tzifa A. Left ventricular non-compaction in a child with bicuspid aortic valve and aortic coarctation. Cardiol Young 2019; 29:1208-1210. [PMID: 31379312 DOI: 10.1017/s1047951119001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present the case of a 3-year-old boy with bicuspid aortic valve, aortic coarctation, and left ventricular non-compaction. The diagnosis was made post-natally with ultrasonography and was verified by cardiac MRI. Aortic coarctation was initially repaired surgically. At age 3 months, recoarctation and heart failure developed. Balloon angioplasty was performed with immediate improvement. At age 3 years, the patient remains asymptomatic and normotensive.
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Affiliation(s)
- Ageliki Karatza
- Department of Pediatrics, Division of Pediatric Cardiology, General University Hospital of Patras, Patras, Greece
| | - Konstantinos S Mylonas
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children's Hospital, Athens, Greece
| | - Aphrodite Tzifa
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children's Hospital, Athens, Greece
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22
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Ayesha B, Ahmed R, Gomceli U, Manrique C, Nicu M, Chilimuri S. A Case of Isolated Left Ventricular Non-Compaction Cardiomyopathy in a HIV Patient Presenting With Acute Heart Failure. Cardiol Res 2019; 10:236-240. [PMID: 31413781 PMCID: PMC6681843 DOI: 10.14740/cr889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
The etiology of cardiomyopathy in a HIV patient is multifactorial. Identifying the etiology of cardiomyopathy in a HIV patient needs extensive evaluation. Common causes include ischemic cardiomyopathy, myocarditis due to viral infections and opportunistic infections, cocaine abuse, alcoholic heart disease, drug toxicity or due to nutritional deficiencies. However, in a number of cases the etiology is unknown. We report a case of 36-year-old African American man with history of HIV who presented with acute heart failure due to left ventricular non-compaction (LVNC). Transthoracic and transesophageal echocardiogram showed significant left ventricular trabeculations and blood flow in deep recesses. Endomyocardial biopsy was suggestive of LVNC. He underwent left ventricular assist device implantation for destination therapy and subsequently cardiac transplantation. The diagnosis of LVNC is often made by echocardiogram. As LVNC could be a normal variant, a comprehensive diagnostic assessment including multimodality imaging, a systematic screening of first degree relatives, and a comprehensive clinical and genetic assessment by a multidisciplinary team may be needed to arrive at the diagnosis. Early diagnosis and timely intervention may reduce the risk of premature death in these young patients.
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Affiliation(s)
- Bibi Ayesha
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Rafeeq Ahmed
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Umut Gomceli
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Carlos Manrique
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Marin Nicu
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Sridhar Chilimuri
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
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23
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Hirono K, Saito K, Munkhsaikhan U, Xu F, Wang C, Lu L, Ichida F, Towbin JA, Purevjav E. Familial Left Ventricular Non-Compaction Is Associated With a Rare p.V407I Variant in Bone Morphogenetic Protein 10. Circ J 2019; 83:1737-1746. [PMID: 31243186 DOI: 10.1253/circj.cj-19-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Left ventricular non-compaction (LVNC) is a heritable cardiomyopathy characterized by hypertrabeculation, inter-trabecular recesses and thin compact myocardium, but the genetic basis and mechanisms remain unclear. This study identified novel LVNC-associated mutations inNOTCH-dependent genes and investigated their mutational effects.Methods and Results:High-resolution melting screening was performed in 230 individuals with LVNC, followed by whole exome and Sanger sequencing of available family members. Dimerization of bone morphogenetic protein 10 (BMP10) and its binding to BMP receptors (BMPRs) were evaluated. Cellular differentiation, proliferation and tolerance to mechanical stretch were assessed in H9C2 cardiomyoblasts, expressing wild-type (WT) or mutant BMP10 delivered by adenoviral vectors. Rare variants, p.W143*-NRG1and p.V407I-BMP10, were identified in 2 unrelated probands and their affected family members. Although dimerization of mutant V407I-BMP10 was preserved like WT-BMP10, V407I-BMP10 pulled BMPR1a and BMPR2 receptors more weakly compared with WT-BMP10. On comparative gene expression and siRNA analysis, expressed BMPR1a and BMPR2 receptors were responsive to BMP10 treatment in H9C2 cardiomyoblasts. Expression of V407I-BMP10 resulted in a significantly lower rate of proliferation in H9C2 cells compared with WT-BMP10. Cyclic stretch resulted in destruction and death of V407I-BMP10 cells. CONCLUSIONS The W143*-NRG1and V470I-BMP10variants are associated with LVNC. Impaired BMPR-binding ability, perturbed proliferation and differentiation processes and intolerance to stretch in V407I-BMP10 mutant cardiomyoblasts may underlie myocardial non-compaction.
