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Polovina M, Tschöpe C, Rosano G, Metra M, Crea F, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Corrado D, Bayes-Genis A, Bozkurt B, Filippatos G, Keren A, Skouri H, Moura B, Volterrani M, Abdelhamid M, Ašanin M, Krljanac G, Tomić M, Savarese G, Adamo M, Lopatin Y, Chioncel O, Coats AJS, Seferović PM. Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies. Eur J Heart Fail 2023; 25:2144-2163. [PMID: 37905371 DOI: 10.1002/ejhf.3076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Despite improvement in survival with contemporary treatment, SCD remains an important cause of mortality in cardiomyopathies. It occurs at a rate ranging between 0.15% and 0.7% per year (depending on the cardiomyopathy), which significantly surpasses SCD incidence in the age- and sex-matched general population. The risk of SCD is affected by multiple factors including the aetiology, genetic basis, age, sex, physical exertion, the extent of myocardial disease severity, conduction system abnormalities, and electrical instability, as measured by various metrics. Over the past decades, the knowledge on the mechanisms and risk factors for SCD has substantially improved, allowing for a better-informed risk stratification. However, unresolved issues still challenge the guidance of SCD prevention in patients with cardiomyopathies. In this review, we aim to provide an in-depth discussion of the contemporary concepts pertinent to understanding the burden, risk assessment and prevention of SCD in cardiomyopathies (dilated, non-dilated left ventricular, hypertrophic, arrhythmogenic right ventricular, and restrictive). The review first focuses on SCD incidence in cardiomyopathies and then summarizes established and emerging risk factors for life-threatening arrhythmias/SCD. Finally, it discusses validated approaches to the risk assessment and evidence-based measures for SCD prevention in cardiomyopathies, pointing to the gaps in evidence and areas of uncertainties that merit future clarification.
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Affiliation(s)
- Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute. Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Biykem Bozkurt
- Section of Cardiology, Winters Center for Heart Failure, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Hadassah-Hebrew University Medical Center Jerusalem, Clalit Services District of Jerusalem, Jerusalem, Israel
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milenko Tomić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University for Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | | | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
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Qi W, Pu L, Zhang J, Chen H, Tang Z, Wang J, Han Y, Chen Y. Validation of the Risk Stratification for Sudden Cardiac Death in Chinese Patients With Hypertrophic Cardiomyopathy. Curr Probl Cardiol 2023; 48:101875. [PMID: 37331610 DOI: 10.1016/j.cpcardiol.2023.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
Accurate identification of hypertrophic cardiomyopathy (HCM) patients at high risk of sudden cardiac death (SCD) event is challenging. The objective of this study was to validate the three SCD risk stratifications recommended by the 2014 European Society of Cardiology (ESC) guideline, the 2020 American Heart Association /American College of Cardiology (AHA/ACC) guideline, and the 2022 ESC guideline in Chinese patients with HCM. Our study population are made up of a cohort of 856 HCM patients without prior SCD events. The endpoint was defined as SCD or equivalent events (successful resuscitation after cardiac arrest or appropriate ICD shock for ventricular tachycardia or ventricular fibrillation). During a median follow-up of 43 months, SCD endpoints occurred in 44 (5.1%) patients. A total of 34 (77.3%) patients suffering from SCD events were classified correctly into high-risk groups by the 2020 AHA/ACC guideline, 27(61.4%) by the 2022 ESC guideline, and 13 (29.6%) by the 2014 ESC guideline. The C-statistic of the 2020 AHA/ACC guideline was 0.68 (95% CI, 0.60-0.76), which performed better than the 2022 ESC guideline (0.65: 95% CI, 0.56-0.73), and the 2014 ESC guideline (0.58: 95% CI, 0.48-0.67). The 2020 AHA/ACC guideline displayed better discrimination for SCD risk stratification in Chinese HCM patients than the other two guidelines, with a higher sensitivity but lower specificity.
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MESH Headings
- Humans
- United States
- Risk Assessment
- Risk Factors
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Arrhythmias, Cardiac
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- China/epidemiology
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Affiliation(s)
- Weitang Qi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lutong Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jinquan Zhang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Zihuan Tang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuchi Han
- Wexner Medical Center, College of Medicine, The Ohio State University, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 200] [Impact Index Per Article: 200.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Mukhtar G, Sasidharan B, Krishnamoorthy KM, Kurup HKN, Gopalakrishnan A, SasiKumar D, P SS, Valaparambil AK, Sivasubramonian S, Sivadasanpillai H. Clinical profile and outcomes of pediatric hypertrophic cardiomyopathy in a South Indian tertiary care cardiac center: a three decade experience. BMC Pediatr 2023; 23:446. [PMID: 37679699 PMCID: PMC10483701 DOI: 10.1186/s12887-023-04255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Although much research has been done on adult hypertrophic cardiomyopathy, data on pediatric hypertrophic cardiomyopathy is still limited. METHODS AND RESULTS The study enrolled all patients with cardiomyopathy who presented to us between 1990 to 2020 and were younger than 18 yrs. During the thirty-year study period, we identified 233 cases of pediatric cardiomyopathy. Sixty-three cases (27%) had hypertrophic cardiomyopathy. Out of the 63 HCM cases, 12% presented in the neonatal period and 37% presented in the first year of life. The median age of presentation was 7 yrs (Range 0.1-18 yrs). Sixteen patients had proven syndromic, metabolic, or genetic disease (25%). LV outflow obstruction was present in 30 patients (47%). Noonan syndrome was present in 9 of the 63 patients (14%). Dyspnea on exertion was the most common mode of presentation. Cardiac MRI was done in 28 patients, out of which 17 had late gadolinium enhancement (LGE). Mid myocardial enhancement was the most common pattern. Four patients had LGE of more than 15%. Over a mean follow-up period of 5.6 years (0.1-30 years), twenty-one were lost to follow-up (33%). Among the patients whose outcome was known, eleven died (26%), and thirty-one (73%) were alive. The 5-year survival rate of HCM patients was 82%, and the 10-year survival rate was 78%. Seven died of sudden cardiac death, three from heart failure, and one from ventricular arrhythmias. Sustained ventricular arrhythmias were seen in three patients and atrial arrhythmias in two. First-degree AV block was seen in 10 patients (15%) and bundle branch blocks (BBB) in five (8%). Eight patients required ICD or transplant (12.7%). Two patients underwent ICD for primary prevention, and one underwent PPI for distal AV conduction disease. Among the various clinical, echocardiographic, and radiological risk factors studied, only consanguinity showed a trend towards higher events of death or ventricular arrhythmias (P-value 0.08). CONCLUSION More than one-third of our HCM cohort presented in infancy. LV outflow tract obstruction is common (47%). Mid myocardial enhancement was the most common pattern of late gadolinium enhancement. SCD was the most common cause of death. The outcome in our HCM cohort is good and similar to other population cohorts. Only Consanguinity showed a trend towards higher events of death or ventricular arrhythmias.
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Affiliation(s)
- Gousia Mukhtar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India.
