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Shang E, Tan H. Comparison of Drug Therapy Efficacy in Patients With Hypertrophic Cardiomyopathy: A Network Meta-Analysis. Am J Cardiol 2024; 226:97-107. [PMID: 39019204 DOI: 10.1016/j.amjcard.2024.07.007] [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: 05/19/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
The aim of this network meta-analysis was to compare the efficacy of various commonly used drugs in treating patients with hypertrophic cardiomyopathy (HCM). Randomized controlled trials on drugs for HCM treatment were retrieved from PubMed, Embase, Cochrane Library, and Web of Science (search cutoff: January 10, 2024). Quality assessment was performed using the risk of bias tool, and data analysis used R software. Seventeen studies (1,133 patients with HCM) were included. The network meta-analysis indicated that mavacamten and perhexiline improved peak oxygen consumption compared with placebo. Mavacamten reduced N-terminal pro-B-type natriuretic peptide, left ventricular mass index, left atrial volume index, and septal E/e' ratio. Losartan decreased systolic blood pressure, whereas candesartan, mavacamten, and valsartan reduced maximum wall thickness. Perhexiline had better efficacy in increasing peak oxygen consumption, and candesartan in reducing maximum wall thickness. No drug significantly improved left ventricular ejection fraction compared with placebo. In conclusion, on the basis of current studies, commonly used drugs may effectively improve some of the outcome measures in patients with HCM, whereas the novel drug mavacamten showed significant therapeutic effects in most of the remaining outcome measures except for left ventricular ejection fraction.
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Affiliation(s)
- Erhan Shang
- School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, Guangdong, China.
| | - Hongmei Tan
- School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, Guangdong, China.
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2
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Tamargo J, Tamargo M, Caballero R. Hypertrophic cardiomyopathy: an up-to-date snapshot of the clinical drug development pipeline. Expert Opin Investig Drugs 2022; 31:1027-1052. [PMID: 36062808 DOI: 10.1080/13543784.2022.2113374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is a complex cardiac disease with highly variable phenotypic expression and clinical course most often caused by sarcomeric gene mutations resulting in left ventricular hypertrophy, fibrosis, hypercontractility, and diastolic dysfunction. For almost 60 years, HCM has remained an orphan disease and still lacks a disease-specific treatment. AREAS COVERED This review summarizes recent preclinical and clinical trials with repurposed drugs and new emerging pharmacological and gene-based therapies for the treatment of HCM. EXPERT OPINION The off-label drugs routinely used alleviate symptoms but do not target the core pathophysiology of HCM or prevent or revert the phenotype. Recent advances in the genetics and pathophysiology of HCM led to the development of cardiac myosin adenosine triphosphatase inhibitors specifically directed to counteract the hypercontractility associated with HCM-causing mutations. Mavacamten, the first drug specifically developed for HCM successfully tested in a phase 3 trial, represents the major advance for the treatment of HCM. This opens new horizons for the development of novel drugs targeting HCM molecular substrates which hopefully modify the natural history of the disease. The role of current drugs in development and genetic-based approaches for the treatment of HCM are also discussed.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - María Tamargo
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
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Cheng Z, Qi M, Zhang C, Mao Y. Myocardial Fibrosis in the Pathogenesis, Diagnosis, and Treatment of Hypertrophic Cardiomyopathy. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a type of hereditary cardiomyopathy caused by gene mutation. Its histological features include cardiomyocyte hypertrophy and disarray as well as myocardial fibrosis. Gene mutation, abnormal signal transduction, and abnormal energy metabolism are
considered the main mechanisms of myocardial fibrosis. There is a strong correlation between myocardial fibrosis and the occurrence, development, and prognosis of HCM. We review the application of myocardial fibrosis in the diagnosis and treatment of HCM, focusing on research progress and
the application of magnetic resonance imaging on the basis of the characteristics of fibrosis in the diagnosis and prognosis of HCM.