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Affiliation(s)
- Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama.,The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Kazuyoshi Saito
- Department of Pediatrics, Graduate School of Medicine, University of Toyama.,The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center.,The Heart Institute, Department of Pediatrics, University of Tennessee Health Science Center
| | - Undral Munkhsaikhan
- The Heart Institute, Department of Pediatrics, University of Tennessee Health Science Center.,Children's Foundation Research Institute, Le Bonheur Children's Hospital Memphis
| | - Fuyi Xu
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center
| | - Ce Wang
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Lu Lu
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Jeffrey A Towbin
- The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center.,The Heart Institute, Department of Pediatrics, University of Tennessee Health Science Center.,Children's Foundation Research Institute, Le Bonheur Children's Hospital Memphis.,Pediatric Cardiology, St. Jude Children's Research Hospital
| | - Enkhsaikhan Purevjav
- The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center.,The Heart Institute, Department of Pediatrics, University of Tennessee Health Science Center
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24
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Kayvanpour E, Sedaghat-Hamedani F, Gi WT, Tugrul OF, Amr A, Haas J, Zhu F, Ehlermann P, Uhlmann L, Katus HA, Meder B. Clinical and genetic insights into non-compaction: a meta-analysis and systematic review on 7598 individuals. Clin Res Cardiol 2019; 108:1297-308. [PMID: 30980206 DOI: 10.1007/s00392-019-01465-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Left ventricular non-compaction has been increasingly diagnosed in recent years. However, it is still debated whether non-compaction is a pathological condition or a physiological trait. In this meta-analysis and systematic review, we compare studies, which investigated these two different perspectives. Furthermore, we provide a comprehensive overview on the clinical outcome as well as genetic background of left ventricular non-compaction cardiomyopathy in adult patients. METHODS AND RESULTS We retrieved PubMed/Medline literatures in English language from 2000 to 19/09/2018 on clinical outcome and genotype of patients with non-compaction. We summarized and extensively reviewed all studies that passed selection criteria and performed a meta-analysis on key phenotypic parameters. Altogether, 35 studies with 2271 non-compaction patients were included in our meta-analysis. The mean age at diagnosis was the mid of their fifth decade. Two-thirds of patients were male. Congenital heart diseases including atrial or ventricular septum defect or Ebstein anomaly were reported in 7% of patients. Twenty-four percent presented with family history of cardiomyopathy. The mean frequency of neuromuscular diseases was 5%. Heart rhythm abnormalities were reported frequently: conduction disease in 26%, supraventricular tachycardia in 17%, and sustained or non-sustained ventricular tachycardia in 18% of patients. Three important outcome measures were reported including systemic thromboembolic events with a mean frequency of 9%, heart transplantation with 4%, and adequate ICD therapy with 15%. Nine studies investigated the genetics of non-compaction cardiomyopathy. The most frequently mutated gene was TTN with a pooled frequency of 11%. The average frequency of MYH7 mutations was 9%, for MYBPC3 mutations 5%, and for CASQ2 and LDB3 3% each. TPM1, MIB1, ACTC1, and LMNA mutations had an average frequency of 2% each. Mutations in PLN, HCN4, TAZ, DTNA, TNNT2, and RBM20 were reported with a frequency of 1% each. We also summarized the results of eight studies investigating the non-compaction in altogether 5327 athletes, pregnant women, patients with sickle cell disease, as well as individuals from population-based cohorts, in which the presence of left ventricular hypertrabeculation ranged from 1.3 to 37%. CONCLUSION The summarized data indicate that non-compaction may lead to unfavorable outcome in different cardiomyopathy entities. The presence of key features in a multimodal diagnostic approach could distinguish between benign morphological trait and manifest cardiomyopathy.
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25
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Frandon J, Bricq S, Bentatou Z, Marcadet L, Barral PA, Finas M, Fagret D, Kober F, Habib G, Bernard M, Lalande A, Miquerol L, Jacquier A. Semi-automatic detection of myocardial trabeculation using cardiovascular magnetic resonance: correlation with histology and reproducibility in a mouse model of non-compaction. J Cardiovasc Magn Reson 2018; 20:70. [PMID: 30355287 PMCID: PMC6201553 DOI: 10.1186/s12968-018-0489-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The definition of left ventricular (LV) non-compaction is controversial, and discriminating between normal and excessive LV trabeculation remains challenging. Our goal was to quantify LV trabeculation on cardiovascular magnetic resonance (CMR) images in a genetic mouse model of non-compaction using a dedicated semi-automatic software package and to compare our results to the histology used as a gold standard. METHODS Adult mice with ventricular non-compaction were generated by conditional trabecular deletion of Nkx2-5. Thirteen mice (5 controls, 8 Nkx2-5 mutants) were included in the study. Cine CMR series were acquired in the mid LV short axis plane (resolution 0.086 × 0.086x1mm3) (11.75 T). In a sub set of 6 mice, 5 to 7 cine CMR were acquired in LV short axis to cover the whole LV with a lower resolution (0.172 × 0.172x1mm3). We used semi-automatic software to quantify the compacted mass (Mc), the trabeculated mass (Mt) and the percentage of trabeculation (Mt/Mc) on all cine acquisitions. After CMR all hearts were sliced along the short axis and stained with eosin, and histological LV contouring was performed manually, blinded from the CMR results, and Mt, Mc and Mt/Mc were quantified. Intra and interobserver reproducibility was evaluated by computing the intra class correlation coefficient (ICC). RESULTS Whole heart acquisition showed no statistical significant difference between trabeculation measured at the basal, midventricular and apical parts of the LV. On the mid-LV cine CMR slice, the median Mt was 0.92 mg (range 0.07-2.56 mg), Mc was 12.24 mg (9.58-17.51 mg), Mt/Mc was 6.74% (0.66-17.33%). There was a strong correlation between CMR and the histology for Mt, Mc and Mt/ Mc with respectively: r2 = 0.94 (p < 0.001), r2 = 0.91 (p < 0.001), r2 = 0.83 (p < 0.001). Intra- and interobserver reproducibility was 0.97 and 0.8 for Mt; 0.98 and 0.97 for Mc; 0.96 and 0.72 for Mt/Mc, respectively and significantly more trabeculation was observed in the Mc Mutant mice than the controls. CONCLUSION The proposed semi-automatic quantification software is accurate in comparison to the histology and reproducible in evaluating Mc, Mt and Mt/ Mc on cine CMR.
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Affiliation(s)
- Julien Frandon
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- Department of Radiology, Timone University Hospital, Marseille, France
- Department of Radiology, Nîmes University Hospital, Nîmes, France
| | | | | | - Laetitia Marcadet
- CNRS UMR 7288, Developmental Biology Institute of Marseille, Aix-Marseille University, Marseille, France
| | | | - Mathieu Finas
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - Daniel Fagret
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Université Grenoble Alpes, Grenoble, France
| | - Frank Kober
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - Gilbert Habib
- Department of Cardiology, APHM, la Timone Hospital, Marseille, France
| | | | - Alain Lalande
- Le2i, Université de Bourgogne Franche-Comté, Dijon, France
- Department of MRI, University Hospital Francois Mitterrand, Dijon, France
| | | | - Alexis Jacquier
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- Department of Radiology, Timone University Hospital, Marseille, France
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26
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Abstract
In athletes who undertake a high volume of high intensity exercise, the resultant changes in cardiac structure and function which develop as a result of physiological adaptation to exercise (so called "Athlete's Heart") may overlap with some features of pathological conditions. This chapter will focus on the left side of the heart, where left ventricular cavity enlargement, increase in left ventricular wall thickness and increased left ventricular trabeculation associated with athletic remodelling may sometimes be difficult to differentiate from conditions such as dilated cardiomyopathy, hypertrophic cardiomyopathy or isolated left ventricular non-compaction. The distinction between physiological versus pathological changes in athletes is imperative as an incorrect diagnosis can have important consequences, such as exclusion from competitive sport, or false reassurance and missed opportunity for effective therapeutic intervention.
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Affiliation(s)
| | - Dhrubo Rakhit
- University Hospital Southampton, Southampton, Hampshire, UK.
