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Nikoo MH, Zarrabi M, Moaref A, Razeghian-Jahromi I. Global Longitudinal Strain May Be the One that Appropriately Identifies Candidates of ICD Implantation. Cardiol Res Pract 2024; 2024:2214072. [PMID: 38264236 PMCID: PMC10805553 DOI: 10.1155/2024/2214072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/20/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) significantly contributes to an elevated risk of sudden cardiac death. Primary prevention is implemented by using an implantable cardioverter defibrillator (ICD). However, all of the HCM patients do not really need ICD therapy. Providing a superior index for ICD indication compared with the current indices like ejection fraction is essential to differentiate high-risk patients efficiently. The present study assessed the potential of global longitudinal strain (GLS) for the differentiation of HCM patients based on their need for ICD shocks. Patients with HCM were considered in four defined centers between March and June 2021. Those with previous ICD implantation or current candidates for ICD therapy were included in the study. Participants were subjected to speckle-tracking echocardiography, and GLS as well as some other echocardiographic parameters were recorded. Afterwards, data from implanted ICDs were extracted. Patients who received ICD shocks (appropriate) due to ventricular tachycardia (VT)/ventricular fibrillation (VF) were categorized in group A. The remaining patients were constituted group B who received inappropriate shocks, i.e., other than VT/VF. Overall, 34 patients were found eligible to participate with a mean age of 62 ± 16.1 years including 64.7% of males. Among a variety of echocardiographic parameters, GLS was the sole one that was significantly higher in group A compared with that in group B. Our findings revealed that only GLS could predict fatal arrhythmias. To substantiate, the odds of VT were raised by 43% with a single increase in GLS unit. GLS showed the highest accuracy for ICD indication among HCM patients and, therefore, could be a solid and early criterion to predict the incidence of life-threatening arrhythmias. In this regard, identifying appropriate HCM patients with respect to their need for ICD therapy is feasible.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zarrabi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moaref
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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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: 213] [Impact Index Per Article: 213.0] [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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3
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Association of NT-proBNP and hs-cTnT with Imaging Markers of Diastolic Dysfunction and Focal Myocardial Fibrosis in Hypertrophic Cardiomyopathy. Life (Basel) 2022; 12:life12081241. [PMID: 36013420 PMCID: PMC9410236 DOI: 10.3390/life12081241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Serum biomarkers such as N-terminal prohormone of the brain natriuretic peptide (NT-proBNP) and cardiac troponins are elevated in patients with hypertrophic cardiomyopathy (HCM). At present, it is not clear if these markers are associated with distinct clinical alterations in HCM, such as left ventricular hypertrophy, outflow tract obstruction, myocardial fibrosis and/or diastolic dysfunction (DD), which are associated with adverse cardiovascular outcome. Here we evaluate the association of NT-proBNP and high sensitivity cardiac troponin T (hs-cTnT) to a variety of cardiac imaging parameters in HCM patients in a multivariable regression analysis. This retrospective cross-sectional study included 366 HCM patients who underwent transthoracic echocardiography (TTE), 218 of whom also obtained cardiovascular magnetic resonance (CMR) to assess focal myocardial fibrosis by LGE. Multivariable regression analyses revealed the strongest association of the DD parameters E/E′ mean and E/E′ septal with NT-proBNP (b = 0.06, 95%-CI [0.05−0.07], p < 0.001, R2 = 0.28; b = 0.08, 95%-CI [0.06−0.1], p < 0.001, R2 = 0.25) and LGE size showed the strongest association with hs-cTnT (b = 0.20, 95%-CI [0.15−0.24], p < 0.001, R2 = 0.28). This study indicates that NT-proBNP and hs-cTnT are associated with structural and functional alterations in HCM. NT-proBNP is a stronger predictor for DD, while hs-cTnT is associated with the extent of focal myocardial fibrosis. Both biomarkers might be useful in the diagnostic procedure in addition to imaging parameters.