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Affiliation(s)
- Zeyi Cheng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan, China
| | - Miaomiao Qi
- Department of Cardiology, The Second Hospital of Lanzhou University, Lanzhou, 730000 Gansu, China
| | - Chengyuan Zhang
- The Second Medical School of Lanzhou University, Lanzhou, 730000 Gansu, China
| | - Yanxia Mao
- The Second Medical School of Lanzhou University, Lanzhou, 730000 Gansu, China
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Os HA, Rollefstad S, Gerdts E, Kringeland E, Ikdahl E, Semb AG, Midtbø H. Preclinical cardiac organ damage during statin treatment in patients with inflammatory joint diseases: the RORA-AS statin intervention study. Rheumatology (Oxford) 2020; 59:3700-3708. [PMID: 32386421 PMCID: PMC7946801 DOI: 10.1093/rheumatology/keaa190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Statin treatment has been associated with reduction in blood pressure and arterial stiffness in patients with inflammatory joint diseases (IJD). We tested whether statin treatment also was associated with regression of preclinical cardiac organ damage in IJD patients. METHODS Echocardiography was performed in 84 IJD patients (52 RA, 20 ankylosing spondylitis, 12 psoriatric arthritis, mean age 61 (9) years, 63% women) without known cardiovascular disease before and after 18 months of rosuvastatin treatment. Preclinical cardiac organ damage was identified by echocardiography as presence of left ventricular (LV) hypertrophy, LV concentric geometry, increased LV chamber size and/or dilated left atrium. RESULTS At baseline, hypertension was present in 63%, and 36% used biologic DMARDs (bDMARDs). Preclinical cardiac organ damage was not influenced by rosuvastatin treatment (44% at baseline vs 50% at follow-up, P = 0.42). In uni- and multivariable logistic regression analyses, risk of preclinical cardiac organ damage at follow-up was increased by higher baseline body mass index [odds ratio (OR) 1.3, 95% CI: 1.1, 1.5, P = 0.01] and presence of preclinical cardiac organ damage at baseline (OR 6.4, 95% CI: 2.2, 18.5, P = 0.001) and reduced by use of bDMARDs at follow-up (OR 0.3, 95% CI: 0.1, 0.9, P = 0.03). CONCLUSION Rosuvastatin treatment was not associated with a reduction in preclinical cardiac organ damage in IJD patients after 18 months of treatment. However, use of bDMARDS at follow-up was associated with lower risk of preclinical cardiac organ damage at study end, pointing to a possible protective cardiac effect of bDMARDs in IJD patients. CLINICALTRIALS.GOV https://clinicaltrials.gov/NCT01389388.
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Affiliation(s)
- Hanna A Os
- Department of Clinical Science, University of Bergen, Bergen
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen
| | | | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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5
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Tao L, Shi J, Huang X, Hua F, Yang L. Identification of a lncRNA-miRNA-mRNA network based on competitive endogenous RNA theory reveals functional lncRNAs in hypertrophic cardiomyopathy. Exp Ther Med 2020; 20:1176-1190. [PMID: 32742356 DOI: 10.3892/etm.2020.8748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/04/2019] [Indexed: 12/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease that affects 1 in every 200 people in the general population, leading to cardiac ischemia, heart failure and increased risk of sudden death. Recently, accumulating evidence has suggested that long noncoding RNAs (lncRNAs) may serve specific roles in various biological processes and participate in the pathology of various diseases, including HCM. Although a large number of lncRNAs have been detected, the functions of lncRNAs in HCM are still unknown. In the present study, a global triple network based on competitive endogenous RNA (ceRNA) theory was constructed using data from the National Center for Biotechnology Information Gene Expression Omnibus. Furthermore, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses of mRNAs in the lncRNA-microRNA (miRNA)-mRNA network were performed using the Cytoscape plugins, BiNGO and Database. The lncRNA-miRNA-mRNA network was composed of 30 lncRNA nodes, 94 mRNA nodes and 8 miRNA nodes. Subsequently, hub nodes and the number of relationship pairs were analyzed and showed that 5 lncRNAs (ENST00000597346.1, ENST00000458178.1, ENST00000544461.1, ENST00000567093.1 and ENST00000571219.1) were closely related to HCM. Cluster module analysis and Random Walk with Restart of the ceRNA network further confirmed the potential role of two lncRNAs (ENST00000458178.1 and ENST00000567093.1) in HCM. The present study provides a new strategy for identifying potential pathways associated with HCM or other diseases. Furthermore, lncRNA-miRNA pairs may be regarded as candidate diagnostic biomarkers or potential therapeutic targets for HCM.
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Affiliation(s)
- Lichan Tao
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Jia Shi
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Xiaoli Huang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Fei Hua
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
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Maltês S, Lopes LR. New perspectives in the pharmacological treatment of hypertrophic cardiomyopathy. Rev Port Cardiol 2020; 39:99-109. [PMID: 32245685 DOI: 10.1016/j.repc.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/17/2019] [Accepted: 03/10/2019] [Indexed: 10/24/2022] Open
Abstract
Hypertrophic cardiomyopathy is an inherited cardiac disease and a major cause of heart failure and sudden death. Even though it was described more than 50 years ago, sarcomeric hypertrophic cardiomyopathy still lacks a disease-specific treatment. The drugs routinely used alleviate symptoms but do not prevent or revert the phenotype. With recent advances in the knowledge about the genetics and pathophysiology of hypertrophic cardiomyopathy, new genetic and pharmacological approaches have been recently discovered and studied that, by influencing different pathways involved in this disease, have the potential to function as disease-modifying therapies. These promising new pharmacological and genetic therapies will be the focus of this review.