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Kavassery Mahadevan Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Harikrishnan K N Kurup
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Deepa SasiKumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Sankara Sarma P
- Achutha Menon Center for Health Science Studies, Thiruvananthapuram, Kerala, 695011, India
| | - Ajit Kumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
| | - Harikrishnan Sivadasanpillai
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, SCTIMST, Thiruvananthapuram, Kerala, 695011, India
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Santoro F, Mango F, Mallardi A, D'Alessandro D, Casavecchia G, Gravina M, Correale M, Brunetti ND. Arrhythmic Risk Stratification among Patients with Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:jcm12103397. [PMID: 37240503 DOI: 10.3390/jcm12103397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a cardiac muscle disorder characterized by generally asymmetric abnormal hypertrophy of the left ventricle without abnormal loading conditions (such as hypertension or valvular heart disease) accounting for the left ventricular wall thickness or mass. The incidence of sudden cardiac death (SCD) in HCM patients is about 1% yearly in adults, but it is far higher in adolescence. HCM is the most frequent cause of death in athletes in the Unites States of America. HCM is an autosomal-dominant genetic cardiomyopathy, and mutations in the genes encoding sarcomeric proteins are identified in 30-60% of cases. The presence of this genetic mutation carries more than 2-fold increased risk for all outcomes, including ventricular arrhythmias. Genetic and myocardial substrate, including fibrosis and intraventricular dispersion of conduction, ventricular hypertrophy and microvascular ischemia, increased myofilament calcium sensitivity and abnormal calcium handling, all play a role as arrhythmogenic determinants. Cardiac imaging studies provide important information for risk stratification. Transthoracic echocardiography can be helpful to evaluate left ventricular (LV) wall thickness, LV outflow-tract gradient and left atrial size. Additionally, cardiac magnetic resonance can evaluate the prevalence of late gadolinium enhancement, which when higher than 15% of LV mass is a prognostic maker of SCD. Age, family history of SCD, syncope and non-sustained ventricular tachycardia at Holter ECG have also been validated as independent prognostic markers of SCD. Arrhythmic risk stratification in HCM requires careful evaluation of several clinical aspects. Symptoms combined with electrocardiogram, cardiac imaging tools and genetic counselling are the modern cornerstone for proper risk stratification.
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Affiliation(s)
- Francesco Santoro
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Federica Mango
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Adriana Mallardi
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Damiano D'Alessandro
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Matteo Gravina
- Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
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Abstract
PURPOSE OF REVIEW Hypertrophic cardiomyopathy (HCM) is one of the leading causes of sudden cardiac death (SCD) in younger people and athletes. It is crucial to identify the risk factors for SCD in individuals with HCM. This review, based on recent systematic literature studies, will focus on the risk factors for SCD in patients with HCM. RECENT FINDINGS An increasing number of studies have further explored the risk factors for SCD in patients with HCM, and new risk markers have emerged accordingly. In addition, more accurate SCD risk estimation and stratification methods have been proposed and continuously improved. SUMMARY The identification of independent risk factors for HCM-related SCD would likely contribute to risk stratification. However, it is difficult to predict SCD with absolute certainty, as the annual incidence of SCD in adult patients with HCM is approximately 1%. The review discusses the established risk factors, such as a family history of SCD, unexplained syncope and some new risk factors. Taken together, the findings of this review demonstrate that there is a need for further research on individual risk factors and that SCD risk stratification in HCM patients remains a clinical challenge.
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Affiliation(s)
- Ying Hong
- Department of Cardiology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Wilber W. Su
- Department of Cardiology, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Xiaoping Li
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
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7
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Lorenzini M, Norrish G, Field E, Ochoa JP, Cicerchia M, Akhtar MM, Syrris P, Lopes LR, Kaski JP, Elliott PM. Penetrance of Hypertrophic Cardiomyopathy in Sarcomere Protein Mutation Carriers. J Am Coll Cardiol 2021; 76:550-559. [PMID: 32731933 PMCID: PMC7397507 DOI: 10.1016/j.jacc.2020.06.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/10/2023]
Abstract
Background Predictive genetic screening of relatives of patients with hypertrophic cardiomyopathy (HCM) caused by sarcomere protein (SP) gene mutations is current standard of care, but there are few data on long-term outcomes in mutation carriers without HCM. Objectives The aim of this study was to determine the incidence of new HCM diagnosis in SP mutation carriers. Methods This was a retrospective analysis of adult and pediatric SP mutation carriers identified during family screening who did not fulfill diagnostic criteria for HCM at first evaluation. Results The authors evaluated 285 individuals from 156 families (median age 14.2 years [interquartile range: 6.8 to 31.6 years], 141 [49.5%] male individuals); 145 (50.9%) underwent cardiac magnetic resonance (CMR). Frequency of causal genes was as follows: MYBPC3 n = 123 (43.2%), MYH7 n = 69 (24.2%), TNNI3 n = 39 (13.7%), TNNT2 n = 34 (11.9%), TPM1 n = 9 (3.2%), MYL2 n = 6 (2.1%), ACTC1 n = 1 (0.4%), multiple mutations n = 4 (1.4%). Median follow-up was 8.0 years (interquartile range: 4.0 to 13.3 years) and 86 (30.2%) patients developed HCM; 16 of 50 (32.0%) fulfilled diagnostic criteria on CMR but not echocardiography. Estimated HCM penetrance at 15 years of follow-up was 46% (95% confidence interval [CI]: 38% to 54%). In a multivariable model adjusted for age and stratified for CMR, independent predictors of HCM development were male sex (hazard ratio [HR]: 2.91; 95% CI: 1.82 to 4.65) and abnormal electrocardiogram (ECG) (HR: 4.02; 95% CI: 2.51 to 6.44); TNNI3 variants had the lowest risk (HR: 0.19; 95% CI: 0.07 to 0.55, compared to MYBPC3). Conclusions Following a first negative screening, approximately 50% of SP mutation carriers develop HCM over 15 years of follow-up. Male sex and an abnormal ECG are associated with a higher risk of developing HCM. Regular CMR should be considered in long-term screening.
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Affiliation(s)
- Massimiliano Lorenzini
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; University College London Institute of Cardiovascular Science, London, United Kingdom
| | - Gabrielle Norrish
- University College London Institute of Cardiovascular Science, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Ella Field
- University College London Institute of Cardiovascular Science, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Juan Pablo Ochoa
- Health in Code S.L., Scientific Department, A Coruña, Spain; Universidade da Coruña, GRINCAR (Cardiovascular Research Group), A Coruña, Spain
| | - Marcos Cicerchia
- Health in Code S.L., Scientific Department, A Coruña, Spain; Universidade da Coruña, GRINCAR (Cardiovascular Research Group), A Coruña, Spain
| | - Mohammed M Akhtar
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; University College London Institute of Cardiovascular Science, London, United Kingdom
| | - Petros Syrris
- University College London Institute of Cardiovascular Science, London, United Kingdom
| | - Luis R Lopes
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; University College London Institute of Cardiovascular Science, London, United Kingdom
| | - Juan Pablo Kaski
- University College London Institute of Cardiovascular Science, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Perry M Elliott
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; University College London Institute of Cardiovascular Science, London, United Kingdom.