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4
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Bhattacharya M, Lu DY, Ventoulis I, Greenland GV, Yalcin H, Guan Y, Marine JE, Olgin JE, Zimmerman SL, Abraham TP, Abraham MR, Shatkay H. Machine Learning Methods for Identifying Atrial Fibrillation Cases and Their Predictors in Patients With Hypertrophic Cardiomyopathy: The HCM-AF-Risk Model. CJC Open 2021; 3:801-813. [PMID: 34169259 PMCID: PMC8209373 DOI: 10.1016/j.cjco.2021.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) patients have a high incidence of atrial fibrillation (AF) and increased stroke risk, even with low CHA2DS2-VASc (congestive heart failure, hypertension, age diabetes, previous stroke/transient ischemic attack) scores. Hence, there is a need to understand the pathophysiology of AF/stroke in HCM. In this retrospective study, we develop and apply a data-driven, machine learning–based method to identify AF cases, and clinical/imaging features associated with AF, using electronic health record data. Methods HCM patients with documented paroxysmal/persistent/permanent AF (n = 191) were considered AF cases, and the remaining patients in sinus rhythm (n = 640) were tagged as No-AF. We evaluated 93 clinical variables; the most informative variables useful for distinguishing AF from No-AF cases were selected based on the 2-sample t test and the information gain criterion. Results We identified 18 highly informative variables that are positively (n = 11) and negatively (n = 7) correlated with AF in HCM. Next, patient records were represented via these 18 variables. Data imbalance resulting from the relatively low number of AF cases was addressed via a combination of oversampling and undersampling strategies. We trained and tested multiple classifiers under this sampling approach, showing effective classification. Specifically, an ensemble of logistic regression and naïve Bayes classifiers, trained based on the 18 variables and corrected for data imbalance, proved most effective for separating AF from No-AF cases (sensitivity = 0.74, specificity = 0.70, C-index = 0.80). Conclusions Our model (HCM-AF-Risk Model) is the first machine learning–based method for identification of AF cases in HCM. This model demonstrates good performance, addresses data imbalance, and suggests that AF is associated with a more severe cardiac HCM phenotype.
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Affiliation(s)
- Moumita Bhattacharya
- Computational Biomedicine and Machine Learning Lab, Department of Computer and Information Sciences, University of Delaware, Newark, Delaware, USA
| | - Dai-Yin Lu
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA.,Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Ioannis Ventoulis
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabriela V Greenland
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA.,Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Hulya Yalcin
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yufan Guan
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joseph E Marine
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey E Olgin
- Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Stefan L Zimmerman
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Theodore P Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA.,Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - M Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland, USA.,Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Hagit Shatkay
- Computational Biomedicine and Machine Learning Lab, Department of Computer and Information Sciences, University of Delaware, Newark, Delaware, USA
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5
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac condition and highly heterogeneous. Echocardiography and genetic and clinical screening have led to detection in women of childbearing age. Maternal and fetal outcomes among women with HCM are favorable. Genetic counseling is recommended. Prepregnancy clinical evaluation and risk assessment are paramount in ensuring optimal outcomes. Most women carry moderate risk of morbidity, have clinical evaluations and echocardiography each trimester, and deliver vaginally. Those who are symptomatic or have significant left ventricular outflow obstruction or recurrent arrhythmias prior to pregnancy are at higher risk and should be monitored at least monthly.
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Affiliation(s)
- Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, CVC Suite 2364, Ann Arbor, MI 48109-5853, USA.
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6
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Yeung C, Enriquez A, Suarez-Fuster L, Baranchuk A. Atrial fibrillation in patients with inherited cardiomyopathies. Europace 2020; 21:22-32. [PMID: 29684120 DOI: 10.1093/europace/euy064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) often complicates the course of inherited cardiomyopathies and, in some cases, may be the presenting feature. Each inherited cardiomyopathy has its own peculiar pathogenetic characteristics that can contribute to the development and maintenance of AF. Atrial fibrillation may occur as a consequence of disease-specific defects, non-specific cardiac chamber changes secondary to the primary illness, or a combination thereof. The presence of AF can denote a turning point in the progression of the disease, promoting clinical deterioration and increasing morbidity and mortality. Furthermore, the management of AF can be particularly challenging in patients with inherited cardiomyopathies. In this article, we review the current information on the prevalence, pathophysiology, risk factors, and treatment of AF in three different inherited cardiomyopathies: hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia/cardiomyopathy, familial dilated cardiomyopathy, and left ventricular non-compaction cardiomyopathy.