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Affiliation(s)
- Sérgio Maltês
- Clínica Universitária de Cardiologia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Luis Rocha Lopes
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, Inglaterra; St. Bartholomew's Hospital, Barts Heart Centre, London, Inglaterra; Centro Cardiovascular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Maltês S, Lopes LR. New perspectives in the pharmacological treatment of hypertrophic cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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8
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Coppini R, Ferrantini C, Cerbai E. Novel pharmacological approaches for paediatric hypertrophic cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yu B, Liu D, Zhang H, Xie D, Nie W, Shi K, Yang P. Anti-hypertrophy effect of atorvastatin on myocardium depends on AMPK activation-induced miR-143-3p suppression via Foxo1. Biomed Pharmacother 2018; 106:1390-1395. [PMID: 30119211 DOI: 10.1016/j.biopha.2018.07.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is a pathological characteristic shared by distinct heart disorders. Atorvastatin is employed as a lipid lowering agent and its heart protection effect has been recently reported as well. Thus, the current study attempted to validate the anti-hypertrophy effect of atorvastatin as well as the associated mechanism. Hypertrophic feature was induced in rats using transverse aortic constriction (TAC) method and in cardiomyocytes using angiotensin II (Ang II). Then the animals and cells were treated with atorvastatin and the effect on cardiac weight and structure as well as cell viability, surface area, and apoptosis was assessed. The mechanism associated with the anti-hypertrophy effect of atorvastatin was further explored by focusing on the AMPK/Foxo1/miR-143-3p axis. The results showed that the administration of atorvastatin significantly suppressed TAC-induced heart weight increase and attenuated cardiac structure deteriorations in rats. In in vitro assays, atorvastatin increased cell viability, and reduced cell surface area and apoptosis in Ang II-treated H9c2 cells. At molecular level, atorvastatin activated AMPK, which further promoted Foxo1 activation and suppressed miR-143-3p level. The key role of AMPK during atorvastatin treatment was further validated by subjecting Ang II-treated H9c2 cells to co-incubation of atorvastatin and Compound C, which blocked the pro-survival and anti-hypertrophy effect of atorvastatin on H9c2 cells. The findings outlined in the current study confirmed the anti-hypertrophy effect of atorvastatin and provided a preliminary explanation on the mechanism associated with the treatment: the protective effect of atorvastatin on myocardium against hypertrophy depended on miR-143-3p inhibition via AMPK and Foxo1 activation.
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MESH Headings
- AMP-Activated Protein Kinases/metabolism
- Angiotensin II/toxicity
- Animals
- Apoptosis/drug effects
- Atorvastatin/pharmacology
- Cell Line
- Cell Survival/drug effects
- Disease Models, Animal
- Hypertrophy, Left Ventricular/chemically induced
- Hypertrophy, Left Ventricular/enzymology
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/prevention & control
- Male
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/enzymology
- Myocytes, Cardiac/pathology
- Nerve Tissue Proteins/metabolism
- Rats, Sprague-Dawley
- Signal Transduction/drug effects
- Ventricular Function, Left/drug effects
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Bo Yu
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China
| | - Dongna Liu
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China
| | - Hongli Zhang
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China
| | - Di Xie
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China
| | - Wei Nie
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China
| | - Kaiyao Shi
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China.
| | - Ping Yang
- Department of Cardiology, Jilin Provincial Key Laboratory for Genetic Diagnosis of Cardiovascular Disease, China-Japan Union Hospital of Jilin University, Changchun 130033, People's Republic of China.
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10
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Strand LN, Young RL, Bertoni AG, Bluemke DA, Burke GL, Lima JA, Sotoodehnia N, Psaty BM, McClelland RL, Heckbert SR, Delaney JA. New statin use and left ventricular structure: Estimating long-term associations in the Multi-Ethnic Study of Atherosclerosis (MESA). Pharmacoepidemiol Drug Saf 2018; 27:570-580. [PMID: 29380457 PMCID: PMC5984180 DOI: 10.1002/pds.4389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Only small and short-term studies have evaluated statins in relation to changes in heart structure. We estimated the association between new statin use and 10-year remodeling of the left ventricle. METHODS The Multi-Ethnic Study of Atherosclerosis collected data on statin use over approximately 10 years, conducting cardiac magnetic resonance (CMR) imaging at baseline and the 10-year exam. Participants were free of baseline cardiovascular disease, and we excluded users of statins at baseline. Statin initiation was defined as a report of current use at any of the 4 subsequent exams. Primary outcomes were the change in left ventricular mass index (LVMI; % predicted by height, weight, and sex) and mass-to-volume ratio. Associations were estimated in a propensity score-matched analysis. RESULTS A total of 3113 participants (53% female; 40% European-American, 25% African-American, 22% Hispanic-American, and 13% Chinese-American) were eligible; 2431 returned for follow-up CMR imaging after a median of 9.4 years. Statin therapy (moderate dose, 76%) was started by 36% of participants (N = 872). We excluded 42 participants with incident myocardial infarction. Compared with nonuse, statin use was associated with less 10-year progression in LVMI (-2.35 percentage points; 95% CI, -4.24 to -0.47; P = .01) and mass-to-volume ratio (-0.03 absolute difference; 95% CI, -0.07 to -0.00; P = .02); effects were small in magnitude. A dose response was observed: Higher statin dose was associated with less LVMI progression. CONCLUSIONS In contrast to previous small studies, we found very modest associations between statin use and indices of left ventricular remodeling over 10 years in this prospective study of a diverse cohort.
