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Réant P, Bonnet G, Dubé F, Massie C, Reynaud A, Michaud M, Duchateau J, Lafitte S. Hypersynchrony in sarcomeric hypertrophic cardiomyopathy: description and mechanistic approach using multimodal electro-mechanical non-invasive cartography (HSYNC study). Front Cardiovasc Med 2024; 11:1359657. [PMID: 38911519 PMCID: PMC11193380 DOI: 10.3389/fcvm.2024.1359657] [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] [Received: 01/16/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Background Little is known about left ventricular (LV) sequences of contraction and electrical activation in hypertrophic cardiomyopathy (HCM). A better understanding of the underlying relation between mechanical and electrical activation may allow the identification of predictive response criteria to right ventricular DDD pacing in obstructive patients. Objective To describe LV mechanical and electrical activation sequences in HCM patients compared to controls. Materials and methods We prospectively studied, in 40 HCM patients (20 obstructive and 20 non-obstructive) and 20 healthy controls: (1) mechanical activation using echocardiography at rest and cardiac magnetic resonance imaging, (2) electrical activation using 3-dimensional electrocardiographic mapping (ECM). Results In echocardiography, healthy controls had a physiological apex-to-base delay (ABD) during contraction (23.8 ± 16.2 ms). Among the 40 HCM patients, 18 HCM patients presented a loss of this ABD (<10 ms, defining hypersynchrony) more frequently than controls (45% vs. 5%, p = 0.017). These patients had a lower LV end-diastolic volume (71.4 ± 9.7 ml/m2 vs. 82.4 ± 14.8 ml/m2, p = 0.01), lower native T1 values (988 ± 32 ms vs. 1,028 ± 39 ms, p = 0.001) and tended to have lower LV mass (80.7 ± 23.7 g/m2 vs. 94.5 ± 25.3 g/m2, p = 0.08) compared with HCM patients that had a physiological contraction sequence. There was no significant relation between ABD and LV outflow tract obstruction. While HCM patients with a physiological contraction sequence presented an ECM close to those encountered in controls, patients with a loss of ABD presented a particular pattern of ECM with the first potential more frequently occurring in the postero-basal region. Conclusion The LV contraction sequence can be modified in HCM patients, with a loss of the physiological ABD, and is associated with smaller LV dimensions and a particular pattern of ECM. Further research is needed to determine whether this pattern is related to an electrical substrate or is the consequence of the hypertrophied heart's specific geometry. Clinical trial registration ClinicalTrial.gov: NCT02559726.
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Affiliation(s)
- Patricia Réant
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, IHU Lyric, Bordeaux-Pessac, France
- Cardiology Department, CIC-P 1401, Bordeaux-Pessac, France
- Cardiology Department, INSERM 1045, Bordeaux, France
| | - Guillaume Bonnet
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, IHU Lyric, Bordeaux-Pessac, France
- Cardiology Department, CIC-P 1401, Bordeaux-Pessac, France
- Cardiology Department, INSERM 1045, Bordeaux, France
| | - Frédérique Dubé
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Charles Massie
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, Sacred Heart Hospital of Montreal, Montreal, QC, Canada
| | - Amélie Reynaud
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Matthieu Michaud
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, CIC-P 1401, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, IHU Lyric, Bordeaux-Pessac, France
| | - Stéphane Lafitte
- Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- Cardiology Department, University of Bordeaux, Bordeaux, France
- Cardiology Department, IHU Lyric, Bordeaux-Pessac, France
- Cardiology Department, CIC-P 1401, Bordeaux-Pessac, France
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Pavri BB. Helping the hypertrophied (but nonobstructed) heart. Heart Rhythm 2023; 20:1314-1315. [PMID: 37247687 DOI: 10.1016/j.hrthm.2023.05.029] [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: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Behzad B Pavri
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
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3