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Affiliation(s)
- Cynthia Yeung
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Andres Enriquez
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | | | - Adrian Baranchuk
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
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7
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Badran HM, Soltan G, Almeleigi R, Faheem N, Yacoub MH. Prognostic significance of left ventricular end diastolic pressure using E/E' in patients with hypertrophic cardiomyopathy. Echocardiography 2019; 36:2167-2175. [PMID: 31742769 DOI: 10.1111/echo.14539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/27/2019] [Accepted: 10/25/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is a prominent feature of hypertrophic cardiomyopathy (HCM). Prediction of LV filling pressure using the ratio between early diastolic transmitral flow and mitral annular velocity (E/e') had proved a good accuracy. AIM OF THIS STUDY We investigated the value of E/e' to predict cardiovascular (CV) mortality in patients with HCM. METHODS A total of 243 patients with HCM had E/e' measured in combination with clinical evaluation, conventional echocardiographic measurements, cardiopulmonary exercise evaluation, and Holter monitoring. RESULTS During a mean follow-up of (3.2 ± 1.2 years), 17 (7%) patients died. Non survivors had significantly higher SBP, DBP, left ventricular outflow tract obstruction (LVOTO) gradient, mitral E, and E/e', but lower e' of mitral annulus and more prevalent restrictive filling pattern. E/e' was directly correlated with age (r = .24, P < .005), left atrial volume index (r = .44, P < .0001), LVMI (r=0.23,P<.005), LVOT gradient (r = .43, P < .0001), NYHA class (r = .19, P < .006), pulmonary artery pressure (r = .24, P < .005), positive family history of HCM (r = .22, P < .005), and inversely related to peak systolic velocity (S) (r = .44, P < .0001). By multivariate analysis, only LVOTO ([RR] 4.11, 95% CI 1.002 to 1.148, P < .04) and E/e' were independent predictors for overall mortality in HCM (relative risk [RR] 5.27, 95% CI 1.002 to 1.024, P < .02). The risk of dying increased with increasing E/e' ratio, being approximately 4 times higher for patients in the highest quartile (HR 3.8 (CI 1.38-5.12, log-rank < 0.002)). CONCLUSIONS In hypertrophic cardiomyopathy, the E/e' ratio remains a powerful predictor of all-cause mortality, particularly if it is associated with LVOT obstruction.
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Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department, Menoufia University, Tanta, Egypt.,The BAHCM National Program, Tanta, Egypt
| | - Ghada Soltan
- Cardiology Department, Menoufia University, Tanta, Egypt
| | - Reda Almeleigi
- Cardiology Department, Menoufia University, Tanta, Egypt
| | - Naglaa Faheem
- Cardiology Department, Menoufia University, Tanta, Egypt.,The BAHCM National Program, Tanta, Egypt
| | - Magdi H Yacoub
- The BAHCM National Program, Tanta, Egypt.,Imperial College, London, UK
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8
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Song C, Wang S, Guo Y, Zheng X, Lu J, Fang X, Wang S, Huang X. Preoperative NT-proBNP Predicts Midterm Outcome After Septal Myectomy. J Am Heart Assoc 2019; 8:e011075. [PMID: 30760079 PMCID: PMC6405667 DOI: 10.1161/jaha.118.011075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prognostic value of N‐terminal pro–brain natriuretic peptide (NT‐proBNP) in patients with hypertrophic cardiomyopathy who underwent septal myectomy has not been well studied. Methods and Results We retrospectively evaluated NT‐proBNP levels in 758 patients (46.1±13.8 years; median follow‐up, 936 days) who underwent septal myectomy in our center between March 2011 and April 2018. The median NT‐proBNP level was 1450.5 (interquartile range 682.6‐2649.5) pg/mL. Overall, 22 (2.9%) patients died during follow‐up; of these, 86.4% were cardiovascular deaths. The 3‐year survival free from all‐cause mortality by tertile was 95.2% (95% CI 91.1% to 97.4%; NT‐proBNP >2080 pg/mL), 98.3% (95% CI 94.6% to 99.5%; NT‐proBNP, 947‐2080 pg/mL), and 99.2% (95% CI, 94.4% to 99.9%; NT‐proBNP <947 pg/mL). The 3‐year survival rate free from cardiovascular mortality by tertiles was 95.2% in the highest tertile, 98.8% in the middle tertile, and 99.2% in the lowest tertile. Cox regression analysis indicated that Ln(NT‐proBNP) was a significantly independent predictor of all‐cause mortality (hazard ratio 2.380, 95% CI 1.356‐4.178, P=0.003) and cardiovascular mortality (hazard ratio 2.788, 95% CI 1.450‐5.362, P=0.002). In addition, concomitant coronary artery bypass grafting for coronary artery disease was also an independent predictor of cardiovascular mortality (hazard ratio 5.178, 95% CI 1.597‐16.789, P=0.006). Conclusions Increased preoperative NT‐proBNP level is a strong predictor of midterm mortality in patients undergoing septal myectomy.