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Affiliation(s)
| | - Rebekah L Young
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alain G Bertoni
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Bluemke
- National Institutes of Health Clinical Center, Bethesda, MD, USA
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Gregory L Burke
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joao A Lima
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Cardiology, University of Washington, Seattle, WA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Robyn L McClelland
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Joseph A Delaney
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Marian AJ, van Rooij E, Roberts R. Genetics and Genomics of Single-Gene Cardiovascular Diseases: Common Hereditary Cardiomyopathies as Prototypes of Single-Gene Disorders. J Am Coll Cardiol 2017; 68:2831-2849. [PMID: 28007145 DOI: 10.1016/j.jacc.2016.09.968] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 01/05/2023]
Abstract
This is the first of 2 review papers on genetics and genomics appearing as part of the series on "omics." Genomics pertains to all components of an organism's genes, whereas genetics involves analysis of a specific gene or genes in the context of heredity. The paper provides introductory comments, describes the basis of human genetic diversity, and addresses the phenotypic consequences of genetic variants. Rare variants with large effect sizes are responsible for single-gene disorders, whereas complex polygenic diseases are typically due to multiple genetic variants, each exerting a modest effect size. To illustrate the clinical implications of genetic variants with large effect sizes, 3 common forms of hereditary cardiomyopathies are discussed as prototypic examples of single-gene disorders, including their genetics, clinical manifestations, pathogenesis, and treatment. The genetic basis of complex traits is discussed in a separate paper.
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Affiliation(s)
- Ali J Marian
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, and Texas Heart Institute, Houston, Texas.
| | - Eva van Rooij
- Hubrecht Institute, KNAW and University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert Roberts
- University of Arizona College of Medicine, Phoenix, Arizona
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12
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Hersi A, Giannoccaro JP, Howarth A, Exner D, Weeks S, Eitel I, Herman RC, Duff H, Ritchie D, Mcrae M, Sheldon R. Statin Induced Regression of Cardiomyopathy Trial: A Randomized, Placebo-controlled Double-blind Trial. Heart Views 2016; 17:129-135. [PMID: 28400935 PMCID: PMC5363087 DOI: 10.4103/1995-705x.201784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM), characterized by a thickened, fibrotic myocardium, remains the most common cause of sudden cardiac death in young adults. Based on animal and clinical data, we hypothesized that atorvastatin would induce left ventricular (LV) mass regression. Methods: Statin Induced Regression of Cardiomyopathy Trial (SIRCAT) was a randomized, placebo-controlled study. The primary endpoint was change in LV mass measured by cardiac magnetic resonance imaging 12 months after treatment with once-daily atorvastatin 80 mg or placebo. A key secondary endpoint was diastolic dysfunction measured echocardiographically by transmitral flow velocities. SIRCAT is registered with www.clinicaltrials.gov (NCT00317967). Results: Of 222 screened patients, 22 were randomized evenly to atorvastatin and placebo. The mean age was 47 ± 10 years, and 15 (68%) were male. All subjects completed the protocol. At baseline, LV masses were 197 ± 76 g and 205 ± 82 g in the placebo and atorvastatin groups, respectively. After 12 months treatment, the LV masses in the placebo and atorvastatin groups were 196 ± 80 versus 206 ± 92 g (P = 0.80), respectively. Echocardiographic indices were not different in the two groups at baseline. After 12 months, diastolic dysfunction as assessed using transmitral flow velocities E/E', A/A', and peak systolic mitral velocity showed no benefit from atorvastatin. Conclusions: In patients with HCM, atorvastatin did not cause LV mass regression or improvements in LV diastolic function.