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8
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Lorenzini M, Anastasiou Z, O'Mahony C, Guttman OP, Gimeno JR, Monserrat L, Anastasakis A, Rapezzi C, Biagini E, Garcia-Pavia P, Limongelli G, Pavlou M, Elliott PM. Mortality Among Referral Patients With Hypertrophic Cardiomyopathy vs the General European Population. JAMA Cardiol 2021; 5:73-80. [PMID: 31774458 DOI: 10.1001/jamacardio.2019.4534] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance It is unclear whether hypertrophic cardiomyopathy (HCM) conveys excess mortality when compared with the general population. Objective To compare the survival of patients with HCM with that of the general European population. Design, Setting, and Participants Retrospective cohort study of 4893 consecutive adult patients with HCM presenting at 7 European referral centers between 1980 and 2013. The data were analyzed between April 2018 and August 2019. Main Outcomes and Measures Survival was compared using standardized mortality ratios (SMRs) calculated with data from Eurostat, stratified by study period, country, sex, and age, and using a composite end point in the HCM cohort of all-cause mortality, aborted sudden cardiac death, and heart transplant. Results Of 4893 patients with HCM, 3126 (63.9%) were male, and the mean (SD) age at presentation was 49.2 (16.4) years. During a median follow-up of 6.2 years (interquartile range, 3.1-9.8 years), 721 patients (14.7%) reached the composite end point. Compared with the general population, patients with HCM had excess mortality throughout the age spectrum (SMR, 2.0, 95% CI, 1.48-2.63). Excess mortality was highest among patients presenting prior to the year 2000 but persisted in the cohort presenting between 2006 and 2013 (SMR, 1.84; 95% CI, 1.55-2.18). Women had higher excess mortality than men (SMR, 2.66; 95% CI, 2.38-2.97; vs SMR, 1.68; 95% CI, 1.52-1.85; P < .001). Conclusions and Relevance Among patients referred to European specialty centers, HCM was associated with significant excess mortality through the life course. Although there have been improvements in survival with time, potentially reflecting improved treatments for HCM, these findings highlight the need for more research into the causes of excess mortality among patients with HCM and for better risk stratification.
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Affiliation(s)
- Massimiliano Lorenzini
- Barts Heart Centre, Institute for Cardiovascular Science, St Bartholomew's Hospital, University College London, London, United Kingdom.,Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zacharias Anastasiou
- Department of Statistical Science, University College London, London, United Kingdom
| | - Constantinos O'Mahony
- Barts Heart Centre, Institute for Cardiovascular Science, St Bartholomew's Hospital, University College London, London, United Kingdom
| | - Oliver P Guttman
- Barts Heart Centre, Institute for Cardiovascular Science, St Bartholomew's Hospital, University College London, London, United Kingdom
| | - Juan Ramon Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Lorenzo Monserrat
- Cardiology Department and Research Unit, A Coruña University Hospital, Galician Health Service, A Coruña, Spain
| | - Aristides Anastasakis
- Unit of Inherited Cardiovascular Diseases, First Department of Cardiology, University of Athens, Athens, Greece
| | - Claudio Rapezzi
- Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Biagini
- Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta del Hierro-Majadahonda, Madrid, Spain.,Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares, Madrid, Spain.,Facultad de Ciencias de la Salud, University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Giuseppe Limongelli
- Department of Cardiothoracic Sciences, Monaldi Hospital, AORN Colli, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | - Perry M Elliott
- Barts Heart Centre, Institute for Cardiovascular Science, St Bartholomew's Hospital, University College London, London, United Kingdom
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Risk stratification in hypertrophic cardiomyopathy. Herz 2020; 45:50-64. [PMID: 29696341 DOI: 10.1007/s00059-018-4700-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/15/2018] [Accepted: 03/24/2018] [Indexed: 12/20/2022]
Abstract
Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). The greatest challenge in the management of HCM is identifying those at increased risk, since an implantable cardioverter-defibrillator (ICD) is a potentially life-saving therapy. We sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting data on risk stratification, with balanced guidance regarding rational clinical decision-making. Additionally, we sought to determine the status of the current implementation of guidelines compiled by HCM experts worldwide. The HCM Risk-SCD model helps improve the risk stratification of HCM patients for primary prevention of SCD by calculating an individual risk estimate that contributes to the clinical decision-making process. Improved risk stratification is important for decision-making before ICD implantation for the primary prevention of SCD.
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10
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5178] [Impact Index Per Article: 1035.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Balaji S, DiLorenzo MP, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P, Law IH, Kantoch MJ, Kertesz NJ, Strieper M, Erickson CC, Moore JP, Nakano SJ, Singh HR, Chang P, Cohen M, Fournier A, Ilina MV, Smith RT, Zimmerman F, Horndasch M, Li W, Batra A, Liberman L, Hamilton R, Janson CM, Sanatani S, Zeltser I, McDaniel G, Blaufox AD, Garnreiter JM, Katcoff H, Shah M. Risk factors for lethal arrhythmic events in children and adolescents with hypertrophic cardiomyopathy and an implantable defibrillator: An international multicenter study. Heart Rhythm 2019; 16:1462-1467. [DOI: 10.1016/j.hrthm.2019.04.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 11/16/2022]
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12
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and defined by unexplained isolated progressive myocardial hypertrophy, systolic and diastolic ventricular dysfunction, arrhythmias, sudden cardiac death and histopathologic changes, such as myocyte disarray and myocardial fibrosis. Mutations in genes encoding for proteins of the contractile apparatus of the cardiomyocyte, such as β-myosin heavy chain and myosin binding protein C, have been identified as cause of the disease. Disease is caused by altered biophysical properties of the cardiomyocyte, disturbed calcium handling, and abnormal cellular metabolism. Mutations in sarcomere genes can also activate other signaling pathways via transcriptional activation and can influence non-cardiac cells, such as fibroblasts. Additional environmental, genetic and epigenetic factors result in heterogeneous disease expression. The clinical course of the disease varies greatly with some patients presenting during childhood while others remain asymptomatic until late in life. Patients can present with either heart failure symptoms or the first symptom can be sudden death due to malignant ventricular arrhythmias. The morphological and pathological heterogeneity results in prognosis uncertainty and makes patient management challenging. Current standard therapeutic measures include the prevention of sudden death by prohibition of competitive sport participation and the implantation of cardioverter-defibrillators if indicated, as well as symptomatic heart failure therapies or cardiac transplantation. There exists no causal therapy for this monogenic autosomal-dominant inherited disorder, so that the focus of current management is on early identification of asymptomatic patients at risk through molecular diagnostic and clinical cascade screening of family members, optimal sudden death risk stratification, and timely initiation of preventative therapies to avoid disease progression to the irreversible adverse myocardial remodeling stage. Genetic diagnosis allowing identification of asymptomatic affected patients prior to clinical disease onset, new imaging technologies, and the establishment of international guidelines have optimized treatment and sudden death risk stratification lowering mortality dramatically within the last decade. However, a thorough understanding of underlying disease pathogenesis, regular clinical follow-up, family counseling, and preventative treatment is required to minimize morbidity and mortality of affected patients. This review summarizes current knowledge about molecular genetics and pathogenesis of HCM secondary to mutations in the sarcomere and provides an overview about current evidence and guidelines in clinical patient management. The overview will focus on clinical staging based on disease mechanism allowing timely initiation of preventative measures. An outlook about so far experimental treatments and potential for future therapies will be provided.
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Affiliation(s)
- Cordula Maria Wolf
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
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13
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Goff ZD, Calkins H. Sudden death related cardiomyopathies - Hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2019; 62:212-216. [PMID: 31004609 DOI: 10.1016/j.pcad.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a form of inherited cardiomyopathy. Most individuals with HCM experience minimal symptoms throughout their lifetime. However, those with HCM are at risk of ventricular arrhythmias and sudden cardiac death (SCD), the most feared complication of HCM. Implantable cardioverter defibrillator (ICD) implantation has played a large role in transforming this disease from one with an ominous prognosis to one with mortality rates that are on par with the general public. Since the early 2000s, balance between SCD prevention and unnecessary ICD placement has been sought, this is reflected in the evolution of SCD risk stratification models for patients with HCM. This review discusses key concepts pertaining to HCM, with emphasis on prevention of SCD, and summarizes and compares the recommendations for ICD implantation in current guidelines.