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Yang W, Wu T, Wu Y, Xu J, Jiang Z, Zhou X, Shan Q. Left Bundle Branch Pacing for Bradycardia in Non-obstructive Hypertrophic Cardiomyopathy Patients: Feasibility, Safety, and Effect. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07440-5. [PMID: 36847900 DOI: 10.1007/s10557-023-07440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Left bundle branch pacing (LBBP) is as an innovative physiological pacing approach. The research on LBBP in non-obstructive hypertrophic cardiomyopathy (NOHCM) patients is scarce. This study aimed to assess the feasibility, safety, and effect of LBBP in bradycardia NOHCM patients with permanent pacemaker (PPM) implantation indication. METHODS Thirteen consecutive patients with NOHCM who received LBBP were retrospectively enrolled as a hypertrophic cardiomyopathy (HCM) group. Following 1:3 matching, 39 patients without HCM were randomly matched as a control group. Echocardiographic index and pacing parameters were collected. RESULTS The successful LBBP was achieved in 96.2% of all cases (50/52), and the success rate of the HCM group was 92.3% (12/13). In the HCM group, the paced QRS duration (from the pacing stimulus to QRS end) was 145.6±20.8 ms. The stimulus to left ventricular activation time (s-LVAT) was 87.4±15.2 ms. In the control group, the paced QRS duration was 139.4±17.2 ms, and the s-LVAT was 79.9±14.1 ms. During the implantation, R-wave sensing and the pacing threshold of the HCM group were significantly higher than the control group (20.2±10.5 vs 12.5±5.9 mV, P < 0.05; 0.8±0.3 vs 0.6±0.2V/0.4 ms, P < 0.05). In addition, the fluoroscopic duration and procedural duration were longer in the HCM group (14.8±8.3 vs 10.3±6.6min, P = 0.07; 131.8±50.5 vs 101.4±41.6 min, P < 0.05). The lead insertion depth was 15±2 mm in the HCM group, and no procedure-related complications occurred. During the 12-month follow-up, pacing parameters remained stable and were of no significance in the two groups. The cardiac function did not deteriorate, and the left ventricular outflow tract gradient (LVOTG) did not increase in the follow-up. CONCLUSION LBBP might be feasible and safe for NOHCM patients with conventional bradycardia pacing indication, and there is no deterioration in cardiac function and LVOTG of patients with NOHCM.
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Affiliation(s)
- Wen Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Tian Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Yixian Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Jiayi Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Zhixin Jiang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Xiujuan Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China.
| | - Qijun Shan
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China.
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Lebowitz S, Kowalewski M, Raffa GM, Chu D, Greco M, Gandolfo C, Mignosa C, Lorusso R, Suwalski P, Pilato M. Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review. J Clin Med 2022; 11:3405. [PMID: 35743475 PMCID: PMC9225325 DOI: 10.3390/jcm11123405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hypertrophic obstructive cardiomyopathy (HOCM) is a heterogeneous disease with different clinical presentations, albeit producing similar dismal long-term outcomes if left untreated. Several approaches are available for the treatment of HOCM; e.g., alcohol septal ablation (ASA) and surgical myectomy (SM). The objectives of the current review were to (1) discuss the place of the standard invasive treatment modalities (ASA and SM) for HOCM; (2) summarize and compare novel techniques for the management of HOCM; (3) analyze current guidelines addressing HOCM management; and (4) offer suggestions for the treatment of complex HOCM presentations. METHODS We searched the literature and attempted to gather the most relevant and impactful available evidence on ASA, SM, and other invasive means of treatment of HOCM. The literature search yielded thousands of results, and 103 significant publications were ultimately included. RESULTS We critically analyzed available guidelines and provided context in the setting of patient selection for standard and novel treatment modalities. This review offers the most comprehensive analysis to-date of available invasive treatments for HOCM. These include the standard treatments, SM and ASA, as well as novel treatments such as dual-chamber pacing and radiofrequency catheter ablation. We also account for complex pathoanatomic presentations and current guidelines to offer suggestions for tailored care of patients with HOCM. Finally, we consider promising future therapies for HOCM. CONCLUSIONS HOCM is a heterogeneous disease associated with poor outcomes if left untreated. Several strategies for treatment of HOCM are available but patient selection for the procedure is crucial.