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Affiliation(s)
- Ahmad Hersi
- Department of Cardiac Sciences, King Saud University Medical City, College of Medicine, Riyadh, Kingdom of Saudi Arabia
| | - J Peter Giannoccaro
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Howarth
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Derek Exner
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Weeks
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Ingo Eitel
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - R Cameron Herman
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Henry Duff
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Debbie Ritchie
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Mcrae
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Robert Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
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13
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Bonsu KO, Reidpath DD, Kadirvelu A. Effects of Statin Treatment on Inflammation and Cardiac Function in Heart Failure: An Adjusted Indirect Comparison Meta-Analysis of Randomized Trials. Cardiovasc Ther 2015; 33:338-46. [DOI: 10.1111/1755-5922.12150] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Kwadwo Osei Bonsu
- School of Medicine and Health Sciences; Monash University; Bandar Sunway Selangor DE Malaysia
- Pharmacy Department; Accident and Emergency Directorate; Komfo Anokye Teaching Hospital; Kumasi Ghana
| | - Daniel Diamond Reidpath
- School of Medicine and Health Sciences; Monash University; Bandar Sunway Selangor DE Malaysia
| | - Amudha Kadirvelu
- School of Medicine and Health Sciences; Monash University; Bandar Sunway Selangor DE Malaysia
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14
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Morimoto T, Katanasaka Y, Sunagawa Y, Hirano S, Miyazaki Y, Funamoto M, Hojo Y, Suzuki H, Morimoto E, Ueno M, Shimatsu A, Satoh-Asahara N, Yamakage H, Wada H, Hasegawa K. Effects of Statins on Left Ventricular Diastolic Function in Patients with Dyslipidemia and Diastolic Dysfunction (Stat-LVDF Study). Biol Pharm Bull 2015; 38:1404-9. [DOI: 10.1248/bpb.b15-00126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tatsuya Morimoto
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
- Shizuoka General Hospital
- Division of Translational Research, Kyoto Medical Center, National Hospital Organization
| | - Yasufumi Katanasaka
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
- Shizuoka General Hospital
- Division of Translational Research, Kyoto Medical Center, National Hospital Organization
| | - Yoichi Sunagawa
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
- Shizuoka General Hospital
- Division of Translational Research, Kyoto Medical Center, National Hospital Organization
| | - Sae Hirano
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
- Shizuoka Saiseikai General Hospital
| | - Yusuke Miyazaki
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
| | - Masafumi Funamoto
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
| | - Yuya Hojo
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
| | - Hidetoshi Suzuki
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka
| | | | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine
| | - Akira Shimatsu
- Clinical Research Institute, Kyoto Medical Center, National Hospital Organization
| | - Noriko Satoh-Asahara
- Clinical Research Institute, Kyoto Medical Center, National Hospital Organization
| | - Hajime Yamakage
- Clinical Research Institute, Kyoto Medical Center, National Hospital Organization
| | - Hiromichi Wada
- Division of Translational Research, Kyoto Medical Center, National Hospital Organization
| | - Koji Hasegawa
- Division of Translational Research, Kyoto Medical Center, National Hospital Organization
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16
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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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Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) affects a significant percentage of young individuals. SCDs are due to genetic heart disorders, such as cardiomyopathies and channelopathies. In the present review, we will describe the recent advancements in understanding the genetic and molecular basis of hereditary cardiac diseases. RECENT FINDINGS Considerable progress has been made in identification of new genes associated with monogenic familial arrhythmogenic syndromes, giving the opportunity to delineate their molecular pathogenesis and identify potential targets for therapeutic intervention. Research discoveries and rapidly dropping costs of DNA sequencing technologies have resulted in availability of genetic testing panels. SUMMARY Advances in genetic sequencing technology are expected to significantly impact the clinical practice in the near future. Genetic testing represents a powerful tool for cause determination of arrhythmogenic cardiac diseases, efficient screening of family members, possible risk stratification and treatment choices. However, specific expertise is required for rational ordering and correct interpretation of the genetic screening results.
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Tousoulis D, Oikonomou E, Siasos G, Stefanadis C. Statins in heart failure--With preserved and reduced ejection fraction. An update. Pharmacol Ther 2013; 141:79-91. [PMID: 24022031 DOI: 10.1016/j.pharmthera.2013.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 12/26/2022]
Abstract
HMG-CoA reductase inhibitors or statins beyond their lipid lowering properties and mevalonate inhibition exert also their actions through a multiplicity of mechanisms. In heart failure (HF) the inhibition of isoprenoid intermediates and small GTPases, which control cellular function such as cell shape, secretion and proliferation, is of clinical significance. Statins share also the peroxisome proliferator-activated receptor pathway and inactivate extracellular-signal-regulated kinase phosphorylation suppressing inflammatory cascade. By down-regulating Rho/Rho kinase signaling pathways, statins increase the stability of eNOS mRNA and induce activation of eNOS through phosphatidylinositol 3-kinase/Akt/eNOS pathway restoring endothelial function. Statins change also myocardial action potential plateau by modulation of Kv1.5 and Kv4.3 channel activity and inhibit sympathetic nerve activity suppressing arrhythmogenesis. Less documented evidence proposes also that statins have anti-hypertrophic effects - through p21ras/mitogen activated protein kinase pathway - which modulate synthesis of matrix metalloproteinases and procollagen 1 expression affecting interstitial fibrosis and diastolic dysfunction. Clinical studies have partly confirmed the experimental findings and despite current guidelines new evidence supports the notion that statins can be beneficial in some cases of HF. In subjects with diastolic HF, moderately impaired systolic function, low b-type natriuretic peptide levels, exacerbated inflammatory response and mild interstitial fibrosis evidence supports that statins can favorably affect the outcome. Under the lights of this evidence in this review article we discuss the current knowledge on the mechanisms of statins' actions and we link current experimental and clinical data to further understand the possible impact of statins' treatment on HF syndrome.
