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Chimenti C, Iacovoni A, Montalto A, Emdin M, Olivotto I, Basso C, De Chiara BC, Bottillo I, Ciampi CM, Dellegrottaglie S, Di Marco M, Gentile P, Girolami F, Grammatico P, Iascone M, La Franca E, Lofiego C, Matteucci A, Pasqualucci D, Pentiricci S, Perugini E, Pieroni M, Quarta G, Re F, Scelsi L, Todiere G, Alfarano M, De Gaspari M, Bilato C, Corda M, De Luca L, Geraci G, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gulizia MM, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. ANMCO position paper 'Hypertrophic cardiomyopathy: from diagnosis to treatment'. Eur Heart J Suppl 2025; 27:v256-v279. [PMID: 40385469 PMCID: PMC12078773 DOI: 10.1093/eurheartjsupp/suaf077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Hypertrophic cardiomyopathy (HCM) is a non-rare genetic cardiomyopathy, with an estimated prevalence of 1:500, characterized by an increase in the left ventricular wall thickness in the absence of increased loading conditions. The hypertrophy is mostly asymmetric and predominantly affects the basal septum and anterior wall. Left ventricular outflow tract obstruction, at rest or after provocative tests, is detected in many patients and represents the primary cause of reduced functional capacity, as well as an independent predictor of sudden cardiac death and advanced heart failure. Until ∼1 year ago, symptomatic patients despite maximal therapy with β-blockers or calcium channel blockers plus disopyramide had only basal septal reduction therapy through myectomy or septal alcoholization as additional therapeutic options. Today, a new class of drugs that inhibit cardiac myosin activity is available for patients with obstructive HCM. In light of the new treatment perspectives, the correct clinical-therapeutic classification of affected patients becomes of fundamental importance for the cardiologist. The aim of this position paper is to increase the knowledge of cardiologists in the field of HCM, defining its epidemiological, genetic, and pathological characteristics, identifying the diagnostic criteria and instrumental methods capable of stratifying the risk profile, with the aim of an optimal therapy tailored on the single patient.
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Affiliation(s)
- Cristina Chimenti
- UOC Malattie Apparato Cardiovascolare, AOU ‘Policlinico Umberto I’, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico, 155, Roma 00161, Italy
| | | | - Andrea Montalto
- UOC Cardiochirurgia, Azienda Ospedaliera Sant’Anna e San Sebastiano, Caserta, Italy
| | - Michele Emdin
- Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio (FTGM)—Stabilimento di Pisa, Italy
| | - Iacopo Olivotto
- SOC Cardiologia Pediatrica e della Transizione, AOU Meyer—IRCCS, Firenze, Italy
| | - Cristina Basso
- UOC Patologia Cardiovascolare, Azienda Ospedaliera- Dipartimento di Scienze Cardio-toraco-vascolari e di Sanità Pubblica, Università degli Studi, Padova, Italy
| | - Benedetta Carla De Chiara
- SC Cardiochirurgia e del Trapianto di Cuore, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Irene Bottillo
- UOC Laboratorio di Genetica Medica, Dipartimento di Medicina Sperimentale, A.O. San Camillo Forlanini, Roma, Italy
- Sapienza Università, Roma, Italy
| | - Claudio Mario Ciampi
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania, Italy
| | - Santo Dellegrottaglie
- Laboratorio RM Cardiovascolare—Unità Imaging Cardiovascolare Avanzato, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, NA, Italy
| | | | - Piero Gentile
- Cardiologia 2—Insufficienza Cardiaca e Trapianto, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- Scuola di Medicina e Chirurgia, Università Bicocca, Milano, Italy
| | - Francesca Girolami
- SOC Cardiologia Pediatrica e della Transizione, AOU Meyer—IRCCS, Firenze, Italy
| | - Paola Grammatico
- UOC Laboratorio di Genetica Medica, Dipartimento di Medicina Sperimentale, A.O. San Camillo Forlanini, Roma, Italy
- Sapienza Università, Roma, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Eluisa La Franca
- Dipartimento di Cardiologia, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT)-IRCCS, UPMC, Palermo, Italy
| | - Carla Lofiego
- SOD Cardiologia-UTIC, Dipartimento di Scienze Cardiovascolari, AOU delle Marche, Ancona, Italy
| | - Andrea Matteucci
- UOC Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Roma, Italy
| | | | | | | | - Maurizio Pieroni
- Cardiomiopatie, AOU Careggi—Università degli Studi, Firenze, Italy
| | | | - Federica Re
- UOC Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Laura Scelsi
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giancarlo Todiere
- Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio (FTGM)—Stabilimento di Pisa, Italy
| | - Maria Alfarano
- UOC Malattie Apparato Cardiovascolare, AOU ‘Policlinico Umberto I’, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico, 155, Roma 00161, Italy
| | - Monica De Gaspari
- UOC Patologia Cardiovascolare, Azienda Ospedaliera- Dipartimento di Scienze Cardio-toraco-vascolari e di Sanità Pubblica, Università degli Studi, Padova, Italy
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell’Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Marco Corda
- Cardiologia con UTIC, Azienda Ospedaliera ‘G. Brotzu’, Cagliari, Italy
| | - Leonardo De Luca
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanna Geraci
- U.O.C. Cardiologia, Presidio Ospedaliero Sant’Antonio Abate, ASP Trapani, Erice, Italy
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze, Italy
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, ReggioEmilia, Italy
| | - Vittorio Pascale
- UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro, Italy
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant’Anna e San Sebastiano, Caserta, Italy
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli, TO, Italy
| | - Michele Massimo Gulizia
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania, Italy
| | - Federico Nardi
- Dipartimento di Cardiologia, Ospedale Santo Spirito, Casale Monferrato AL, Italy
| | - Domenico Gabrielli
- UOC Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Roma, Italy
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti, BA, Italy
| | - Fabrizio Oliva
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti, BA, Italy
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- Associazione Nazionale Medici Cardiologi Ospedalieri—ANMCO, Firenze, Italy
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Frye C, Escudero M, Saunders W, Ajijola O, Mawardi G, Nandkeolyar S, Kelly N, Phelan D. The Efficacy of Goal-Directed Valsalva to Elicit Clinically Significant Gradients in Patients With Obstructive Hypertrophic Cardiomyopathy Taking Mavacamten Therapy. J Am Soc Echocardiogr 2025; 38:51-52. [PMID: 39401730 DOI: 10.1016/j.echo.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/01/2024] [Accepted: 10/02/2024] [Indexed: 11/22/2024]
Affiliation(s)
- Cody Frye
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina.
| | - Melissa Escudero
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
| | - William Saunders
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
| | - Olafunke Ajijola
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
| | - George Mawardi
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
| | - Shuktika Nandkeolyar
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
| | - Noreen Kelly
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
| | - Dermot Phelan
- Atrium Health, Sanger Heart & Vascular Institute, Hypertrophic Cardiomyopathy Center, Charlotte, North Carolina
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Wang H, Zhu Y, Quintana E, Ibáñez C, Deng Y, Wei X, Liu Y. Systolic anterior motion-mediated mitral regurgitation and surgical management in hypertrophic obstructive cardiomyopathy. Eur J Cardiothorac Surg 2024; 66:ezae376. [PMID: 39412497 DOI: 10.1093/ejcts/ezae376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 09/24/2024] [Accepted: 10/14/2024] [Indexed: 11/07/2024] Open
Abstract
Mitral regurgitation mediated by systolic anterior motion is a typical manifestation in patients with hypertrophic obstructive cardiomyopathy. Although septal myectomy is currently the preferred treatment for patients with drug-refractory hypertrophic obstructive cardiomyopathy, surgical management of associated mitral regurgitation remains controversial. Whether septal myectomy alone or additional valve procedures are required to correct significant mitral regurgitation depends largely on the pathophysiology of each individual. For intervention purposes, it is important to identify the real systolic anterior motion-mediated mitral regurgitation and clarify the mitral structural abnormalities, as well as the other conditions, which may indicate the degree of mitral valve competence. As a first-line imaging modality in the management of hypertrophic cardiomyopathy, echocardiography could provide crucial information for surgical decision making. In this article, we focus on elucidating the typical echocardiographic features of systolic anterior motion-mediated mitral regurgitation and offer an assessment process to determine other contributors to obstruction and mitral regurgitation. Additionally, guidance for surgical decision making for mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy is discussed.