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Affiliation(s)
- Zackary D Goff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Hugh Calkins
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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14
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Abstract
Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death (SCD), although perhaps not as significantly as previously believed. Given the heterogeneous nature of this disease entity, risk stratification of individuals with HCM remains challenging. The recent HCM risk-SCD prediction model seems to perform well in assessing individual SCD risk. Even though implantable cardiac defibrillators (ICDs) are effective in preventing SCD in patients at increased risk, the importance of shared decision making in deciding whether or not to undergo ICD implantation cannot be understated.
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Affiliation(s)
- Sei Iwai
- Cardiac Electrophysiology, New York Medical College, Westchester Medical Center Health System, Valhalla, NY, USA.
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15
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Reis L, Teixeira R, Fernandes A, Almeida I, Madeira M, Silva J, Botelho A, Pais J, Nascimento J, Gonçalves L. Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: What has Changed in The Guidelines? Arq Bras Cardiol 2018; 110:524-531. [PMID: 30226910 PMCID: PMC6023627 DOI: 10.5935/abc.20180099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/11/2017] [Indexed: 12/19/2022] Open
Abstract
Background The new European Society of Cardiology guidelines for hypertrophic
cardiomyopathy (HCM) define the estimation of sudden cardiac death (SCD)
risk as an integral part of clinical management. An implantable cardioverter
defibrillator (ICD) is recommended (class IIa) when the risk is ≥
6%. Objectives To compare the SCD risk stratification according to the 2011 and 2014
recommendations for ICD implantation in patients with HCM. Methods Retrospective study including 105 patients diagnosed with HCM. The indication
for ICD was assessed using the 2011 and 2014 guidelines. Statistical
analysis was performed using SPSS software version 19.0.0.2®. The
tests performed were bilateral, considering the significance level of 5% (p
< 0.05). Results Regarding primary prevention, according to the 2011 ACCF/AHA recommendations,
39.0% of the patients had indication for ICD implantation (level of evidence
IIa). Using the 2014 guidelines, only 12.4% of the patients had an
indication for ICD implantation. Comparing the two risk stratification
models for patients with HCM, we detected a significant reduction in the
number of indications for ICD implantation (p < 0.001). Of the 41
patients classified as IIa according to the 2011 recommendations, 68.3%
received a different classification according to the 2014 guidelines. Conclusion Significant differences were found when comparing the SCD risk stratification
for ICD implantation in the two guidelines. The current SCD risk score seems
to identify many low-risk patients who are not candidates for ICD
implantation. The use of this new score results in a significant reduction
in the number of ICD implanted.
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Affiliation(s)
- Liliana Reis
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Rogerio Teixeira
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Andreia Fernandes
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Inês Almeida
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Marta Madeira
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Joana Silva
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Ana Botelho
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - João Pais
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - José Nascimento
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
| | - Lino Gonçalves
- Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra - Portugal
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16
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Emet S, Dadashov M, Sonsoz MR, Cakir MO, Yilmaz M, Elitok A, Bilge AK, Mercanoglu F, Oncul A, Adalet K, Onur I. Galectin-3: A Novel Biomarker Predicts Sudden Cardiac Death in Hypertrophic Cardiomyopathy. Am J Med Sci 2018; 356:537-543. [PMID: 30342718 DOI: 10.1016/j.amjms.2018.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/03/2018] [Accepted: 08/24/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a primary cardiac disease characterized by left ventricular hypertrophy, myocyte hypertrophy and irregularities and interstitial fibrosis in the absence of any cardiac or systemic diseases and may lead to sudden cardiac death (SCD). Galectin-3 is a β-galactoside-binding lectin that has been associated with cardiac fibrosis and inflammation. In this study, we aimed to investigate the relationship between serum galectin-3 levels and the criteria for 5-year sudden death risk, recently defined in the European Society of Cardiology guidelines (2014), in patients with hypertrophic cardiomyopathy. MATERIALS AND METHODS A total of 52 hypertrophic cardiomyopathy patients were enrolled in the study. Patients were questioned for sudden death risk predictors as outlined in the 2014 European Society of Cardiology guideline. A standardized clinical evaluation was carried out on the basis of previously described prognostic variables to calculate the 5-year risk of SCD. Blood samples were taken from all patients to measure serum galectin-3 levels. A statistical significance level of P < 0.05 was accepted in all tests. RESULTS We found that there was a significant correlation between the estimated 5-year risk of SCD and serum levels of galectin-3. CONCLUSIONS Galectin-3 may be an inexpensive and easily accessible parameter to predict arrhythmia risk. In addition, it can be used to determine antiarrhythmic prophylaxis as a predictor of an arrhythmia storm in implantable cardioverter defibrillator-implanted patients who are not available for magnetic resonance imaging.
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Affiliation(s)
- Samim Emet
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
| | - Mubariz Dadashov
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Mehmet Rasih Sonsoz
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Mustafa Ozan Cakir
- Department of Cardiology, Zonguldak Bulent Ecevit University Medical Faculty, Zonguldak, Turkey
| | - Mustafa Yilmaz
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Fehmi Mercanoglu
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Aytac Oncul
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Kamil Adalet
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Imran Onur
- Department of Cardiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey; Department of Cardiology, Zonguldak Bulent Ecevit University Medical Faculty, Zonguldak, Turkey
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17
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4425] [Impact Index Per Article: 737.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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O’Mahony C, Jichi F, Ommen SR, Christiaans I, Arbustini E, Garcia-Pavia P, Cecchi F, Olivotto I, Kitaoka H, Gotsman I, Carr-White G, Mogensen J, Antoniades L, Mohiddin SA, Maurer MS, Tang HC, Geske JB, Siontis KC, Mahmoud KD, Vermeer A, Wilde A, Favalli V, Guttmann OP, Gallego-Delgado M, Dominguez F, Tanini I, Kubo T, Keren A, Bueser T, Waters S, Issa IF, Malcolmson J, Burns T, Sekhri N, Hoeger CW, Omar RZ, Elliott PM. International External Validation Study of the 2014 European Society of Cardiology Guidelines on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy (EVIDENCE-HCM). Circulation 2018; 137:1015-1023. [DOI: 10.1161/circulationaha.117.030437] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
Background:
Identification of people with hypertrophic cardiomyopathy (HCM) who are at risk of sudden cardiac death (SCD) and require a prophylactic implantable cardioverter defibrillator is challenging. In 2014, the European Society of Cardiology proposed a new risk stratification method based on a risk prediction model (HCM Risk-SCD) that estimates the 5-year risk of SCD. The aim was to externally validate the 2014 European Society of Cardiology recommendations in a geographically diverse cohort of patients recruited from the United States, Europe, the Middle East, and Asia.
Methods:
This was an observational, retrospective, longitudinal cohort study.