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27
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Kim K, Kang MG, Park HW, Koh JS, Park JR, Hwang SJ, Hwang JY. A Rare Case of Left Ventricular Noncompaction in LEOPARD Syndrome. J Cardiovasc Ultrasound 2018; 26:43-44. [PMID: 29629024 PMCID: PMC5881084 DOI: 10.4250/jcu.2018.26.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 11/30/2017] [Revised: 01/19/2018] [Accepted: 02/26/2018] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kyehwan Kim
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyun Woong Park
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jeong Rang Park
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
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28
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Sohn DW, Kim HK, Kim YJ, Oh S, Seong MW, Park SS. Cardiomyopathies with Mixed and Inapparent Morphological Features in Cardiac Troponin I3 Mutation. Korean Circ J 2017; 47:413-417. [PMID: 28567093 PMCID: PMC5449537 DOI: 10.4070/kcj.2016.0302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022] Open
Abstract
The fact that different types of cardiomyopathies can be manifested by the same sarcomere protein gene mutation in a single family is well known. However, mixed features of different types of cardiomyopathies in a single patient have not been well appreciated. We identified a novel mutation in cardiac troponin I3 (Arg186Gly) in the present case, and two of the family members showed mixed morphologic features of hypertrophic cardiomyopathy and left ventricular non-compaction. Moreover, both the features of cardiomyopathies were not apparent for each type of cardiomyopathy. In the patient's family, four other members had unexpected deaths before the age of 30.
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Affiliation(s)
- Dae-Won Sohn
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Sup Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
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29
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Tian T, Yang Y, Zhou L, Luo F, Li Y, Fan P, Dong X, Liu Y, Cui J, Zhou X. Left Ventricular Non-Compaction: A Cardiomyopathy With Acceptable Prognosis in Children. Heart Lung Circ 2017; 27:28-32. [PMID: 28343948 DOI: 10.1016/j.hlc.2017.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on children with left ventricular non-compaction (LVNC) is sparse. The purpose of this study was to evaluate its clinical profiles in a population of Chinese children. METHODS From January 2010 to March 2016, consecutive Chinese children (aged <18 years) with LVNC diagnosed by cardiovascular magnetic resonance (CMR) were prospectively recruited at Fuwai Hospital. RESULTS A total of 41 Chinese children (male: 28%; mean age: 14±4years) were included in this study. Left ventricular non-compaction was not detected in 13 (32%) patients at initial echocardiographic evaluation. Congenital heart disease (CHD) was found in 11 (27%) patients. Four (10%) patients had Wolff-Parkinson-White (WPW) syndrome. Mean left ventricular ejection fraction (LVEF) was 41±15%. Late gadolinium enhancement (LGE) was detected in eight (20%) subjects. During a mean follow-up of 2.9 years, four (9%) patients died or received heart transplantation. These patients had lower systolic blood pressure (91±10 vs. 108±14mmHg; p=0.02), diastolic blood pressure (57±7 vs. 68±8mmHg; p=0.007) and LVEF (19±7 vs. 44±12%; p=0.002) than the survivors. In addition, advanced heart failure (100% vs. 16%; p=0.002) and LGE (50% vs. 5%; p=0.04) were detected more in these subjects. CONCLUSIONS Left ventricular non-compaction is easily overlooked at echocardiographic assessment. Congenital heart disease and WPW syndrome were relatively common in LVNC children. The prognosis of children with LVNC seemed to be better than previous studies reported, and its long-term prognosis needs to be further investigated.
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Affiliation(s)
- Tao Tian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China
| | - Yankun Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China
| | - Lanlan Zhou
- Department of Hematology and Oncology, The Second People's Hospital of Hefei, Hefei, Anhui, China
| | - Fang Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China
| | - Yuehua Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China
| | - Xueqi Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China
| | - Yaxin Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China.
| | - Jingang Cui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China.
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Mediacal College, Beijing 100037, China.
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30
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Ramachandran P, Woo JG, Ryan TD, Bryant R, Heydarian HC, Jefferies JL, Towbin JA, Lorts A. The Impact of Concomitant Left Ventricular Non-compaction with Congenital Heart Disease on Perioperative Outcomes. Pediatr Cardiol 2016; 37:1307-12. [PMID: 27357002 DOI: 10.1007/s00246-016-1435-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
Left ventricular non-compaction (LVNC) is a heterogeneous myocardial disorder characterized by prominent trabeculations and inter-trabecular recesses which may occur in association with congenital heart disease (CHD). To date, few studies have been performed to assess whether the concomitant diagnosis of LVNC affects the outcomes of CHD surgery. A retrospective review of patients with LVNC with CHD (LVNC-CHD), 0-5 years of age, was conducted. Patients with CHD without LVNC (CHD-only) and 0-5 years of age with similar diagnosis distribution were selected for comparison. Perioperative data, including CHD diagnosis, operative course, and postoperative complications were collected and compared between groups. LVNC-CHD was diagnosed in 26 children. Of the 26 with LVNC-CHD, 20 underwent surgery and these patients were compared with 276 CHD-only controls. Median total length of stay in the hospital was 12.5 days (IQR 5.5-63 days) in LVNC-CHD compared to 5 days (IQR 3-10 days) in CHD-only (p < 0.005). Postoperative death, cardiac arrest, or need for ECMO or transplantation occurred in 6/20 (30 %) of the LVNC-CHD patients compared to 3/276 (1 %) of the CHD-only group (p < 0.0001). LVNC-CHD patients had significantly longer hospital length of stay and higher perioperative complications compared to CHD-only patients without myocardial abnormalities. Pediatric cardiac care teams should be cognizant of the possibility of the increased perioperative risk associated with concomitant LVNC. Future prospective studies are warranted.