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Affiliation(s)
- Changpeng Song
- 1 Department of Special Medical Treatment Center Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shengwei Wang
- 2 Department of Cardiovascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ying Guo
- 1 Department of Special Medical Treatment Center Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xinxin Zheng
- 1 Department of Special Medical Treatment Center Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jie Lu
- 1 Department of Special Medical Treatment Center Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaonan Fang
- 1 Department of Special Medical Treatment Center Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shuiyun Wang
- 2 Department of Cardiovascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaohong Huang
- 1 Department of Special Medical Treatment Center Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Torres MF, Perez-Villa F. Heart transplantation in patients with hypertrophic cardiomyopathy. Glob Cardiol Sci Pract 2018; 2018:32. [PMID: 30393644 PMCID: PMC6209439 DOI: 10.21542/gcsp.2018.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Marta Farrero Torres
- IDC salud, Hospital General de Catalunya, Barcelona, Spain.,Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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10
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Gawor M, Śpiewak M, Kubik A, Wróbel A, Lutyńska A, Marczak M, Grzybowski J. Circulating biomarkers of hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy assessed by cardiac magnetic resonance. Biomarkers 2018; 23:676-682. [DOI: 10.1080/1354750x.2018.1474261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Śpiewak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Aleksandra Wróbel
- Department of Medical Biology, Institute of Cardiology, Warsaw, Poland
| | - Anna Lutyńska
- Department of Medical Biology, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
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11
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Fulks M, Kaufman V, Clark M, Stout RL. NT-proBNP Predicts All-Cause Mortality in a Population of Insurance Applicants, Follow-up Analysis and Further Observations. J Insur Med 2018; 47:107-113. [PMID: 29490161 DOI: 10.17849/insm-47-02-107-113.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE - Further refine the independent value of NT-proBNP, accounting for the impact of other test results, in predicting all-cause mortality for individual life insurance applicants with and without heart disease. METHOD - Using the Social Security Death Master File and multivariate analysis, relative mortality was determined for 245,322 life insurance applicants ages 50 to 89 tested for NT-proBNP (almost all based on age and policy amount) along with other laboratory tests and measurement of blood pressure and BMI. RESULTS - NT-proBNP values ≤75 pg/mL included the majority of applicants denying heart disease and had the lowest risk, while values >500 pg/mL for females and >300 pg/mL for males had very high relative risk. Those admitting to heart disease had a higher mortality risk for each band of NT-proBNP relative to those denying heart disease but had a similar and equally predictive risk curve. CONCLUSION - NT-proBNP is a strong independent predictor of all-cause mortality in the absence or presence of known heart disease but the range of values associated with increased risk varies by sex.
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Affiliation(s)
- Michael Fulks
- Michael Fulks, Clinical Reference Laboratory, Jackson, CA; Valerie Kaufman, RGA Reinsurance Company, Chesterfield, MO; Michael Clark, Penn Mutual Life Insurance Company, Horsham, PA; Robert L. Stout, Clinical Reference Laboratory, Lenexa, KS
| | - Valerie Kaufman
- Michael Fulks, Clinical Reference Laboratory, Jackson, CA; Valerie Kaufman, RGA Reinsurance Company, Chesterfield, MO; Michael Clark, Penn Mutual Life Insurance Company, Horsham, PA; Robert L. Stout, Clinical Reference Laboratory, Lenexa, KS
| | - Michael Clark
- Michael Fulks, Clinical Reference Laboratory, Jackson, CA; Valerie Kaufman, RGA Reinsurance Company, Chesterfield, MO; Michael Clark, Penn Mutual Life Insurance Company, Horsham, PA; Robert L. Stout, Clinical Reference Laboratory, Lenexa, KS
| | - Robert L Stout
- Michael Fulks, Clinical Reference Laboratory, Jackson, CA; Valerie Kaufman, RGA Reinsurance Company, Chesterfield, MO; Michael Clark, Penn Mutual Life Insurance Company, Horsham, PA; Robert L. Stout, Clinical Reference Laboratory, Lenexa, KS
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12
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Hiemstra YL, Debonnaire P, Bootsma M, van Zwet EW, Delgado V, Schalij MJ, Atsma DE, Bax JJ, Marsan NA. Global Longitudinal Strain and Left Atrial Volume Index Provide Incremental Prognostic Value in Patients With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005706. [PMID: 28679523 DOI: 10.1161/circimaging.116.005706] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current methods for predicting adverse events in patients with hypertrophic cardiomyopathy are still limited. Left ventricular global longitudinal strain (GLS) and left atrial volume index (LAVI) have been recently proposed as novel prognostic factors in several cardiovascular diseases. The objective of this study was to evaluate the prognostic value of GLS and LAVI in patients with hypertrophic cardiomyopathy. METHODS AND RESULTS Two-dimensional echocardiography was performed in 427 patients with hypertrophic cardiomyopathy (66% men, age 52±15 years), and LAVI and GLS were assessed. During follow-up, the primary end point of all-cause mortality, heart transplantation, sudden cardiac death, and appropriate implantable cardioverter defibrillator therapy was noted. A total of 103 patients reached the primary end point during a follow-up of 6.7 (interquartile range, 3.3-10.0) years. Multivariable Cox regression analysis revealed GLS and LAVI to be independently associated with the primary end point (hazard ratio GLS, 1.10 [1.03-1.19], P=0.007; hazard ratio LAVI, 4.27 [2.35-7.74], P<0.001) after correcting for other clinical variables. When applying the pre-specified cut-off values of 34 mL/m2 for LAVI and -15% for GLS, Kaplan-Meier survival curves showed significant better survival for patients with LAVI <34 mL/m2 (P<0.001) and GLS <-15% (P<0.001) as compared with their counterparts. The likelihood ratio test showed a significant incremental prognostic value of LAVI and GLS (P<0.001) as compared with a model with clinical and standard echocardiographic risk factors. The C-statistic for this model increased from 0.68 to 0.73 when adding GLS and LAVI. CONCLUSIONS GLS and LAVI are independently associated with adverse outcome in patients with hypertrophic cardiomyopathy and may help to optimize risk stratification in these patients.