Results:
The cohort consisted of 3703 patients. Seventy three (2%) patients reached the SCD end point within 5 years of follow-up (5-year incidence, 2.4% [95% confidence interval {CI}, 1.9–3.0]). The validation study revealed a calibration slope of 1.02 (95% CI, 0.93–1.12), C-index of 0.70 (95% CI, 0.68–0.72), and D-statistic of 1.17 (95% CI, 1.05–1.29). In a complete case analysis (n= 2147; 44 SCD end points at 5 years), patients with a predicted 5-year risk of <4% (n=1524; 71%) had an observed 5-year SCD incidence of 1.4% (95% CI, 0.8–2.2); patients with a predicted risk of ≥6% (n=297; 14%) had an observed SCD incidence of 8.9% (95% CI, 5.96–13.1) at 5 years. For every 13 (297/23) implantable cardioverter defibrillator implantations in patients with an estimated 5-year SCD risk ≥6%, 1 patient can potentially be saved from SCD.
Conclusions:
This study confirms that the HCM Risk-SCD model provides accurate prognostic information that can be used to target implantable cardioverter defibrillator therapy in patients at the highest risk of SCD.
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Affiliation(s)
- Constantinos O’Mahony
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science (C.O., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
| | - Fatima Jichi
- Biostatistics Group, University College London Hospitals/University College London Joint Research Office (F.J.)
| | - Steve R. Ommen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
| | - Imke Christiaans
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Center, Department of Clinical and Experimental Cardiology (I.C., A.V., A.W.)
- Department of Clinical Genetics (I.C., A.V.)
| | - Eloisa Arbustini
- Academic Medical Center, Amsterdam, Netherlands. Centre for Inherited Cardiovascular Diseases, Transplant Research Area, Istituto di Ricovero e Cura a Carattere Scientifico Foundation, Policlinico San Matteo, Pavia, Italy (E.A., V.F.)
| | - Pablo Garcia-Pavia
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., M.G.-D., F.D.)
- Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares, Madrid, Spain (P.G.-P.). University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain (P.G.-P.)
| | - Franco Cecchi
- Department of Cardiology, Careggi University Hospital, Florence, Italy (F.C., I.O., I.T.)
| | - Iacopo Olivotto
- Department of Cardiology, Careggi University Hospital, Florence, Italy (F.C., I.O., I.T.)
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Japan (H.K., T.K.)
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel (I.G., A.K.)
| | - Gerald Carr-White
- Guy’s and St. Thomas’ Hospital National Health Service Foundation Trust, London, United Kingdom (G.C.-W., T.B., S.W.)
| | - Jens Mogensen
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
| | - Loizos Antoniades
- Inherited Cardiovascular Disease Unit, Department of Cardiology, Nicosia General Hospital, Latsia, Cyprus (L.A.)
| | - Saidi A. Mohiddin
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
| | - Mathew S. Maurer
- Columbia University Medical Center, New York, NY (M.S.M., C.W.H.)
| | - Hak Chiaw Tang
- Department of Cardiology, National Heart Centre Singapore (H.C.T.)
| | - Jeffrey B. Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
| | - Konstantinos C. Siontis
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (K.C.S.)
| | - Karim D. Mahmoud
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands (K.D.M.)
| | - Alexa Vermeer
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Center, Department of Clinical and Experimental Cardiology (I.C., A.V., A.W.)
- Department of Clinical Genetics (I.C., A.V.)
| | - Arthur Wilde
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Center, Department of Clinical and Experimental Cardiology (I.C., A.V., A.W.)
| | - Valentina Favalli
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Academic Medical Center, Amsterdam, Netherlands. Centre for Inherited Cardiovascular Diseases, Transplant Research Area, Istituto di Ricovero e Cura a Carattere Scientifico Foundation, Policlinico San Matteo, Pavia, Italy (E.A., V.F.)
| | - Oliver P. Guttmann
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- The Inherited Cardiac Diseases Unit, The Heart Hospital (O.P.G., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
| | - Maria Gallego-Delgado
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., M.G.-D., F.D.)
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., M.G.-D., F.D.)
| | - Ilaria Tanini
- Department of Cardiology, Careggi University Hospital, Florence, Italy (F.C., I.O., I.T.)
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Japan (H.K., T.K.)
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel (I.G., A.K.)
- Clalit Health Services Beit Hadfus 20, Jerusalem, Israel (A.K.). Assuta Hospitals, Tel Aviv, Israel (A.K.)
| | - Teofila Bueser
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
- King’s College London, United Kingdom (T.B.). St George’s, University of London, United Kingdom (T.B.)
| | - Sarah Waters
- Guy’s and St. Thomas’ Hospital National Health Service Foundation Trust, London, United Kingdom (G.C.-W., T.B., S.W.)
| | - Issa F. Issa
- Department of Cardiology, Odense University Hospital, Denmark (J.M., I.F.I.)
| | - James Malcolmson
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Department of Cardiology, Odense University Hospital, Denmark (J.M., I.F.I.)
| | - Tom Burns
- Guy’s and St. Thomas’ Hospital National Health Service Foundation Trust, London, United Kingdom (G.C.-W., T.B., S.W.)
| | - Neha Sekhri
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
| | | | | | - Perry M. Elliott
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science (C.O., P.M.E.)
- The Inherited Cardiac Diseases Unit, The Heart Hospital (O.P.G., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
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Abstract
Ventricular arrhythmias remain a significant cause of sudden cardiac death (SCD), and knowledge of their cause and high-risk features is important. SCD occurs when the interaction between vulnerable substrates and acute triggers results in sustained ventricular tachycardia progressing to ventricular fibrillation. Here, the authors aim to review the role of ventricular arrhythmias in SCD, first by approaching the substrates that support ventricular arrhythmias, and then by exploring features of these substrates and the acute triggers that may lead to SCD.
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Affiliation(s)
- Pok Tin Tang
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | | | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Lu DY, Haileselassie B, Ventoulis I, Liu HY, Liang HY, Pozios I, Canepa M, Phillip S, Abraham MR, Abraham T. E/e′ ratio and outcome prediction in hypertrophic cardiomyopathy: the influence of outflow tract obstruction. Eur Heart J Cardiovasc Imaging 2017; 19:101-107. [DOI: 10.1093/ehjci/jex134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/04/2017] [Indexed: 01/05/2023] Open
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21
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6007] [Impact Index Per Article: 858.1] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Konstantinou DM, Efthimiadis GK, Vassilikos V, Paraskevaidis S, Pagourelias E, Maron BJ, Karvounis H. Implantable cardioverter defibrillators for primary prevention of sudden death in hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2017; 17:433-9. [PMID: 26885981 DOI: 10.2459/jcm.0000000000000333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Sudden cardiac death (SCD) may complicate hypertrophic cardiomyopathy (HCM) natural course. Patient selection for implantable cardioverter defibrillator (ICD) therapy in the primary prevention setting is still a challenge. METHODS Thirty-seven HCM patients with a primary prevention ICD were included. All patients underwent preimplantation SCD risk assessment and semi-annual device interrogation during follow-up. Primary end point was the time to first appropriate ICD intervention including antitachycardia pacing or shock. Inappropriately delivered ICD therapies served as secondary end point. RESULTS During a median follow-up of 3.1 years, 10 (27%) patients received one or more appropriate ICD therapies. First appropriate ICD intervention rate was 7.2%/year (95% CI: 3.4-13.2) with a 5-year cumulative probability of 29.2 ± 7.4%. No SCD risk marker was significantly associated with the primary end point, whereas event rates were comparable among patients with one, two or three or more SCD risk markers (log-rank P = 0.58). Patients with a history of SCD in first-degree relatives with HCM were at 3.8 times higher risk of experiencing an ICD intervention compared with those with no family history of SCD (HR: 3.8; 95% CI: 1.0-14.1, P = 0.05). Seven (18.9%) patients experienced one or more inappropriate ICD therapies; beta-blocker therapy was associated with 75% fewer inappropriate ICD interventions (HR: 0.15; 95% CI: 0.03-0.89). CONCLUSION Current criteria identify a subgroup of patients with HCM at increased risk of major arrhythmic events as indicated by high ICD intervention rates. However, no individual risk marker demonstrated superior predictive ability over the others, whereas simple arithmetic summing of risk markers was not associated with increased ICD intervention rates.