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Affiliation(s)
- Preeti Ramachandran
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Thomas D Ryan
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Roosevelt Bryant
- Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Haleh C Heydarian
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - John L Jefferies
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jeffrey A Towbin
- The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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Roston TM, Guo W, Krahn AD, Wang R, Van Petegem F, Sanatani S, Chen SRW, Lehman A. A novel RYR2 loss-of-function mutation (I4855M) is associated with left ventricular non-compaction and atypical catecholaminergic polymorphic ventricular tachycardia. J Electrocardiol 2016; 50:227-233. [PMID: 27646203 DOI: 10.1016/j.jelectrocard.2016.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 07/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy usually caused by gain-of-function mutations ryanodine receptor type-2 (RyR2). Left ventricular non-compaction (LVNC) is an often genetic cardiomyopathy. A rare LVNC-CPVT overlap syndrome may be caused by exon 3 deletion in RyR2. We sought to characterize the phenotypic spectrum and molecular basis of a novel RyR2 mutation identified in a family with both conditions. METHODS Several members of an affected family underwent clinical and genetic assessments. A homology model of the RyR2 pore-region was generated to predict the location and potential impact of their RyR2 mutation. Ca2+-release assays were performed to characterize the functional impact of the RyR2 mutant expressed in HEK293 cells. RESULTS A multigenerational family presented with a history of sudden death and a phenotype of atypical CPVT and LVNC. Genetic testing revealed a RYR2 mutation (I4855M) in two affected individuals. A homology model of the RyR2 pore-region showed that the I4855M mutant reside is located in the highly conserved 'inner vestibule', a water-filled cavity. I4855M may interfere with Ca2+ permeation and affect interactions between RyR2 pore subunits, and is thus predicted in silico to be damaging. Expression and functional studies in HEK293 cells revealed that I4855M inhibited caffeine-induced Ca2+ release and exerted a dominant-negative impact on wild type RyR2. CONCLUSIONS This study identifies a potentially lethal overlapping syndrome of LVNC and atypical CPVT related to a novel RYR2 variant. Structural and functional studies suggest that this is a loss-of-function mutation, which exerts a dominant-negative effect on wild type RyR2.
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Affiliation(s)
- Thomas M Roston
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wenting Guo
- Libin Cardiovascular Institute of Alberta, Department of Physiology & Pharmacology and Department Biochemistry & Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Andrew D Krahn
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ruiwu Wang
- Libin Cardiovascular Institute of Alberta, Department of Physiology & Pharmacology and Department Biochemistry & Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Filip Van Petegem
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Shubhayan Sanatani
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada; Child and Family Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - S R Wayne Chen
- Libin Cardiovascular Institute of Alberta, Department of Physiology & Pharmacology and Department Biochemistry & Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Anna Lehman
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada; Child and Family Research Institute, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
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Caselli S, Ferreira D, Kanawati E, Di Paolo F, Pisicchio C, Attenhofer Jost C, Spataro A, Jenni R, Pelliccia A. Prominent left ventricular trabeculations in competitive athletes: A proposal for risk stratification and management. Int J Cardiol 2016; 223:590-595. [PMID: 27561165 DOI: 10.1016/j.ijcard.2016.08.272] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recently, an unexpectedly large prevalence of Left Ventricular Non Compaction (LVNC) has been reported in athletes, raising the question of the appropriateness of current diagnostic criteria. We sought to describe prevalence and clinical characteristics of athletes with suspected LVNC in a large cohort of Olympic athletes. METHODS Over 29months, 2501 consecutive athletes underwent a cardiac evaluation including physical examination, ECG, exercise test and echocardiography. Additional investigations (Cardiac Magnetic Resonance and/or genetic testing) were selectively performed in athletes with abnormal ECGs, ventricular arrhythmias, borderline LV dysfunction or positive family history. RESULTS Of the 2501 athletes, 36 (1.4%) showed prominent trabeculations suggestive for LVNC. Of these, 3 (0.1%) were considered to be affected by LVNC, based on presence of LV dysfunction (ejection fraction<50%) and/or positive family history and genetic testing; these athletes were cautiously restricted from competitions and entered a clinical follow-up program. The remaining 33 athletes, in the absence of LV impairment or familial cardiac diseases, were considered normal (n=24) or unlikely affected (n=9), regardless of the extent of the trabeculations. CONCLUSIONS In a large athlete population, a marked LV trabecular pattern was seen in 1.4%. Only a small subset of these athletes (0.1%) showed familial, clinical and morphologic changes supporting the diagnosis of LVNC. In the vast majority of the athletes, the increased trabeculations were not associated with LV dysfunction and/or positive family history, likely representing a morphologic LV variant, deprived of clinical significance.
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Affiliation(s)
| | | | - Eyad Kanawati
- Institute of Sports Medicine and Science, Rome, Italy
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Parent JJ, Towbin JA, Jefferies JL. Fibrillin-1 Gene Mutations in Left Ventricular Non-compaction Cardiomyopathy. Pediatr Cardiol 2016; 37:1123-6. [PMID: 27160103 DOI: 10.1007/s00246-016-1404-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/22/2016] [Indexed: 01/21/2023]
Abstract
Left ventricular non-compaction cardiomyopathy (LVNC) is a unique cardiomyopathy with a current yield of about 30-40 % in identifying a causative gene mutation. A retrospective review of all patients with LVNC at our institution was performed and genetic testing was reviewed. Echocardiographic and cardiac magnetic resonance imaging was reviewed to corroborate the reported phenotype. We present a series of patients with LVNC dilated phenotype associated with fibrillin-1 gene mutations. Fifty-one patients were identified as having LVNC with reduced left ventricular function and/or left ventricular dilation. We retrospectively reviewed gene testing in this cohort when available and identified 5 patients (10 %) with an FBN1 gene mutation. Syndrome breakdown as follows: 3 with Marfan, 1 with Shprintzen-Goldberg, and 1 with no identifiable syndrome. Derangements in fibrillin-1 may impact the compaction process resulting in LVNC. Although causation has not been proven by our report, it certainly raises interest in a possible mechanistic relationship between fibrillin-1 and LVNC given the increased prevalence of Marfan syndrome and fibrillin-1 gene mutations in this cohort.
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Affiliation(s)
- John J Parent
- Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, 705 Riley Hospital Drive, RR 127, Indianapolis, IN, 46202, USA.
| | - Jeffrey A Towbin
- Division of Pediatric Cardiology, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - John L Jefferies
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Kornberger A, Stock UA, Risteski P, Beiras Fernandez A. Left ventricular non-compaction cardiomyopathy and left ventricular assist device: a word of caution. J Cardiothorac Surg 2016; 11:108. [PMID: 27422642 PMCID: PMC4946240 DOI: 10.1186/s13019-016-0503-2] [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] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background In patients with left ventricular non-compaction (LVNC), implantation of a left ventricular assist device (LVAD) may be performed as a bridge to transplantation. In this respect, the particular characteristics of the left ventricular myocardium may represent a challenge. Case presentation We report a patient with LVNC who required urgent heart transplantation for inflow cannula obstruction nine months after receiving a LVAD. LVAD parameters, echocardiography and examination of the explanted heart suggested changes of left ventricular configuration brought about by LVAD support as the most likely cause of inflow cannula obstruction. Conclusions We conclude that changes experienced by non-compacted myocardium during LVAD support may give rise to inflow cannula obstruction and flow reduction. Presence of LVNC mandates tight surveillance for changes in LV configuration and LVAD flow characteristics and may justify urgent transplantation listing status.