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Affiliation(s)
- Yasmine L Hiemstra
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Philippe Debonnaire
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Marianne Bootsma
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Erik W van Zwet
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Victoria Delgado
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Martin J Schalij
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Douwe E Atsma
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Jeroen J Bax
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Nina Ajmone Marsan
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands.
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13
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Camm CF, Camm AJ. Atrial Fibrillation and Anticoagulation in Hypertrophic Cardiomyopathy. Arrhythm Electrophysiol Rev 2017; 6:63-68. [PMID: 28835837 PMCID: PMC5522714 DOI: 10.15420/aer.2017.4.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) represents a common inherited cardiac disorder with well-known complications Including stroke and sudden cardiac death. There is a recognised association between HCM and the development of AF. This review describes the epidemiology of AF within the HCM population and analyses the risk factors for the development of AF. It further discusses the outcomes associated with AF in this population, including the evidence in support of higher stroke risk in patients with HCM with AF compared with the general AF population. Finally, the evidence and recommendations for anticoagulation in this patient group are addressed.
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Affiliation(s)
| | - A John Camm
- St George’s, University of London
- Imperial College, London, UK
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Brito D. Predicting risk of sudden death in hypertrophic cardiomyopathy: Can additional simple markers help? Rev Port Cardiol 2017; 36:247-249. [PMID: 28318853 DOI: 10.1016/j.repc.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Dulce Brito
- Hospital de Santa Maria, CHLN, Centro Cardiovascular da Universidade de Lisboa (CCUL), Centro Académico Médico de Lisboa (CAML), Universidade de Lisboa, Lisboa, Portugal.
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Brito D. Predicting risk of sudden death in hypertrophic cardiomyopathy: Can additional simple markers help? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Sahin I, Gungor B, Ozkaynak B, Uzun F, Küçük SH, Avci II, Ozal E, Ayça B, Cetın S, Okuyan E, Dinckal MH. Higher copeptin levels are associated with worse outcome in patients with hypertrophic cardiomyopathy. Clin Cardiol 2016; 40:32-37. [PMID: 27768229 DOI: 10.1002/clc.22602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/27/2016] [Accepted: 09/04/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Correlation of increased copeptin levels with various cardiovascular diseases has been described. The clinical use of copeptin levels in patients with hypertrophic cardiomyopathy (HCM) has not been investigated before. HYPOTHESIS In this study, we aimed to investigate the prognostic value of copeptin levels in patients with hypertrophic cardiomyopathy (HCM). METHODS HCM was defined as presence of left ventricular wall thickness ≥15 mm in a subject without any concomitant disease that may cause left ventricular hypertrophy. Levels of copeptin and plasma N-terminal probrain natriuretic peptide (NT-proBNP) were evaluated prospectively in 24 obstructive HCM patients, 36 nonobstructive HCM patients, and 36 age- and sex-matched control subjects. Blood samples were collected in the morning between 7 and 9 am after overnight fasting. Patients were followed for 24 months. Hospitalization with diagnosis of heart failure/arrhythmia, implantable cardioverter-defibrillator implantation, and cardiac mortality were accepted as adverse cardiac events. RESULTS Copeptin and NT-proBNP levels were higher in the HCM group compared with controls (14.1 vs 8.4 pmol/L, P < 0.01; and 383 vs 44 pg/mL, P < 0.01, respectively). Copeptin and NT-proBNP levels were higher in the obstructive HCM subgroup compared with the nonobstructive HCM subgroup (18.3 vs 13.1 pmol/L, P < 0.01; and 717 vs 223 pg/mL, P < 0.01, respectively). In multivariable logistic regression analysis, copeptin and NT-proBNP levels remained as independent predictors of heart failure (P < 0.01 for both) and adverse cardiac events (P < 0.01 for both). CONCLUSIONS Copeptin and NT-proBNP levels were significantly higher in patients with obstructive HCM, and higher levels were associated with worse outcome.