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Affiliation(s)
- Dimitrios M Konstantinou
- aFirst Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece bHypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Validation of the 2014 European Society of Cardiology Sudden Cardiac Death Risk Prediction Model in Hypertrophic Cardiomyopathy in a Reference Center in South America. Am J Cardiol 2016; 118:121-6. [PMID: 27189816 DOI: 10.1016/j.amjcard.2016.04.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/21/2022]
Abstract
Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HC). Our aim was to conduct an external and independent validation in South America of the 2014 European Society of Cardiology (ESC) SCD risk prediction model to identify patients requiring an implantable cardioverter defibrillator. This study included 502 consecutive patients with HC followed from March, 1993 to December, 2014. A combined end point of SCD or appropriate implantable cardioverter defibrillator therapy was assessed. For the quantitative estimation of individual 5-year SCD risk, we used the formula: 1 - 0.998(exp(Prognostic index)). Our database also included the abnormal blood pressure response to exercise as a risk marker. We analyzed the 3 categories of 5-year risk proposed by the ESC: low risk (LR) <4%; intermediate risk (IR) ≥4% to <6%, and high risk (HR) ≥6%. The LR group included 387 patients (77%); the IR group 39 (8%); and the HR group 76 (15%). Fourteen patients (3%) had SCD/appropriate implantable cardioverter defibrillator therapy (LR: 0%; IR: 2 of 39 [5%]; and HR: 12 of 76 [16%]). In a receiver-operating characteristic curve, the new model proved to be an excellent predictor because the area under the curve for the estimated risk is 0.925 (statistical C: 0.925; 95% CI 0.8884 to 0.9539, p <0.0001). In conclusion, the SCD risk prediction model in HC proposed by the 2014 ESC guidelines was validated in our population and represents an improvement compared with previous approaches. A larger multicenter, independent and external validation of the model with long-term follow-up would be advisable.
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O’Mahony C, Jichi F, Monserrat L, Ortiz-Genga M, Anastasakis A, Rapezzi C, Biagini E, Gimeno JR, Limongelli G, McKenna WJ, Omar RZ, Elliott PM. Inverted U-Shaped Relation Between the Risk of Sudden Cardiac Death and Maximal Left Ventricular Wall Thickness in Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003818. [DOI: 10.1161/circep.115.003818] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
Background—
Hypertrophic cardiomyopathy is associated with sudden cardiac death (SCD). Some studies have shown an association between risk of sudden death and left ventricular maximal wall thickness (MWT), but there are few data in patients with extreme hypertrophy. The aim of this study was to determine the relation between MWT and the risk of SCD.
Methods and Results—
This is a multicenter, retrospective, longitudinal cohort study of 3673 adult (≥16 years) patients, previously used to develop and validate a risk prediction model for SCD (HCM Risk-SCD [hypertrophic cardiomyopathy risk-SCD]). There was an inverted U-shaped relation between MWT and the estimated 5-year risk of SCD. In patients with MWT≥35 mm (n=47; mean age, 33 years; 81% men), there was a single SCD end point (annual rate, 0.2%; 95% confidence interval, 0.03–1.60) and 3 additional cardiovascular events during a median follow-up of 9.5 years. Compared with patients with MWT≤14 mm, those with MWT≥35 mm did not have a higher risk for SCD (hazard ratio, 0.22; 95% confidence interval, 0.03–1.65), cardiovascular death (hazard ratio, 0.66; 95% confidence interval, 0.26–1.67), or all-cause mortality (hazard ratio, 0.73; 95% confidence interval, 0.32–1.69).
Conclusions—
The risk of SCD has a complex, nonlinear relationship to MWT. The pathophysiological mechanisms behind this observation require further study but implantable cardioverter defibrillator implantation should not be guided solely on the severity of left ventricular hypertrophy.
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Affiliation(s)
- Constantinos O’Mahony
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Fatima Jichi
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Lorenzo Monserrat
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Martin Ortiz-Genga
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Aristides Anastasakis
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Claudio Rapezzi
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Elena Biagini
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Juan Ramon Gimeno
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Giuseppe Limongelli
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - William J. McKenna
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Rumana Z. Omar
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Perry M. Elliott
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
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Contemporary strategies for risk stratification and prevention of sudden death with the implantable defibrillator in hypertrophic cardiomyopathy. Heart Rhythm 2016; 13:1155-1165. [PMID: 26749314 DOI: 10.1016/j.hrthm.2015.12.048] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 12/29/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is regarded as the most common nontraumatic cause of sudden death (SD) in young people (including trained athletes). Introduction of implantable cardioverter-defibrillators (ICD) to HCM 15 years ago represented a new paradigm for clinical practice and probably the most significant advance in management of this disease. ICDs offer protection against SD by terminating potentially lethal ventricular tachyarrhythmias (11%/year secondary and 4%/year primary prevention), although implant decisions are weighed against the possibility of device-related complications (5%/year). ICDs have altered the natural history of HCM, creating the opportunity for extended or normal longevity for many patients. However, assessing SD risk and targeting appropriate candidates for prophylactic device therapy can be compounded by unpredictability of the underlying arrhythmogenic substrate, evident by delays ≥10 years between implant and first ICD intervention. Multiple or a single strong risk marker within the clinical profile of an individual HCM patient can justify consideration for a primary-prevention ICD when combined with physician judgment and shared decision making. The role of the mathematical SD risk score proposed by the European Society of Cardiology to identify patients who benefit from ICD therapy is incompletely resolved. Contemporary treatment interventions and advanced risk stratification using ≥1 conventional markers have served the HCM patient population well, with reduced disease-related mortality rates across all age groups to <1%/year, due largely to the penetration of ICDs into HCM practice. Prevention of SD has now become an integral, albeit challenging, component of HCM management, contributing importantly to its emergence as a contemporary treatable cardiac disease.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3711] [Impact Index Per Article: 412.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Maron BJ, Casey SA, Chan RH, Garberich RF, Rowin EJ, Maron MS. Independent Assessment of the European Society of Cardiology Sudden Death Risk Model for Hypertrophic Cardiomyopathy. Am J Cardiol 2015; 116:757-64. [PMID: 26183790 DOI: 10.1016/j.amjcard.2015.05.047] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
Risk stratification for sudden death (SD) is an essential component of hypertrophic cardiomyopathy (HC) management, given the proven effectiveness of implantable cardioverter-defibrillators (ICD) for preventing SD. Although highly effective in identifying high-risk patients, current stratification algorithms remain incomplete and novel strategies are encouraged. In this regard, reliability of the statistical model to predict SD risk in HC, as recommended by the recent European Society of Cardiology (ESC) guidelines, was retrospectively tested in an independent cohort of 1,629 consecutive patients with HC aged ≥16 years. Of the 1,629 patients, 35 incurred SD events, but only 4 of these (11%) had high predictive risk scores >6%/5 years consistent with an ICD recommendation, and most (60%; n = 21) had scores <4%/5 years that would not justify ICDs. Of 46 high-risk patients with appropriate ICD interventions for ventricular fibrillation/tachycardia, 27 (59%) had low SD risk scores of <4%/5 years, regarded by ESC as insufficient to recommend ICDs, and only 12 (26%) had scores >6%/5 years, considered an ICD indication; 11 of these 12 had already met conventional criteria warranting implantation with 2 to 3 risk markers. Of 414 patients with ICDs but without appropriate interventions, 258 (62%) had low risk scores (<4%/5 years) that would argue against implant. In conclusion, primary risk stratification using the ESC prognostic score applied retrospectively to a large independent HC cohort proved unreliable for prediction of future SD events. Most patients with HC with SD or appropriate ICD interventions were misclassified with low risk scores and therefore would have remained unprotected from arrhythmic SD without ICDs.