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Affiliation(s)
- A Kornberger
- Department of Thoracic and Cardiovascular Surgery, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - U A Stock
- Department of Thoracic and Cardiovascular Surgery, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - P Risteski
- Department of Thoracic and Cardiovascular Surgery, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - A Beiras Fernandez
- Department of Thoracic and Cardiovascular Surgery, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Parent JJ, Towbin JA, Jefferies JL. Medical Therapy Leads to Favorable Remodeling in Left Ventricular Non-compaction Cardiomyopathy: Dilated Phenotype. Pediatr Cardiol 2016; 37:674-7. [PMID: 26724283 DOI: 10.1007/s00246-015-1330-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
Left ventricular non-compaction cardiomyopathy (LVNC) is a distinct and heterogeneous entity that can lead to progressive cardiac dysfunction and heart failure. LVNC with dilation and/or dysfunction is associated with a greater mortality risk. We hypothesized that initiation of heart failure medications in patients with LVNC and ventricular dysfunction or dilation would improve systolic function and result in favorable left ventricular remodeling. The study was a retrospective chart review. Inclusion criteria included: presence of LVNC, reduced systolic function or ventricular dilation, therapy with at least one medication (beta blocker, angiotensin-converting-enzyme inhibitor, angiotensin II receptor blocker), imaging pre- and post-initiation of therapy. Fifty-one patients met inclusion criteria. Mean age at initiation of medication was 11.5 ± 11.8 years. Follow-up was 2.4 ± 2.3 years. Three patients (6 %) were solely on a beta blocker, 15 (29 %) on ACE/ARB monotherapy, and 33 (65 %) on dual therapy. At follow-up 45/51 patients (88 %) had improvement in ejection fraction/shortening and 6/51 (12 %) had no change. Ejection fraction, shortening fraction, and left ventricular end-diastolic dimension in the cohort before and after therapeutic intervention demonstrated a 16 ± 12 % improvement in ejection fraction (p < 0.0001), an 8 ± 9 % improvement in shortening fraction (p < 0.0001), and a 0.83 ± 1.93 (p < 0.05) decrease in left ventricular end-diastolic z-score. Early diagnosis and medical treatment of LVNC with reduced systolic function and/or dilation leads to favorable remodeling evident by an improvement in ventricular systolic function and reduction of ventricular end-diastolic dimensions.
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36
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Liu Z, Shan H, Huang J, Li N, Hou C, Pu J. A novel lamin A/C gene missense mutation (445 V > E) in immunoglobulin-like fold associated with left ventricular non-compaction. Europace 2016; 18:617-622. [PMID: 25829471 DOI: 10.1093/europace/euv044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/08/2015] [Indexed: 01/22/2024] Open
Abstract
AIMS Two LMNA mutations (R644C and R190W) have been associated with familial and sporadic left ventricular non-compaction (LVNC). However, the mechanisms underlying these associations have not been elucidated. METHODS AND RESULTS Genomic DNA was isolated from peripheral blood leucocytes and analysed by direct sequencing. Human embryonic kidney 293 cells were transfected with either wild type or mutant LMNA and SCN5A for whole-cell patch-clamp experiment and fluorescence microscopy. Point mutation modeling for mutant LMNA was also performed. One novel LVNC-associated mutation (V445E) in β2 sheet of immunoglobulin (Ig)-like fold was found in the proband and his father. We also found that the peak current of sodium channel was markedly reduced in mutant LMNA compared with WT while the activation, inactivation, and recovery curves were not significantly altered. The mutant lamin A/C were aggregated into multiple highlighted particles. Three β sheets and multiple side chains in Ig-like fold were altered due to the replacement of a valine by glutamic acid. CONCLUSION Our data associated a novel lamin A/C mutation (V445E) with a sudden death form of familial LVNC. The reduced sodium current in mutant LMNA may account for the advent of malignant ventricular arrhythmias. The altered structures of three β sheets and side chains may partially explain the aggregation of lamin A/C protein subjacent to the nuclear envelope.
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MESH Headings
- Adolescent
- DNA Mutational Analysis
- Death, Sudden, Cardiac/etiology
- Echocardiography
- Electrocardiography
- Genetic Predisposition to Disease
- Glutamic Acid
- HEK293 Cells
- Heterozygote
- Humans
- Isolated Noncompaction of the Ventricular Myocardium/diagnosis
- Isolated Noncompaction of the Ventricular Myocardium/genetics
- Isolated Noncompaction of the Ventricular Myocardium/metabolism
- Isolated Noncompaction of the Ventricular Myocardium/physiopathology
- Lamin Type A/chemistry
- Lamin Type A/genetics
- Lamin Type A/metabolism
- Male
- Membrane Potentials
- Microscopy, Fluorescence
- Models, Molecular
- Mutagenesis, Site-Directed
- Mutation, Missense
- Phenotype
- Protein Aggregates
- Protein Conformation, beta-Strand
- Protein Folding
- Structure-Activity Relationship
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/metabolism
- Tachycardia, Ventricular/physiopathology
- Transfection
- Valine
- Ventricular Fibrillation/diagnosis
- Ventricular Fibrillation/genetics
- Ventricular Fibrillation/metabolism
- Ventricular Fibrillation/physiopathology
- Young Adult
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Affiliation(s)
- Zhouying Liu
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Hong Shan
- Department of Biophysics, School of Basic Medical Sciences, Peking University, 38 Xue-Yuan Road, Hai-Dian District, Beijing 100191, P.R. China
| | - Jian Huang
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Ning Li
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Cuihong Hou
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Jielin Pu
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
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Minamisawa M, Koyama J, Ikeda U. Author's reply. J Cardiol 2016; 68:359-60. [PMID: 27004963 DOI: 10.1016/j.jjcc.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sometimes experience the regression of left ventricular hypertrabeculation (LVHT), which is compatible with the diagnosis of LV non-compaction cardiomyopathy (LVNC) in adult patients. However, little is known about the association between LVHT regression and LV systolic function in adult patients. METHODS We prospectively examined 23 consecutive adult patients who fulfilled the echocardiographic criteria for LVNC. LV reverse remodeling (RR) was defined as an absolute increase in LV ejection fraction of >10% at 6 months follow-up. LVHT area was calculated by subtraction from the outer edge to the inner edge of the LVHT at end-systole. RESULTS The mean follow-up period was 61 months. LVRR was observed in 9 patients (39%). The changes in the mean LVHT area showed significant correlation with the changes in LV ejection fraction (r=-0.78, P<0.0001). Cardiac death occurred in 7 patients (50%) without LVRR, but no patients with LVRR died (log-rank, P=0.003). Furthermore, composite of cardiac death and hospitalization of heart failure occurred in 10 patients (71%) without LVRR, whereas there was one patient with LVRR (log-rank, P<0.001). CONCLUSIONS Regression of LVHT is associated with improvement in LV systolic function. LVRR might be associated with a favorable prognosis in patients with LVHT.