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Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece.
| | - Evangelos Oikonomou
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Christodoulos Stefanadis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
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Long-Term Statin Therapy in Patients With Systolic Heart Failure and Normal Cholesterol: Effects on Elevated Serum Markers of Collagen Turnover, Inflammation, and B-Type Natriuretic Peptide. Clin Ther 2012; 34:91-100. [DOI: 10.1016/j.clinthera.2011.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 11/23/2022]
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Knöll R. Myosin binding protein C: implications for signal-transduction. J Muscle Res Cell Motil 2011; 33:31-42. [PMID: 22173300 PMCID: PMC3351598 DOI: 10.1007/s10974-011-9281-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/28/2011] [Indexed: 12/29/2022]
Abstract
Myosin binding protein C (MYBPC) is a crucial component of the sarcomere and an important regulator of muscle function. While mutations in different myosin binding protein C (MYBPC) genes are well known causes of various human diseases, such as hypertrophic (HCM) and dilated (DCM) forms of cardiomyopathy as well as skeletal muscular disorders, the underlying molecular mechanisms remain not well understood. A variety of MYBPC3 (cardiac isoform) mutations have been studied in great detail and several corresponding genetically altered mouse models have been generated. Most MYBPC3 mutations may cause haploinsufficiency and with it they may cause a primary increase in calcium sensitivity which is potentially able to explain major features observed in HCM patients such as the hypercontractile phenotype and the well known secondary effects such as myofibrillar disarray, fibrosis, myocardial hypertrophy and remodelling including arrhythmogenesis. However the presence of poison peptides in some cases cannot be fully excluded and most probably other mechanisms are also at play. Here we shall discuss MYBPC interacting proteins and possible pathways linked to cardiomyopathy and heart failure.
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Affiliation(s)
- Ralph Knöll
- Imperial College, National Heart and Lung Institute, British Heart Foundation-Centre for Research Excellence, Myocardial Genetics, London, UK.
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21
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most-common monogenically inherited form of heart disease, characterized by thickening of the left ventricular wall, contractile dysfunction, and potentially fatal arrhythmias. HCM is also the most-common cause of sudden cardiac death in individuals younger than 35 years of age. Much progress has been made in the elucidation of the genetic basis of HCM, resulting in the identification of more than 900 individual mutations in over 20 genes. Interestingly, most of these genes encode sarcomeric proteins, such as myosin-7 (also known as cardiac muscle β-myosin heavy chain; MYH7), cardiac myosin-binding protein C (MYBPC3), and cardiac muscle troponin T (TNNT2). However, the molecular events that ultimately lead to the clinical phenotype of HCM are still unclear. We discuss several potential pathways, which include altered calcium cycling and sarcomeric calcium sensitivity, increased fibrosis, disturbed biomechanical stress sensing, and impaired cardiac energy homeostasis. An improved understanding of the pathological mechanisms involved will result in greater specificity and success of therapies for patients with HCM.
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Affiliation(s)
- Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Schittenhelmstrasse 12, 24105 Kiel, Germany
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Pan XD, Zeng ZH, Liang LY, Luo JD, Xiao AY, Lai Q, Wen YH, Lu DF, Wang W, He ZC, He WK. The Effects of Simvastatin on Left Ventricular Hypertrophy and Left Ventricular Function in Patients with Essential Hypertension. Clin Exp Hypertens 2011; 33:558-64. [DOI: 10.3109/10641963.2011.577486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ashrafian H, McKenna WJ, Watkins H. Disease pathways and novel therapeutic targets in hypertrophic cardiomyopathy. Circ Res 2011; 109:86-96. [PMID: 21700950 DOI: 10.1161/circresaha.111.242974] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As described in earlier reviews in this series on the molecular basis of hypertrophic cardiomyopathy (HCM), HCM is one of the archetypal monogenic cardiovascular disorders to be understood at the molecular level. Twenty years after the discovery of the first HCM disease gene, genetic studies still confirm that HCM is principally a disease of the sarcomere. At the biophysical level, myofilament mutations generally enhance Ca(2+) sensitivity, maximal force production, and ATPase activity. These defects ultimately appear to converge on energy deficiency and altered Ca(2+) handling as major common paths leading to the anatomic (hypertrophy, myofiber disarray, and fibrosis) and functional features (pathological signaling and diastolic dysfunction) characteristic of HCM. In this review, we provide an account of the consequences of HCM mutations and describe how specifically targeting these molecular features has already yielded early promise for novel therapies for HCM. Although substantial efforts are still required to understand the molecular link between HCM mutations and their clinical consequences, HCM endures as an exemplar of how novel insights derived from molecular characterization of Mendelian disorders can inform the understanding of biological processes and translate into rational therapies.