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Vriesendorp PA, Schinkel AFL, Liebregts M, Theuns DAMJ, van Cleemput J, Ten Cate FJ, Willems R, Michels M. Validation of the 2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:829-35. [PMID: 25922410 DOI: 10.1161/circep.114.002553] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The recently released 2014 European Society of Cardiology guidelines of hypertrophic cardiomyopathy (HCM) use a new clinical risk prediction model for sudden cardiac death (SCD), based on the HCM Risk-SCD study. Our study is the first external and independent validation of this new risk prediction model. METHODS AND RESULTS The study population consisted of a consecutive cohort of 706 patients with HCM without prior SCD event, from 2 tertiary referral centers. The primary end point was a composite of SCD and appropriate implantable cardioverter-defibrillator therapy, identical to the HCM Risk-SCD end point. The 5-year SCD risk was calculated using the HCM Risk-SCD formula. Receiver operating characteristic curves and C-statistics were calculated for the 2014 European Society of Cardiology guidelines, and risk stratification methods of the 2003 American College of Cardiology/European Society of Cardiology guidelines and 2011 American College of Cardiology Foundation/American Heart Association guidelines. During follow-up of 7.7±5.3 years, SCD occurred in 42 (5.9%) of 706 patients (ages 49±16 years; 34% women). The C-statistic of the new model was 0.69 (95% CI, 0.57-0.82; P=0.008), which performed significantly better than the conventional risk factor models based on the 2003 guidelines (C-statistic of 0.55: 95% CI, 0.47-0.63; P=0.3), and 2011 guidelines (C-statistic of 0.60: 95% CI, 0.50-0.70; P=0.07). CONCLUSIONS The HCM Risk-SCD model improves the risk stratification of patients with HCM for primary prevention of SCD, and calculating an individual risk estimate contributes to the clinical decision-making process. Improved risk stratification is important for the decision making before implantable cardioverter-defibrillator implantation for the primary prevention of SCD.
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Affiliation(s)
- Pieter A Vriesendorp
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.).
| | - Arend F L Schinkel
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Max Liebregts
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Dominic A M J Theuns
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Johan van Cleemput
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Folkert J Ten Cate
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Rik Willems
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Michelle Michels
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4431] [Impact Index Per Article: 443.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733-79. [PMID: 25173338 DOI: 10.1093/eurheartj/ehu284] [Citation(s) in RCA: 2823] [Impact Index Per Article: 282.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Ablation Techniques/methods
- Adult
- Angina Pectoris/etiology
- Arrhythmias, Cardiac/etiology
- Cardiac Imaging Techniques/methods
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Clinical Laboratory Techniques/methods
- Death, Sudden, Cardiac/prevention & control
- Delivery of Health Care
- Diagnosis, Differential
- Electrocardiography/methods
- Female
- Genetic Counseling/methods
- Genetic Testing/methods
- Heart Failure/etiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Medical History Taking/methods
- Pedigree
- Physical Examination/methods
- Preconception Care/methods
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prenatal Care/methods
- Risk Factors
- Sports Medicine
- Syncope/etiology
- Thoracic Surgical Procedures/methods
- Ventricular Outflow Obstruction/etiology
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The emerging role of cardiovascular MRI for risk stratification in hypertrophic cardiomyopathy. Clin Radiol 2014; 69:221-30. [DOI: 10.1016/j.crad.2013.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/06/2013] [Accepted: 11/13/2013] [Indexed: 11/24/2022]
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Efthimiadis GK, Pagourelias ED, Gossios T, Zegkos T. Hypertrophic cardiomyopathy in 2013: Current speculations and future perspectives. World J Cardiol 2014; 6:26-37. [PMID: 24575171 PMCID: PMC3935059 DOI: 10.4330/wjc.v6.i2.26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/04/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM), the most variable cardiac disease in terms of phenotypic presentation and clinical outcome, represents the most common inherited cardiomyopathic process with an autosomal dominant trait of inheritance. To date, more than 1400 mutations of myofilament proteins associated with the disease have been identified, most of them “private” ones. This striking allelic and locus heterogeneity of the disease certainly complicates the establishment of phenotype-genotype correlations. Additionally, topics pertaining to patients’ everyday lives, such as sudden cardiac death (SCD) risk stratification and prevention, along with disease prognosis, are grossly related to the genetic variation of HCM. This review incorporates contemporary research findings and addresses major aspects of HCM, including preclinical diagnosis, genetic analysis, left ventricular outflow tract obstruction and SCD. More specifically, the spectrum of genetic analysis, the selection of the best method for obstruction alleviation and the need for a unique and accurate factor for SCD risk stratification are only some of the controversial HCM issues discussed. Additionally, future perspectives concerning HCM and myocardial ischemia, as well as atrial fibrillation, are discussed. Rather than enumerating clinical studies and guidelines, challenging problems concerning the disease are critically appraised by this review, highlighting current speculations and recommending future directions.
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3492] [Impact Index Per Article: 349.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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O'Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C, Biagini E, Gimeno JR, Limongelli G, McKenna WJ, Omar RZ, Elliott PM. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J 2013; 35:2010-20. [PMID: 24126876 DOI: 10.1093/eurheartj/eht439] [Citation(s) in RCA: 734] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young adults. Current risk algorithms provide only a crude estimate of risk and fail to account for the different effect size of individual risk factors. The aim of this study was to develop and validate a new SCD risk prediction model that provides individualized risk estimates. METHODS AND RESULTS The prognostic model was derived from a retrospective, multi-centre longitudinal cohort study. The model was developed from the entire data set using the Cox proportional hazards model and internally validated using bootstrapping. The cohort consisted of 3675 consecutive patients from six centres. During a follow-up period of 24 313 patient-years (median 5.7 years), 198 patients (5%) died suddenly or had an appropriate implantable cardioverter defibrillator (ICD) shock. Of eight pre-specified predictors, age, maximal left ventricular wall thickness, left atrial diameter, left ventricular outflow tract gradient, family history of SCD, non-sustained ventricular tachycardia, and unexplained syncope were associated with SCD/appropriate ICD shock at the 15% significance level. These predictors were included in the final model to estimate individual probabilities of SCD at 5 years. The calibration slope was 0.91 (95% CI: 0.74, 1.08), C-index was 0.70 (95% CI: 0.68, 0.72), and D-statistic was 1.07 (95% CI: 0.81, 1.32). For every 16 ICDs implanted in patients with ≥4% 5-year SCD risk, potentially 1 patient will be saved from SCD at 5 years. A second model with the data set split into independent development and validation cohorts had very similar estimates of coefficients and performance when externally validated. CONCLUSION This is the first validated SCD risk prediction model for patients with HCM and provides accurate individualized estimates for the probability of SCD using readily collected clinical parameters.