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Affiliation(s)
- Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Nagano, Japan
| | - Jun Koyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Nagano, Japan.
| | - Uichi Ikeda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Nagano, Japan
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38
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Abstract
Left ventricular non-compaction (LVNC) is a rare disease that can occur isolated or in association with other disorders, including congenital heart disease and musculoskeletal disorders. It is characterized by a two-layered myocardium with excessive trabeculation of the left ventricle. Diagnosis is challenging as left ventricular trabeculations can be pathological yet can also be a normal finding in athletes and black people, leading to overdiagnosis. Echocardiography and CMR are important diagnostic tools. LVNC is often complicated by ventricular dysfunction, arrhythmias and thromboembolic events. Based on two cases, we review the pathogenesis, genetic background, clinical features and treatment of LVNC according to the available guidelines.
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39
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Kapadia R, Choudhary P, Collins N, Celermajer D, Puranik R. Left Ventricular Non-compaction in Holt-Oram Syndrome. Heart Lung Circ 2016; 25:626-30. [PMID: 26874791 DOI: 10.1016/j.hlc.2015.12.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 11/19/2022]
Abstract
Holt-Oram Syndrome is an autosomal dominant condition with complete penetrance and which involves upper limb skeletal and cardiac abnormalities. The latter can be structural defects or involve the conduction system. This report details the occurrence of left ventricular non-compaction in multiple family members with Holt-Oram Syndrome. It is recommended that patients with the Holt-Oram Syndrome be considered for comprehensive cardiac evaluation to exclude non-compaction cardiomyopathy as this may have significant prognostic implications.
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Affiliation(s)
- Renuka Kapadia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Preeti Choudhary
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicholas Collins
- Cardiovascular Unit, John Hunter Hospital, Newcastle, NSW, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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40
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Minamisawa M, Koyama J, Kozuka A, Miura T, Ebisawa S, Motoki H, Okada A, Izawa A, Ikeda U. Regression of left ventricular hypertrabeculation is associated with improvement in systolic function and favorable prognosis in adult patients with non-ischemic cardiomyopathy. J Cardiol 2016; 68:431-8. [PMID: 26740463 DOI: 10.1016/j.jjcc.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/01/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND We sometimes experience regression of left ventricular hypertrabeculation (LVHT), which is compatible with the diagnosis of LV non-compaction cardiomyopathy (LVNC) in adult patients. However, little is known about the association between LVHT regression and LV systolic function in adult patients. METHODS We prospectively examined 23 consecutive adult patients who fulfilled the echocardiographic criteria for LVNC. LV reverse remodeling (RR) was defined as an absolute increase in LV ejection fraction of >10% at 6 months follow-up. LVHT area was calculated by subtraction from the outer edge to the inner edge of the LVHT at end-systole. RESULTS The mean follow-up period was 61 months. LVRR was observed in 9 patients (39%). The changes in the mean LVHT area showed significant correlation with the changes in LV ejection fraction (r=-0.78, p<0.0001). Cardiac death occurred in 7 patients (50%) without LVRR, but no patients with LVRR died (log-rank, p=0.003). Furthermore, composite of cardiac death and hospitalization for heart failure occurred in 10 patients (71%) without LVRR, whereas there was one patient with LVRR (log-rank, p<0.001). CONCLUSIONS Regression of LVHT is associated with improvement in LV systolic function. LVRR might be associated with a favorable prognosis in patients with LVHT.
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Shimada M, Sakamoto T, Umezu K, Harada Y. Successful staged Fontan completion for a tricuspid atresia patient with left ventricular non-compaction. Interact Cardiovasc Thorac Surg 2015; 22:387-9. [PMID: 26689445 DOI: 10.1093/icvts/ivv356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/30/2015] [Accepted: 11/16/2015] [Indexed: 11/14/2022] Open
Abstract
We report a case of Fontan completion for a tricuspid atresia (TA) patient with left ventricular non-compaction (LVNC). The patient was diagnosed with TA (Ia) with LVNC by fetal echocardiography. Because the unfavourable prognosis of LVNC was anticipated, Imidapril as well as Carvedilol were administered to improve cardiac function, from the early stages of infancy. Staged Fontan completion with fenestration was successfully achieved with improvement of LV function.
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Affiliation(s)
- Masatoshi Shimada
- Department of Cardiovascular Surgery, Nagano Children's Hospital, Azumino, Japan
| | - Takahiko Sakamoto
- Department of Cardiovascular Surgery, Nagano Children's Hospital, Azumino, Japan
| | - Kentaro Umezu
- Department of Cardiovascular Surgery, Nagano Children's Hospital, Azumino, Japan
| | - Yorikazu Harada
- Department of Cardiovascular Surgery, Nagano Children's Hospital, Azumino, Japan
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Ting TW, Jamuar SS, Brett MS, Tan ES, Cham BWM, Lim JY, Law HY, Tan EC, Choo JTL, Lai AHM. Left Ventricular Non-compaction: Is It Genetic? Pediatr Cardiol 2015; 36:1565-72. [PMID: 26108892 DOI: 10.1007/s00246-015-1222-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
Abstract
Left ventricular non-compaction (LVNC) is reported to affect 0.14 % of the pediatric population. The etiology is heterogeneous and includes a wide number of genetic causes. As an illustration, we report two patients with LVNC who were diagnosed with a genetic syndrome. We then review the literature and suggest a diagnostic algorithm to evaluate individuals with LVNC. Case 1 is a 15-month-old girl who presented with hypotonia, global developmental delay, congenital heart defect (including LVNC) and facial dysmorphism. Case 2 is a 7-month-old girl with hypotonia, seizures, laryngomalacia and LVNC. We performed chromosomal microarray for both our patients and detected chromosome 1p36 microdeletion. We reviewed the literature for other genetic causes of LVNC and formulated a diagnostic algorithm, which includes assessment for syndromic disorders, inborn error of metabolism, copy number variants and non-syndromic monogenic disorder associated with LVNC. LVNC is a relatively newly recognized entity, with heterogeneity in underlying etiology. For a systematic approach of evaluating the underlying cause to improve clinical care of these patients, a diagnostic algorithm for genetic evaluation of patients with LVNC is proposed.