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Affiliation(s)
- Houman Ashrafian
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
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Abstract
Understanding the genetic basis of hypertrophic cardiomyopathy (HCM) provides a remarkable opportunity to predict and prevent disease. HCM is caused by mutations in sarcomere genes and is the most common monogenic cardiovascular disorder. Although unexplained left ventricular hypertrophy (LVH) is considered diagnostic, LVH is not always present. LV wall thickness is often normal until adolescence or later, even in individuals known to carry pathogenic sarcomere mutations. In contrast, genetic testing can identify both individuals who carry pathogenic sarcomere mutations and have a clinical diagnosis of HCM, as well as mutation carriers who have not yet manifest LVH but are at very likely to develop disease. Studying this important new patient subset, designated early or preclinical HCM, allows characterization of the initial consequences of sarcomere mutations, prior to the onset of overt hypertrophic remodeling. Such study has defined novel early phenotypes, including impaired left ventricular relaxation, myocardial energetic deficiencies, and altered collagen metabolism, in mutation carriers with apparently normal cardiac morphology. These results indicate that sarcomere mutations have substantial impact on myocardial function and biochemistry before the onset of frank hypertrophy. Furthermore, animal models of preclinical HCM have identified promising new treatment strategies that may diminish the emergence of overt disease. We can now begin to reshape the paradigm for treating genetic disorders. With improved mechanistic insight and the capability for early diagnosis, genetic advances can lead to new approaches for disease modification and prevention.
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Nagueh SF, Lombardi R, Tan Y, Wang J, Willerson JT, Marian AJ. Atorvastatin and cardiac hypertrophy and function in hypertrophic cardiomyopathy: a pilot study. Eur J Clin Invest 2010; 40:976-83. [PMID: 20629707 DOI: 10.1111/j.1365-2362.2010.02349.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic paradigm of cardiac hypertrophy. Cardiac hypertrophy is a major determinant of risk of sudden death and morbidity in HCM. Treatment with statins reverses hypertrophy in animal models of HCM. Thus, statins may afford therapeutic benefits in HCM. METHODS We performed a feasibility study with atorvastatin to gather the pre-requisite data for designing randomized efficacy studies. RESULTS We screened 32 patients with HCM in 18months. Twenty-one patients met the study criteria and consented to participate. The demographics and echocardiographic phenotype of those who did and those who did not participate were not significantly different. We treated the participants with escalating doses of atorvastatin (20, 40 and 80mgday(-1) ) for 2years. We performed ECG and echocardiography and measured plasma lipids, liver enzymes, creatine kinase and B-type natriuretic peptide levels before and after 3, 6, 12 and 24months of therapy. Fifteen, 12 and 11 patients completed 6, 12 and 24months of therapy respectively. Six patients discontinued atorvastatin because of perceived lack of benefit. We stopped atorvastatin in 4 patients because of modest elevations in liver enzymes, creatine kinase or back pain. The characteristics of those who did or did not complete the study were not significantly different. The mean plasma low-density lipoprotein-cholesterol level was reduced by 55%. However, echocardiographic indices of cardiac hypertrophy and function remained unchanged. CONCLUSIONS The findings illustrated the challenges that will be encountered in designing efficacy studies to test the potential beneficial effects of atorvastatin in human HCM.