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Affiliation(s)
- Constantinos O'Mahony
- The Inherited Cardiac Diseases Unit, The Heart Hospital/University College London, 16-18 Westmoreland St., London W1H 8PH, UK
| | - Fatima Jichi
- Biostatistics Group, University College London Hospitals/University College London Research Support Centre, University College London, Gower St., London WC1E 6BT, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, Gower St, London WC1E 6BT, UK
| | - Lorenzo Monserrat
- Cardiology Department and Research Unit, A Coruña University Hospital, Galician Health Service, Spain
| | - Aristides Anastasakis
- Unit of Inherited Cardiovascular Diseases, 1st Department of Cardiology, University of Athens, 99 Michalakopoulou St, Athens 11527, Greece
| | - Claudio Rapezzi
- Institute of Cardiology, Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Elena Biagini
- Institute of Cardiology, Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Juan Ramon Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia-Cartagena s/n. El Palmar, Murcia 30120, Spain
| | - Giuseppe Limongelli
- Monaldi Hospital, Second University of Naples, Via Leonardo Bianchi 1, Naples 80131, Italy
| | - William J McKenna
- The Inherited Cardiac Diseases Unit, The Heart Hospital/University College London, 16-18 Westmoreland St., London W1H 8PH, UK
| | - Rumana Z Omar
- Biostatistics Group, University College London Hospitals/University College London Research Support Centre, University College London, Gower St., London WC1E 6BT, UK Department of Statistical Science, University College London, Gower St, London WC1E 6BT, UK
| | - Perry M Elliott
- The Inherited Cardiac Diseases Unit, The Heart Hospital/University College London, 16-18 Westmoreland St., London W1H 8PH, UK
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Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiomyopathy. J Interv Card Electrophysiol 2013; 38:159-65. [PMID: 24013705 DOI: 10.1007/s10840-013-9829-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/13/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aims to determine whether fragmented QRS (fQRS) in the surface electrocardiogram (ECG) at implantable cardioverter defibrillator (ICD) implant can predict arrhythmic events using appropriate therapy delivered by the ICD as a surrogate. BACKGROUND Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder associated with life-threatening arrhythmias frequently requiring an ICD. Seeking a noninvasive method of risk stratification remains a challenge. METHODS This paper is a retrospective, multicenter study of patients with HOCM and ICD. Surface 12-lead ECGs were analyzed. Appropriate therapy was validated by a blinded Core Lab. Univariate and multivariate analyses were performed. A p value of <0.05 was considered significant. RESULTS We included 102 patients from 13 centers. Mean age at implant was 41.16 ± 18.25 years, 52% were male. Mean left ventricular ejection fraction was 61.56 ± 9.46% and two thirds had heart failure according to the New York Heart Association class I. Secondary prophylaxis ICD implantation was the indication for implant in 40.2% of cases. About half received a single-chamber ICD. fQRS was present at the time of diagnosis in 21 and in 54% at ICD implant. At a mean follow-up of 47.8 ± 39.3 months, 41 patients (40.2%) presented with appropriate therapy. In a multivariate logistic regression, predictors of appropriate therapy included fQRS at implant (odds ratio [OR], 16.4; 95% confidence interval [CI], 3.6-74.0; p = 0.0003), history of combined ventricular tachycardia/fibrillation/sudden death (OR, 14.3; 95% CI, 3.2-69.3; p = 0.001) and history of syncope (OR, 5.5; 95% CI, 1.5-20.4; p = 0.009). Ten deaths (9.8%) occurred during the follow-up. fQRS in the lateral location increased the risk of appropriate therapy (p < 0.0001). CONCLUSIONS fQRS predicts arrhythmic events in patients with HOCM and should be considered in a model of risk stratification.
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127:e6-e245. [PMID: 23239837 PMCID: PMC5408511 DOI: 10.1161/cir.0b013e31828124ad] [Citation(s) in RCA: 3335] [Impact Index Per Article: 303.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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O'Mahony C, Elliott P, McKenna W. Sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 2012; 6:443-51. [PMID: 23022709 DOI: 10.1161/circep.111.962043] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Constantinos O'Mahony
- The Inherited Cardiac Diseases Unit, The Heart Hospital/University College London, London, United Kingdom
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Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012; 125:e2-e220. [PMID: 22179539 PMCID: PMC4440543 DOI: 10.1161/cir.0b013e31823ac046] [Citation(s) in RCA: 3163] [Impact Index Per Article: 263.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. Circulation 2011; 124:e783-831. [PMID: 22068434 DOI: 10.1161/cir.0b013e318223e2bd] [Citation(s) in RCA: 505] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Bernard J. Gersh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | - Barry J. Maron
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | | | - Joseph A. Dearani
- Society of Thoracic Surgeons Representative
- American Association for Thoracic Surgery Representative
| | - Michael A. Fifer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- Heart Rhythm Society Representative
| | - Srihari S. Naidu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- Society for Cardiovascular Angiography and Interventions Representative
| | | | | | - Harry Rakowski
- ACCF/AHA Representative
- American Society of Echocardiography Representative
| | | | | | - James E. Udelson
- Heart Failure Society of America Representative
- American Society of Nuclear Cardiology Representative
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW, Jacobs AK, Smith SC, Anderson JL, Albert NM, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Krumholz HM, Kushner FG, Nishimura RA, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2011; 142:e153-203. [DOI: 10.1016/j.jtcvs.2011.10.020] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Sreeram N, Emmel M, de Giovanni JV. Percutaneous Radiofrequency Septal Reduction for Hypertrophic Obstructive Cardiomyopathy in Children. J Am Coll Cardiol 2011; 58:2501-10. [DOI: 10.1016/j.jacc.2011.09.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 08/31/2011] [Accepted: 09/06/2011] [Indexed: 10/14/2022]
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW, Jacobs AK, Smith SC, Anderson JL, Albert NM, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Krumholz HM, Kushner FG, Nishimura RA, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary. J Thorac Cardiovasc Surg 2011; 142:1303-38. [DOI: 10.1016/j.jtcvs.2011.10.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:2761-96. [PMID: 22068435 DOI: 10.1161/cir.0b013e318223e230] [Citation(s) in RCA: 589] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58:2703-38. [PMID: 22075468 DOI: 10.1016/j.jacc.2011.10.825] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e212-60. [PMID: 22075469 DOI: 10.1016/j.jacc.2011.06.011] [Citation(s) in RCA: 823] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Hypertrophic cardiomyopathy has important differences in children compared with adults, particularly with regard to the range of causes and the outcomes in infants. Survival is highly dependent on etiology, particularly in the youngest patients, and pursuit of the specific cause is therefore necessary. The clinical utility of defining the genotype in children with familial hypertrophic cardiomyopathy exceeds that at other ages and has a highly favorable cost/benefit ratio. Although most of the available information concerning treatment and prevention of sudden death is derived in adults, management of children requires consideration of the differences in age-specific risk/benefit ratios.
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Affiliation(s)
- Steven D Colan
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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