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Affiliation(s)
- Steven Lebowitz
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Mariusz Kowalewski
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6200 MD Maastricht, The Netherlands;
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 00-213 Warsaw, Poland;
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 87-100 Bydgoszcz, Poland
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy; (G.M.R.); (M.G.); (C.G.); (C.M.); (M.P.)
| | - Danny Chu
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center Heart & Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Matteo Greco
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy; (G.M.R.); (M.G.); (C.G.); (C.M.); (M.P.)
| | - Caterina Gandolfo
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy; (G.M.R.); (M.G.); (C.G.); (C.M.); (M.P.)
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy; (G.M.R.); (M.G.); (C.G.); (C.M.); (M.P.)
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6200 MD Maastricht, The Netherlands;
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 00-213 Warsaw, Poland;
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy; (G.M.R.); (M.G.); (C.G.); (C.M.); (M.P.)
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Moreno Garijo J, Ibáñez C, Perdomo JM, Abel MD, Meineri M. Preintervention imaging and intraoperative management care of the hypertrophic obstructive cardiomyopathy patient. Asian Cardiovasc Thorac Ann 2021; 30:35-42. [PMID: 34558997 PMCID: PMC8941714 DOI: 10.1177/02184923211047126] [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] [Indexed: 11/16/2022]
Abstract
With an estimated overall mortality of less than 1 percent per year, hypertrophic cardiomyopathy, is the most common genetic cardiomyopathy. Intraoperative transesophageal echocardiography is the standard of care for assessing patients with hypertrophic obstructive cardiomyopathy undergoing surgical septal myectomy, allowing surgical planning, intraoperative hemodynamic monitoring, and postprocedural assessment of the repair, including detection of immediate complications. At various phases during surgical septal myectomy, the changing hemodynamic conditions may lead to worsening or improvement in left ventricle outflow tract obstruction by change in preload or afterload, systolic anterior motion of the mitral valve, or sympathetic stimulation. These characteristics represent unique challenges in the management of these patients, requiring a comprehensive understanding of the management of all the conditions required to decrease the left ventricle outflow tract gradient avoiding obstruction, which include the maintenance of sinus rhythm, adequate rate avoiding tachycardia and bradycardia, and avoidance of systemic hypotension preserving preload and afterload, with adequate vasoactive agents. The aim of this review is to summarize the perioperative assessment and management of patients undergoing hypertrophic obstructive myopathy surgery.
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Affiliation(s)
- Jacobo Moreno Garijo
- Department of Anesthesia and Pain Management, 33540Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Cristina Ibáñez
- Department of Anesthesiology, Hospital Clínic, 16493University of Barcelona, Barcelona, Spain
| | - Juan M Perdomo
- Department of Anesthesiology, Hospital Clínic, 16493University of Barcelona, Barcelona, Spain
| | - Martin D Abel
- Department of Anesthesiology and Perioperative Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Massimiliano Meineri
- Department of Anesthesiology and Critical Care, 40628Herzzentrum Leipzig, Leipzig, Germany
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6
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Arnold AD, Howard JP, Chiew K, Kerrigan WJ, de Vere F, Johns HT, Churlilov L, Ahmad Y, Keene D, Shun-Shin MJ, Cole GD, Kanagaratnam P, Sohaib SMA, Varnava A, Francis DP, Whinnett ZI. Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 5:321-333. [PMID: 30715300 PMCID: PMC6775860 DOI: 10.1093/ehjqcco/qcz006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
Abstract
Aims Right ventricular pacing for left ventricular outflow tract gradient reduction in hypertrophic obstructive cardiomyopathy remains controversial. We undertook a meta-analysis for echocardiographic and functional outcomes. Methods and results Thirty-four studies comprising 1135 patients met eligibility criteria. In the four blinded randomized controlled trials (RCTs), pacing reduced gradient by 35% [95% confidence interval (CI) 23.2–46.9, P < 0.0001], but there was only a trend towards improved New York Heart Association (NYHA) class [odds ratio (OR) 1.82, CI 0.96–3.44; P = 0.066]. The unblinded observational studies reported a 54.3% (CI 44.1–64.6, P < 0.0001) reduction in gradient, which was a 18.6% greater reduction than the RCTs (P = 0.0351 for difference between study designs). Observational studies reported an effect on unblinded NYHA class at an OR of 8.39 (CI 4.39–16.04, P < 0.0001), 450% larger than the OR in RCTs (P = 0.0042 for difference between study designs). Across all studies, the gradient progressively decreased at longer follow durations, by 5.2% per month (CI 2.5–7.9, P = 0.0001). Conclusion Right ventricular pacing reduces gradient in blinded RCTs. There is a non-significant trend to reduction in NYHA class. The bias in assessment of NYHA class in observational studies appears to be more than twice as large as any genuine treatment effect.