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Affiliation(s)
- Teck Wah Ting
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Singhealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore
| | - Saumya Shekhar Jamuar
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Singhealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore.
| | | | - Ee Shien Tan
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Singhealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore
| | - Breana Wen Min Cham
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Jiin Ying Lim
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Hai Yang Law
- Singhealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore.,DNA Diagnostic and Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jonathan Tze Liang Choo
- Singhealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore.,Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Angeline Hwei Meeng Lai
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Singhealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore
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43
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Dhar R, Reardon W, McMahon CJ. Biventricular non-compaction hypertrophic cardiomyopathy in association with congenital complete heart block and type I mitochondrial complex deficiency. Cardiol Young 2015; 25:1019-21. [PMID: 25023008 DOI: 10.1017/S1047951114001279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a baby girl with an antenatal diagnosis of biventricular non-compaction and complete heart block detected at 22 weeks' gestation. Postnatal echocardiography confirmed severe biventricular non-compaction hypertrophic cardiomyopathy, multiple muscular ventricular septal defects, and mild-moderate pulmonary valve stenosis. Skeletal muscle biopsy confirmed complex 1 mitochondrial respiratory chain deficiency. An epicardial VVI pacemaker was implanted on day 3 of life and revised at 7 years of age. She remains stable at 8 years of age following pacing and medical treatment with carvedilol, aspirin, co-enzyme Q10, and carnitine. This represents the first report of biventricular non-compaction hypertrophic phenotype in association with congenital complete heart block and complex 1 mitochondrial respiratory chain deficiency in a child.
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Choudhary P, Hsu CJ, Grieve S, Smillie C, Singarayar S, Semsarian C, Richmond D, Muthurangu V, Celermajer DS, Puranik R. Improving the diagnosis of LV non-compaction with cardiac magnetic resonance imaging. Int J Cardiol 2014; 181:430-6. [PMID: 25569272 DOI: 10.1016/j.ijcard.2014.12.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Current diagnostic criteria for left ventricular non-compaction (LVNC) poorly correlate with clinical outcomes. We aimed to develop a cardiac magnetic resonance (CMR) based semi-automated technique for quantification of non-compacted (NC) and compacted (C) masses and to ascertain their relationships to global and regional LV function. METHODS We analysed CMR data from 30 adults with isolated LVNC and 20 controls. NC and C masses were measured using relative signal intensities of myocardium and blood pool. Global and regional LVNC masses was calculated and correlated with both global and regional LV systolic function as well as occurrence of arrhythmia. RESULTS LVNC patients had significantly higher end-systolic (ES) and end-diastolic (ED) NC:C ratios compared to controls (ES 0.21 [SD 0.09] vs. 0.12 [SD 0.02], p<0.001; ED 0.39 [SD 0.08] vs. 0.26 [SD 0.05], p<0.001). NC:C ratios correlated inversely with global ejection fraction, with a stronger correlation in ES vs. ED (r=-0.58, p<0.001 vs. r=-0.30, p=0.03). ES basal, mid and apical NC:C ratios also showed a significant inverse correlation with global LV ejection fraction (ES basal r=-0.29, p=0.04; mid-ventricular r=-0.50, p<0.001 and apical r=-0.71, p<0.001). Upon ROC testing, an ES NC:C ratio of 0.16 had a sensitivity of 70% and a specificity of 95% for detection of significant LVNC. Patients with sustained ventricular tachycardia had a significantly higher ES NC:C ratio (0.31 [SD 0.18] vs. 0.20 [SD 0.06], p=0.02). CONCLUSIONS The NC:C ratio derived from relative signal intensities of myocardium and blood pool improves the ability to detect clinically relevant NC compared to previous CMR techniques.
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Affiliation(s)
- P Choudhary
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
| | - C J Hsu
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
| | - S Grieve
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - C Smillie
- Bankstown Heart Clinic, Bankstown, Sydney, Australia
| | - S Singarayar
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
| | - C Semsarian
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia; Agnes Gignes Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia
| | - D Richmond
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
| | | | - D S Celermajer
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia
| | - R Puranik
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
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Egashira T, Yuasa S, Kimura M, Sawano M, Anzai A, Hayashida K, Kawamura A, Kimura T, Nishiyama N, Aizawa Y, Takatsuki S, Tsuruta H, Murata M, Yamada Y, Kohno T, Maekawa Y, Sano M, Kosaki K, Fukuda K. Coexistence of two distinct fascinating cardiovascular disorders: heterotaxy syndrome with left ventricular non-compaction and vasospastic angina. Int J Cardiol 2014; 174:e54-6. [PMID: 24768391 DOI: 10.1016/j.ijcard.2014.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/02/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Toru Egashira
- Department of Cardiology, Keio University School of Medicine, Japan.
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Mai Kimura
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Atsushi Anzai
- Department of Cardiology, Keio University School of Medicine, Japan
| | | | - Akio Kawamura
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Japan
| | | | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Japan
| | | | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Japan
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Mandaliya R, Boigon M, Nweke N, Fierstein J. Left Ventricular Non-Compaction Syndrome Misdiagnosed as Dilated Cardiomyopathy on Several Occasions, Presenting With Recurrent Stroke. Cardiol Res 2014; 5:42-47. [PMID: 28392874 PMCID: PMC5358278 DOI: 10.14740/cr323w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Accepted: 02/10/2014] [Indexed: 12/15/2022] Open
Abstract
A 57-year-old African American female with a history of ischemic cardiomyopathy and a recent stroke with no residual deficits presented with apraxia and confusion. Non-contrast CT scan of the head revealed multiple embolic strokes in both cerebral hemispheres. Transthoracic echocardiography raised the suspicion for increased trabecular meshwork in the left ventricle. Cardiac MRI confirmed the findings of isolated left ventricular non-compaction (LVNC) syndrome. A contrast-enhanced transesophageal echocardiogram demonstrated the characteristic features of this unusual disease with the additional demonstration of contrast filling the trabecular meshwork. Interestingly multiple transthoracic echocardiograms in the past had failed to identify myocardial non-compaction. The patient was started on warfarin for prophylactic anticoagulation and an implantable defibrillator was placed to lower the risk of sudden death. LVNC is a rare type of genetic cardiomyopathy characterized by excessively prominent trabeculations and deep inter-trabecular recesses in the ventricle wall. Non-compaction remains frequently overlooked even by experienced echocardiographers. Failure to diagnosis may lead to insufficient treatment since it is often associated with a risk of thromboembolism, life-threatening arrhythmias and sudden death. Furthermore, because of the familial association described with ventricular non-compaction, screening of first relatives with echocardiography is recommended.