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Affiliation(s)
- Hui Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristina Ibáñez
- Department of Anesthesiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Xiang Wei
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
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Mustafic M, Jandér R, Marlevi D, Rickenlund A, Rück A, Saleh N, Abdi S, Eriksson MJ, Damlin A. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: do mitral valve leaflet length, septal thickness, or sex affect the outcome? Cardiovasc Interv Ther 2024; 39:479-489. [PMID: 38807005 PMCID: PMC11436449 DOI: 10.1007/s12928-024-01014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
This retrospective cohort study aimed to assess whether basal septal wall thickness (BSWT), anterior (AML) and posterior (PML) mitral leaflet length, or sex were associated with remaining left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA). One hundred fifty-four patients who underwent ASA at the Karolinska University Hospital in Stockholm, Sweden, between 2009 and 2021, were included retrospectively. Anatomical and hemodynamic parameters were collected from invasive catheterization before and during ASA, and from echocardiography (ECHO) examinations before, during, and at 1-year follow-up after ASA. Linear and logistic regression models were used to assess the association between sex, BSWT, AML, PML, and outcome, which was defined as the remaining LVOTO (≥ 30 mmHg) after ASA. The median follow-up was 364 days (interquartile range 334-385 days). BSWT ≥ 23 mm (n = 13, 12%) was associated with remaining LVOTO at follow-up (p = 0.004). Elongated mitral valve leaflet length (either AML or PML) was present in 125 (90%) patients. Elongated AML (> 24 mm) was present in 67 (44%) patients, although AML length was not associated with remaining LVOTO at follow-up. Elongated PML (> 14 mm) was present in 114 (74%) patients and was not associated with remaining LVOTO at follow-up. No significant sex differences were observed regarding the remaining LVOTO. ECHO measurement of BSWT can be effectively used to select patients for successful ASA and identify those patients with a risk of incomplete resolution of LVOTO after ASA.
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Affiliation(s)
- Mesud Mustafic
- Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Jandér
- Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - David Marlevi
- Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Anette Rickenlund
- Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
- Unit of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nawzad Saleh
- Department of Cardiology, Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
- Unit of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sam Abdi
- Department of Internal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria J Eriksson
- Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Damlin
- Division of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden.
- Department of Cardiology, Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden.
- Unit of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Desai MY, Hajj-Ali A, Rutkowski K, Ospina S, Gaballa A, Emery M, Asher C, Xu B, Thamilarasan M, Popovic ZB. Real-world experience with mavacamten in obstructive hypertrophic cardiomyopathy: Observations from a tertiary care center. Prog Cardiovasc Dis 2024; 86:62-68. [PMID: 38354765 DOI: 10.1016/j.pcad.2024.02.001] [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: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND In symptomatic obstructive hypertrophic cardiomyopathy (oHCM) patients, mavacamten is commercially approved to help improve left ventricular (LV) outflow tract (LVOT) gradients, symptoms, and reduce eligibility for septal reduction therapy (SRT) under the risk evaluation and mitigation strategy (REMS) program. We sought to prospectively report the initial real-world clinical experience with the use of commercially available mavacamten in a multi-hospital tertiary healthcare system. METHODS We studied the first 150 consecutive oHCM patients (mean age 65 years, 53% women, 83% on betablockers and 61% in New York Heart Association [NYHA] class III) who were initiated on 5 mg of mavacamten with dose titrations using symptom assessment and echocardiographic measurements of LVOT gradient and LV ejection fraction (LVEF) measurements. We measured changes in NYHA class, LVEF, LVOT gradients (resting and Valsalva) at baseline, 4, 8 and 12 weeks. RESULTS At 261 ± 143 days (range of 31-571 days), 69 (46%) patients had ≥1 NYHA class, and 27 (18%) additional patients had ≥2 NYHA class improvement. The mean Valsalva LVOT gradient decreased from 72 ± 43 mmHg at baseline to 29 ± 31 mmHg at 4 weeks, 29 ± 28 mmHg at 8 weeks and 30 ± 29 mmHg at 12 weeks (p < 0.001). At baseline, 100% patients had Valsalva LVOT gradients ≥30 mmHg, which reduced to 29% at 4 weeks, 28% at 8 weeks and 30% at 12 weeks. In 40 patients who reported no symptomatic improvement, the mean Valsalva LVOT gradient decreased from 73 ± 39 mmHg at baseline to 34 ± 27 mmHg at 4 weeks, 35 ± 28 mmHg at 8 weeks and 30 ± 24 mmHg at 12 weeks (P < 0.001). The mean LVEF at baseline was 66 ± 6% and changed to 64 ± 5% at 4 weeks, 63 ± 5% at 8 weeks and 62 ± 7% at 12 weeks (p < 0.0001). No patient underwent SRT, developed LVEF ≤30% or developed heart failure requiring admission. Three (2%) patients needed temporary interruption of mavacamten due to LVEF<50%. CONCLUSIONS In a real-world study in symptomatic oHCM patients at a multi-hospital tertiary care referral center, we demonstrate the efficacy and safety, along with the logistic feasibility of prescribing mavacamten under the REMS program.