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Affiliation(s)
- Irfan Sahin
- Department of Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Baris Gungor
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Berk Ozkaynak
- Department of Cardiovascular Surgery, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Suat Hayri Küçük
- Department of Biochemistry, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Ilhan Iker Avci
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Ender Ozal
- Department of Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Burak Ayça
- Department of Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Sukru Cetın
- Department of Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey
| | - Mustafa Hakan Dinckal
- Department of Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey
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An S, Fan C, Yan L, Cai C, Yang Y, Zhai S, Zhao S, Liu Y, Duan F, Wang Z, Li Y. Comparison of Long-Term Outcome between Apical and Asymmetric Septal Hypertrophic Cardiomyopathy. Cardiology 2016; 136:108-114. [DOI: 10.1159/000448239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/07/2016] [Indexed: 11/19/2022]
Abstract
Objectives: As reported, diagnostic age, gender and presence of outflow tract obstruction have an impact on prognosis in patients with hypertrophic cardiomyopathy. The aim of this study was to compare the long-term outcome between apical hypertrophic cardiomyopathy (ApHCM) and asymmetric septal hypertrophic cardiomyopathy (ASHCM) after the exclusion of these factors. Methods: A total of 540 patients (270 with ApHCM and 270 with ASHCM) identified in a consecutive single-center cohort were retrospectively studied. The two groups were matched by diagnostic age, gender and the presence of outflow tract obstruction. Clinical characteristics and long-term outcomes were compared. Results: The mean follow-up duration in ASHCM and ApHCM were 6.6 ± 5.5 and 7.6 ± 4.1 years, respectively. During follow-up, 16 patients experienced cardiovascular death in the ASHCM group, while 2 patients experienced cardiovascular death in the ApHCM group (6.3 vs. 0.7%, p < 0.01). Cardiovascular morbidity in the ASHCM and ApHCM groups were 39.9 and 18.5% (p < 0.01). In the multivariate Cox regression analysis late gadolinium enhancement (LGE; HR 4.81, 95% CI 1.28-78.0, p = 0.03) and unexplained syncope (HR 9.68, 95% CI 1.9-17.2, p < 0.01) were independent predictors for cardiovascular mortality. Unexplained syncope was independently associated with a higher risk for sudden cardiac death (HR 4.3, 95% CI 1.2-15.3, p = 0.02). Conclusions: After eliminating the interference of diagnostic age, gender and outflow tract obstruction, ASHCM represented a worse prognosis with a higher incidence of cardiovascular mortality and morbidity than ApHCM. LGE was a strong predictor for cardiovascular death.
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Kehl DW, Buttan A, Siegel RJ, Rader F. Clinical utility of natriuretic peptides and troponins in hypertrophic cardiomyopathy. Int J Cardiol 2016; 218:252-258. [PMID: 27236124 DOI: 10.1016/j.ijcard.2016.05.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 05/12/2016] [Indexed: 01/23/2023]
Abstract
The diagnosis of hypertrophic cardiomyopathy (HCM) is based on clinical, echocardiographic and in some cases genetic findings. However, prognostication remains limited except in the subset of patients with high-risk indicators for sudden cardiac death. Additional methods are needed for risk stratification and to guide clinical management in HCM. We reviewed the available data regarding natriuretic peptides and troponins in HCM. Plasma levels of natriuretic peptides, and to a lesser extent serum levels of troponins, correlate with established disease markers, including left ventricular thickness, symptom status, and left ventricular hemodynamics by Doppler measurements. As a reflection of left ventricular filling pressure, natriuretic peptides may provide an objective measure of the efficacy of a specific therapy. Both natriuretic peptides and troponins predict clinical risk in HCM independently of established risk factors, and their prognostic power is additive. Routine measurement of biomarker levels therefore may be useful in the clinical evaluation and management of patients with HCM.