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Affiliation(s)
- Rohan Mandaliya
- Department of Internal Medicine, Abington Memorial Hospital, Abington, PA 19001, USA
| | - Margot Boigon
- Department of Internal Medicine, Abington Memorial Hospital, Abington, PA 19001, USA
| | - Nneka Nweke
- Department of Internal Medicine, Abington Memorial Hospital, Abington, PA 19001, USA
| | - Jeffrey Fierstein
- Division of Cardiology, Abington Memorial Hospital, Abington, PA 19001, USA
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Hajj-Chahine J, Tomasi J, Corbi P, Jayle C. Abnormal origin of the right coronary artery in a patient with left ventricular non-compaction. Eur J Cardiothorac Surg 2014; 46:506. [PMID: 24401690 DOI: 10.1093/ejcts/ezt591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Jacques Tomasi
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Pierre Corbi
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Christophe Jayle
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Ohno S, Omura M, Kawamura M, Kimura H, Itoh H, Makiyama T, Ushinohama H, Makita N, Horie M. Exon 3 deletion of RYR2 encoding cardiac ryanodine receptor is associated with left ventricular non-compaction. Europace 2014; 16:1646-54. [PMID: 24394973 DOI: 10.1093/europace/eut382] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Ryanodine receptor gene (RYR2) mutations are well known to cause catecholaminergic polymorphic ventricular tachycardia (CPVT). Recently, RYR2 exon 3 deletion has been identified in patients with dilated cardiomyopathy (DCM) and/or CPVT. This study aimed to screen for the RYR2 exon 3 deletion in CPVT probands, characterize its clinical pathology, and confirm the genomic rearrangement. METHODS AND RESULTS Our cohort consisted of 24 CPVT probands. Polymerase chain reaction (PCR)-based conventional genetic analysis did not identify any mutations in coding exons of RYR2 in these probands. They were screened using multiplex ligation-dependent probe amplification (MLPA). In probands identified with RYR2 exon 3 deletion, the precise location of the deletion was identified by quantitative PCR and direct sequencing methods. We identified two CPVT probands from unrelated families who harboured a large deletion including exon 3. The probands were 9- and 17-year-old girls. Both probands had a history of syncope related to emotional stress or exercise, exhibited bradycardia, and were diagnosed with left ventricular non-compaction (LVNC). We examined 10 family members and identified six more RYR2 exon 3 deletion carriers. In total, there were eight carriers, of which seven were diagnosed with LVNC (87.5%). Two carriers under the age of 4 years remained asymptomatic, although they were diagnosed with LVNC. Using quantitative PCR and direct sequencing, we confirmed that the deletions were 1.1 and 37.7 kb in length. CONCLUSION RYR2 exon 3 deletion is frequently associated with LVNC. Therefore, detection of the deletion offers a new modality for predicting the prognosis of patients with LVNC with ventricular/atrial arrhythmias, particularly in children.
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Affiliation(s)
- Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Masato Omura
- Cardiovasacular Department, Saiseikai Shimonoseki General Hospital, Shimonoseki 759-6603, Japan
| | - Mihoko Kawamura
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Hiromi Kimura
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Hideki Itoh
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroya Ushinohama
- Cardiovascular Department, Fukuoka Children's Hospital and Medical Center for infectious disease, Fukuoka 810-0063, Japan
| | - Naomasa Makita
- Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Science, Nagasaki 852-8523, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
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Marchal P, Lairez O, Cognet T, Chabbert V, Barrier P, Berry M, Méjean S, Roncalli J, Rousseau H, Carrié D, Galinier M. Relationship between left ventricular sphericity and trabeculation indexes in patients with dilated cardiomyopathy: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2013; 14:914-20. [PMID: 23644933 DOI: 10.1093/ehjci/jet064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS To study the relationship between left ventricular (LV) trabeculations, volume, and sphericity in patients with dilated cardiomyopathy (DCM) by cardiac magnetic resonance imaging (CMR). METHODS AND RESULTS Eighty-two patients with DCM were prospectively explored by CMR. The segmental trabeculation index (STI) was defined by the ratio of trabeculated layer thickness on compacted layer thickness per segment. The global trabeculation index (GTI) was defined by the ratio of the sum of the total trabeculated layer thickness to the sum of the total compacted layer thickness. The apex was excluded from the analysis. The mean number of segments with trabeculation per patient was 10 ± 2 with a mean GTI of 0.68 ± 0.32. The LV sphericity index was inversely correlated with LV ejection fraction (R = -0.42, P = 0.0002) and positively with the brain natriuretic peptide (BNP) level (R = 0.34, P = 0.003). The maximal STI was positively correlated with the indexed LV end-diastolic volume (R = 0.32, P = 0.004) and the LV sphericity index (R = 0.25, P = 0.02), but not with the BNP level or LV ejection fraction. The GTI was positively correlated with the LV sphericity index (R = 0.27, P = 0.016) but not with indexed LV end-diastolic volume, BNP levels, or LV ejection fraction. CONCLUSION Trabeculation indexes depend on LV shape and are positively correlated with LV sphericity. These results encourage interpreting LV trabeculation with caution in patients with DCM, considering additional morphologic criteria such as LV geometry.
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Affiliation(s)
- Pauline Marchal
- Department of Cardiology, University Hospital of Rangueil, 1, Avenue Jean Poulhès, TSA 50032, Toulouse Cedex 9 31059, France
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Panduranga P, Al-Mukhaini M. Sickle cell disease with left ventricular non-compaction: A rare association. J Cardiol Cases 2011; 3:e75-e77. [PMID: 30532842 PMCID: PMC6265093 DOI: 10.1016/j.jccase.2010.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/06/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 11/25/2022] Open
Abstract
Cardiac abnormalities described in sickle cell disease are pulmonary hypertension, dilated left or right atrium/ventricle, valvular abnormalities, hyperdynamic left ventricle with hypertrophy, and left or right ventriclular dysfunction. However, features consistent with left ventricular non-compaction have not been described previously in patients with sickle cell disease. We describe the case of a 21-year-old male with sickle cell disease and left ventricular non-compaction, which is a rare association and discuss the possible mechanisms for such an association.
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