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Affiliation(s)
- Milind Y Desai
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA.
| | - Adel Hajj-Ali
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Katy Rutkowski
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Susan Ospina
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Andrew Gaballa
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Michael Emery
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Craig Asher
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Bo Xu
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Maran Thamilarasan
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
| | - Zoran B Popovic
- From the Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Weston, Cleveland, OH, USA
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Webb JJ. Mid-Ventricular Obliteration Diagnosed by Bedside-Focused Echocardiography in the Emergency Department in a Patient With Syncope and Associated Hypertrophic Cardiomyopathy: A Case Report. Cureus 2024; 16:e65066. [PMID: 39171031 PMCID: PMC11338671 DOI: 10.7759/cureus.65066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/23/2024] Open
Abstract
Syncope is a common complaint encountered in emergency medicine practice with multiple potential etiologies to investigate. The utility of focused bedside echocardiography allows emergency physicians to diagnose acute cardiovascular causes in a time-sensitive fashion. In this case report, a 61-year-old female with mixed aortic valve disease presented to the emergency department after a syncopal episode. In addition to standard electrocardiogram and laboratory testing, investigation with focused echocardiography performed at the point of care revealed mid-ventricular obliteration due to hypertrophic myocardial remodeling, left ventricular underfilling, and hyperdynamic performance. Key echocardiographic findings that may assist emergency physicians in recognizing and managing this physiological entity were discussed.
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Affiliation(s)
- Jeremy J Webb
- Emergency Medicine, LewisGale Medical Center, Salem, USA
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Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB. Obstruction in Hypertrophic Cardiomyopathy: Many Faces. J Am Soc Echocardiogr 2024; 37:613-625. [PMID: 38428652 DOI: 10.1016/j.echo.2024.02.010] [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: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, exhibits left ventricular hypertrophy not secondary to other causes, with varied phenotypic expression. Enhanced actin-myosin interaction underlies excessive myocardial contraction, frequently resulting in dynamic obstruction within the left ventricle. Left ventricular outflow tract obstruction, occurring at rest or with provocation in 75% of HCM patients, portends adverse prognosis, contributes to symptoms, and is frequently a therapeutic target. Transthoracic echocardiography plays a crucial role in the screening, initial diagnosis, management, and risk stratification of HCM. Herein, we explore echocardiographic evaluation of HCM, emphasizing Doppler assessment for obstruction. Echocardiography informs management strategies through noninvasive hemodynamic assessment, which is frequently obtained with various provocative maneuvers. Recognition of obstructive HCM phenotypes and associated anatomical abnormalities guides therapeutic decision-making. Doppler echocardiography allows monitoring of therapeutic responses, whether it be medical therapies (including cardiac myosin inhibitor therapy) or septal reduction therapies, including surgical myectomy and alcohol septal ablation. This article discusses the hemodynamics of obstruction and practical application of Doppler assessment in HCM. In addition, it provides a visual atlas of obstruction in HCM, including high-quality figures and complementary videos that illustrate the many facets of dynamic obstruction.
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Affiliation(s)
- Muhannad Abbasi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kevin C Ong
- Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Brian Newman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Gilliland YE. Septal Perforator Artery Doppler Flow in Hypertrophic Cardiomyopathy: Searching for Clinical Applicability. J Am Soc Echocardiogr 2024; 37:352-355. [PMID: 38160933 DOI: 10.1016/j.echo.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Yvonne E Gilliland
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
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Abraham MR, Abraham TP. Role of Imaging in the Diagnosis, Evaluation, and Management of Hypertrophic Cardiomyopathy. Am J Cardiol 2024; 212S:S14-S32. [PMID: 38368033 DOI: 10.1016/j.amjcard.2023.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is increasingly recognized and may benefit from the recent approval of new, targeted medical therapy. Successful management of HCM is dependent on early and accurate diagnosis. The lack of a definitive diagnostic test, the wide variation in phenotype and the commonness of phenocopy conditions, and the presence of normal or hyperdynamic left ventricular function in most patients makes HCM a condition that is highly dependent on imaging for all aspects of management including, diagnosis, classification, predicting risk of complications, detecting complications, identifying risk for ventricular arrhythmias, evaluating choice of therapy and monitoring therapy, intraprocedural guidance, and screening family members. Although echocardiographic imaging remains the mainstay in the diagnosis and subsequent management of HCM, this disease clearly requires multimethod imaging for various aspects of optimal patient care. Advances in echocardiography hardware and techniques, development and refinement of imaging with computed tomography, magnetic resonance, and nuclear scanning, and the emergence of very focused assessments such as diastology and fibrosis imaging have all advanced the diagnosis and management of HCM. In this review, we discuss the relative utility and evidence support for these imaging approaches to contribute to improve patient outcomes.
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Affiliation(s)
- Maria Roselle Abraham
- UCSF Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Theodore P Abraham
- UCSF Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, California.
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