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Affiliation(s)
- Devin W Kehl
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anshu Buttan
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Robert J Siegel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - Florian Rader
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Zhang C, Liu R, Yuan J, Cui J, Hu F, Yang W, Zhang Y, Chen Y, Qiao S. Predictive Values of N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin I for Myocardial Fibrosis in Hypertrophic Obstructive Cardiomyopathy. PLoS One 2016; 11:e0146572. [PMID: 26765106 PMCID: PMC4713160 DOI: 10.1371/journal.pone.0146572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/18/2015] [Indexed: 11/28/2022] Open
Abstract
Background Both high-sensitivity cardiac troponin T and B-type natriuretic peptide are useful in detecting myocardial fibrosis, as determined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR), in patients with non-obstructive hypertrophic cardiomyopathy. However, their values to predict myocardial fibrosis in hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. We investigated the role of N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and cardiac troponin I (cTnI) to identify LGE-CMR in patients with HOCM. Methods Peripheral concentrations of NT-proBNP and cTnI were determined in patients with HOCM (n = 163; age = 47.2 ± 10.8 years; 38.7% females). Contrast-enhanced CMR was performed to identify and quantify myocardial fibrosis. Results LGE was detected in 120 of 163 patients (73.6%). Patients with LGE had significantly higher levels of NT-proBNP and cTnI than those without LGE (1386.2 [904.6–2340.8] vs. 866.6 [707.2–1875.2] pmol/L, P = 0.003; 0.024 [0.010–0.049] vs. 0.010 [0.005–0.021] ng/ml, P <0.001, respectively). The extent of LGE was positively correlated with log cTnI (r = 0.371, P <0.001) and log NT-proBNP (r = 0.211, P = 0.007). On multivariable analysis, both log cTnI and maximum wall thickness (MWT) were independent predictors of the presence of LGE (OR = 3.193, P = 0.033; OR = 1.410, P < 0.001, respectively), whereas log NT-proBNP was not. According to the ROC curve analysis, combined measurements of MWT ≥21 mm and/or cTnI ≥0.025ng/ml indicated good diagnostic performance for the presence of LGE, with specificity of 95% or sensitivity of 88%. Conclusions Serum cTnI is an independent predictor useful for identifying myocardial fibrosis, while plasma NT-proBNP is only associated with myocardial fibrosis on univariate analysis. Combined measurements of serum cTnI with MWT further improve its value in detecting myocardial fibrosis in patients with HOCM.
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Affiliation(s)
- Changlin Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Cui
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenghuan Hu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youzhou Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
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Pasqualucci D, Fornaro A, Castelli G, Rossi A, Arretini A, Chiriatti C, Targetti M, Girolami F, Corda M, Orrù P, Matta G, Stefàno P, Cecchi F, Porcu M, Olivotto I. Clinical Spectrum, Therapeutic Options, and Outcome of Advanced Heart Failure in Hypertrophic Cardiomyopathy. Circ Heart Fail 2015; 8:1014-21. [PMID: 26446673 DOI: 10.1161/circheartfailure.114.001843] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical course of patients with hypertrophic cardiomyopathy and advanced heart failure (HF) subtended by progressive left ventricular dysfunction has received limited attention. Our aim was to assess the outcome of HF and impact of treatment options including the implantable cardioverter-defibrillator and heart transplantation (HT) in patients with hypertrophic cardiomyopathy evaluated at 2 Italian referral centers >3 decades. METHODS AND RESULTS All-cause mortality and a combined end point including death, HT, or appropriate implantable cardioverter-defibrillator shock were assessed in 71 consecutive patients with HF not related to outflow obstruction (7% of the entire hypertrophic cardiomyopathy cohort) followed up for 6.1±6.9 years after development of New York Heart Association class III to IV symptoms. At enrollment, left ventricular ejection fraction was <50% in 55 patients and >50% in 16; all had restrictive left ventricular filling. During follow-up, 35 patients died (49%%; 5-year rate, 49%) and 53 met the combined end point (75%; 5-year rate, 62%). Most events occurred in the 3 years after HF onset (17% per year compared with only 3% per year subsequently). Appropriate implantable cardioverter-defibrillator shocks occurred in 11 of 34 implanted patients. Of 37 patients evaluated for HT, 14 were transplanted, 10 listed, and 13 excluded; 2 early post-HT deaths occurred in patients with elevated pulmonary vascular resistance. Eleven of the 14 HT patients were alive at 10±8 years. CONCLUSIONS In hypertrophic cardiomyopathy, advanced HF not associated with outflow obstruction portends a severely unfavorable prognosis, particularly in the first 3 years after onset of symptoms, despite frequently preserved systolic function in about one quarter of the patients. Outcome of HT is favorable but requires early consideration, as the window of opportunity may be short.
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Affiliation(s)
- Daniele Pasqualucci
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.).
| | - Alessandra Fornaro
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Gabriele Castelli
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Alessandra Rossi
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Anna Arretini
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Chiara Chiriatti
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Mattia Targetti
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Francesca Girolami
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Marco Corda
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Pierpaolo Orrù
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Gildo Matta
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Pierluigi Stefàno
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Franco Cecchi
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Maurizio Porcu
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
| | - Iacopo Olivotto
- From the Departments of Cardiology (D.P., M.C., P.O., M.P.) and Radiology (G.M.), Brotzu Hospital, Cagliari, Italy; Referral Center for Cardiomyopathies (A.F., G.C., A.R., A.A., C.C., M.T., I.O.), Genetic Diagnostics Unit (F.G.), and Cardiac Surgery (P.S.), Careggi University Hospital, Florence, Italy; and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy (F.C.)