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Affiliation(s)
- Sherif F Nagueh
- The Methodist-DeBakey Heart Center, The Methodist Hospital Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA
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Rokutan H, Anker SD, Springer J. In vivomodels of cardiac diseases: application to drug development and screening. Expert Opin Drug Discov 2009; 5:65-78. [DOI: 10.1517/17460440903460299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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28
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Experimental therapies in hypertrophic cardiomyopathy. J Cardiovasc Transl Res 2009; 2:483-92. [PMID: 20560006 DOI: 10.1007/s12265-009-9132-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 09/16/2009] [Indexed: 12/31/2022]
Abstract
The quintessential clinical diagnostic phenotype of human hypertrophic cardiomyopathy (HCM) is primary cardiac hypertrophy. Cardiac hypertrophy is also a major determinant of mortality and morbidity including the risk of sudden cardiac death (SCD) in patients with HCM. Reversal and attenuation of cardiac hypertrophy and its accompanying fibrosis is expected to improve morbidity as well as decrease the risk of SCD in patients with HCM.The conventionally used pharmacological agents in treatment of patients with HCM have not been shown to reverse or attenuate established cardiac hypertrophy and fibrosis. An effective treatment of HCM has to target the molecular mechanisms that are involved in the pathogenesis of the phenotype. Mechanistic studies suggest that cardiac hypertrophy in HCM is secondary to activation of various hypertrophic signaling molecules and, hence, is potentially reversible. The hypothesis is supported by the results of genetic and pharmacological interventions in animal models. The results have shown potential beneficial effects of angiotensin II receptor blocker losartan, mineralocorticoid receptor blocker spironolactone, 3-hydroxy-3-methyglutaryl-coenzyme A reductase inhibitors simvastatin and atorvastatin, and most recently, N-acetylcysteine (NAC) on reversal or prevention of hypertrophy and fibrosis in HCM. The most promising results have been obtained with NAC, which through multiple thiol-responsive mechanisms completely reversed established cardiac hypertrophy and fibrosis in three independent studies. Pilot studies with losartan and statins in humans have established the feasibility of such studies. The results in animal models have firmly established the reversibility of established cardiac hypertrophy and fibrosis in HCM and have set the stage for advancing the findings in the animal models to human patients with HCM through conducting large-scale efficacy studies.
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Shephard R, Semsarian C. Role of animal models in HCM research. J Cardiovasc Transl Res 2009; 2:471-82. [PMID: 20560005 DOI: 10.1007/s12265-009-9120-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/17/2009] [Indexed: 10/25/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a complex cardiovascular genetic disorder characterized by marked clinical and genetic heterogeneity. Major advances have been made in the clinical characterization of patients with HCM and in identifying causative gene mutations. However, many questions remain regarding the underlying disease mechanisms. Furthermore, in a disease where no pharmacological treatments currently exists which can either prevent or cause regression of disease, processes to identify novel therapies are the crucial next steps. Animal models of HCM have already proved to be universally useful in confirming gene causation and dissecting out key molecular pathways involved in the development of HCM and its sequelae, including heart failure and sudden death. These findings have led to studies in animal models investigating novel therapeutic approaches in HCM, specifically targeting the development and progression of cardiac hypertrophy, fibrosis, and heart failure. This review will provide a brief summary of some of the key animal models of HCM and how these models have been utilized to understand disease mechanisms and to investigate new potential therapies. Ongoing studies using animal models of HCM will lead to a greater understanding of disease pathogenesis and will facilitate the translation of these findings to improved clinical outcomes in HCM patients.
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Affiliation(s)
- Rhian Shephard
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Locked Bag 6, Newtown, Sydney, NSW, 2042, Australia
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Bos JM, Towbin JA, Ackerman MJ. Diagnostic, prognostic, and therapeutic implications of genetic testing for hypertrophic cardiomyopathy. J Am Coll Cardiol 2009; 54:201-11. [PMID: 19589432 DOI: 10.1016/j.jacc.2009.02.075] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/20/2009] [Accepted: 02/24/2009] [Indexed: 02/05/2023]
Abstract
Over the last 2 decades, the pathogenic basis for the most common heritable cardiovascular disease, hypertrophic cardiomyopathy (HCM), has been investigated extensively. Affecting approximately 1 in 500 individuals, HCM is the most common cause of sudden death in young athletes. In recent years, genomic medicine has been moving from the bench to the bedside throughout all medical disciplines including cardiology. Now, genomic medicine has entered clinical practice as it pertains to the evaluation and management of patients with HCM. The continuous research and discoveries of new HCM susceptibility genes, the growing amount of data from genotype-phenotype correlation studies, and the introduction of commercially available genetic tests for HCM make it essential that the modern-day cardiologist understand the diagnostic, prognostic, and therapeutic implications of HCM genetic testing.
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Affiliation(s)
- J Martijn Bos
- Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota 55905, USA
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Cambronero F, Marín F, Roldán V, Hernández-Romero D, Valdés M, Lip GYH. Biomarkers of pathophysiology in hypertrophic cardiomyopathy: implications for clinical management and prognosis. Eur Heart J 2009; 30:139-51. [PMID: 19136482 DOI: 10.1093/eurheartj/ehn538] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The study of biomarkers and their signalling pathways has allowed the development of new therapeutic strategies in a range of disorders. The aim of the present systematic review is to provide an overview of different biomarkers in patients with hypertrophic cardiomyopathy that could give some insight into the pathophysiologic mechanism(s) underlying the typical clinical and histological manifestations of the disease. Several pathophysiological models are presented and discussed, including studies that have investigated these biomarkers for diagnostic and prognostic reasons, in relation to disease progression and/or mortality.
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Affiliation(s)
- Francisco Cambronero
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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