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N-terminal probrain natriuretic peptide levels as a predictor of functional outcomes in patients with ischemic stroke. Neuroreport 2015; 25:985-90. [PMID: 25102374 DOI: 10.1097/wnr.0000000000000195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prognostic value of the N-amino terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) in acute ischemic stroke (AIS) is uncertain. We sought to determine whether NT-proBNP levels were associated with functional outcomes after AIS. From August 2012 to October 2013, consecutive first-ever AIS patients admitted to the Department of Emergency of the First Affiliated Hospital of Xinxiang Medical University, China, were included in this study. Plasma NT-proBNP levels were measured from admission. Outcomes were measured as 90-day modified Rankin Scale score ('good outcome'=0-2 vs. 'poor'). Multivariate logistic regression was used to assess associations between NT-proBNP levels and outcomes. Predictive performance of NT-proBNP as compared with the clinical model was assessed by comparing receiver-operating characteristic curves. During this study period, 217 consecutive patients with AIS were included and completed 90 days of follow-up. There was a strong positive correlation between the plasma level of NT-proBNP and the National Institutes of Health Stroke Scale score (r=0.415, P=0.000). Plasma levels of NT-proBNP in patients with an unfavorable outcome were significantly higher than those in patients with a favorable outcome [3432 (interquartile range, 1100-54991) vs. 978 (interquartile range, 123-1705) pg/ml; P=0.000]. In multivariate analyses, after adjusting for all other significant outcome predictors, the NT-proBNP level that remained can be seen as an independent unfavorable outcome predictor, with an adjusted odds ratios of 4.14 (95% confidence interval, 2.72-7.99; P=0.000). Our results show that plasma NT-proBNP levels were significantly elevated in patients with an unfavorable outcome and might be of clinical importance as a supplementary tool for the assessment of functional outcomes in patients with AIS.
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Thin-filament mutations, hypertrophic cardiomyopathy, and risk. J Am Coll Cardiol 2015; 64:2601-2604. [PMID: 25524338 DOI: 10.1016/j.jacc.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/20/2022]
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Guttmann OP, Mohiddin SA, Elliott PM. Almanac 2014: cardiomyopathies. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Olivotto I, d'Amati G, Basso C, Van Rossum A, Patten M, Emdin M, Pinto Y, Tomberli B, Camici PG, Michels M. Defining phenotypes and disease progression in sarcomeric cardiomyopathies: contemporary role of clinical investigations. Cardiovasc Res 2015; 105:409-23. [DOI: 10.1093/cvr/cvv024] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Biomarkers in cardiology--part 1--in heart failure and specific cardiomyopathies. Arq Bras Cardiol 2014; 103:451-9. [PMID: 25590924 PMCID: PMC4290735 DOI: 10.5935/abc.20140184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/30/2014] [Indexed: 02/02/2023] Open
Abstract
Cardiovascular diseases are the leading causes of mortality and morbidity in Brazil.
The primary and secondary preventions of those diseases are a priority for the health
system and require multiple approaches to increase their effectiveness. Biomarkers
are tools used to more accurately identify high-risk individuals, to speed the
diagnosis, and to aid in treatment and prognosis determination. This review aims to
highlight the importance of biomarkers in clinical cardiology practice, and to raise
relevant points of their use and the promises for the coming years. This document was
divided into two parts, and this first one discusses the use of biomarkers in
specific cardiomyopathies and heart failure.
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Abstract
Cardiomyopathies are myocardial disorders that are not explained by abnormal loading conditions and coronary artery disease. They are classified into a number of morphological and functional phenotypes that can be caused by genetic and non-genetic mechanisms. The dominant themes in papers published in 2012-2013 are similar to those reported in Almanac 2011, namely, the use (and interpretation) of genetic testing, development and application of novel non-invasive imaging techniques and use of serum biomarkers for diagnosis and prognosis. An important innovation since the last Almanac is the development of more sophisticated models for predicting adverse clinical events.
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Affiliation(s)
- Oliver P Guttmann
- Inherited Cardiac Diseases Unit, The Heart Hospital, University College London, , London, UK
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27
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Liebetrau C, Gaede L, Dörr O, Troidl C, Voss S, Hoffmann J, Paszko A, Weber M, Rolf A, Hamm C, Nef H, Möllmann H. Release kinetics of N-terminal pro-B-type natriuretic peptide in a clinical model of acute myocardial infarction. Clin Chim Acta 2014; 429:34-7. [DOI: 10.1016/j.cca.2013.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/10/2013] [Accepted: 11/14/2013] [Indexed: 11/28/2022]
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