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Affiliation(s)
- Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Kayla Chiew
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - William J Kerrigan
- Cardiology Department, Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Felicity de Vere
- Cardiology Department, Imperial College Healthcare NHS Trust, Du Cane Road, London, UK
| | - Hannah T Johns
- University of Melbourne, Burgundy Street, Heidelberg, Victoria, Australia
| | - Leonid Churlilov
- University of Melbourne, Burgundy Street, Heidelberg, Victoria, Australia
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Graham D Cole
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - S M Afzal Sohaib
- Cardiology Department, St Bartholomew's Hospital, W Smithfield, London, UK
| | - Amanda Varnava
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
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Savarimuthu S, Harky A. Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy. J Card Surg 2020; 35:2017-2024. [PMID: 32652778 DOI: 10.1111/jocs.14815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Affecting 1 in 500 individuals; hypertrophic cardiomyopathy is an autosomal dominant cardiovascular disorder which is prevalent throughout the world. Surgical myectomy (SM) and alcohol septal ablation (ASA) are two methods currently used for the management of drug refractory hypertrophic obstructive cardiomyopathy (HOCM). ASA may prove to be a useful, less invasive treatment in patients with HOCM METHODS: Electronic literature search was conducted to identify articles that discussed methods to treat drug refractory HOCM. No limits were placed on timing of the publication or the type of article. Keywords and MeSH terms were used and the results were summarized in the relevant section. RESULTS Current evidence suggests that alcohol septal ablation is a safe and effective procedure in treating patients with HOCM with similar short- and long-term outcomes when compared with SM. CONCLUSION ASA has been shown to be a safe and reliable procedure; imaging techniques and dedicated multi-disciplinary teams can be used to select patients with HOCM. Though SM is recommended as gold standard treatment for drug refractory HOCM, ASA may play an increasing role in the near future due an ageing population; both ASA and SM can have a beneficial role in treating those who are affected by HOCM when the appropriate group of patients are selected for each intervention.
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Affiliation(s)
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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Malcolmson JW, Guttmann OP. Pacemaker therapy for hypertrophic obstructive cardiomyopathy: unresolved contradictions between observational and randomized studies. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:281-282. [PMID: 30907927 DOI: 10.1093/ehjqcco/qcz017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- James W Malcolmson
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.,The Heart Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Oliver P Guttmann
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.,Institute of Cardiovascular Science, University College London, Gower Street, London, UK
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Javidgonbadi D, Abdon NJ, Andersson B, Schaufelberger M, Östman-Smith I. Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions. Europace 2019; 20:1683-1691. [PMID: 29121221 PMCID: PMC6182309 DOI: 10.1093/europace/eux331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022] Open
Abstract
Aims Examination of long-term results following different treatments in hypertrophic obstructive cardiomyopathy (HOCM) in a complete geographical cohort. Methods and results HOCM patients attending during 2002–13 in all 10 hospitals in the West Götaland Region, Sweden, were identified (n = 251), follow-up 14.4 (±8.9) years (mean ± SD), 121 managed medically, 42 treated with myectomy and 88 with short atrioventricular (AV) delay pacing as first interventional procedure. Post-intervention follow-up was 12.9 ± 8.7 years and 12.2 ± 5.0 years, respectively. Both intervention treatments improved New York Heart Association (NYHA) class and outflow gradients significantly. Patients treated with pacing were older (median age 64 vs. 43 years, P < 0.001). Freedom from disease-related death post-procedure at 5, 10, and 20 years were 93%, 80%, 56% vs. 93%, 93%, 57% in pacing and myectomy groups, respectively (log-rank P = 0.43). Survival after diagnosis was not different in patients just treated conservatively (P = 0.51 pacing/conservative; P = 0.39 myectomy/conservative). Reintervention for outflow gradients in patients ≥18 years at procedure occurred in 3.5% in pacing group and 15.6% in myectomy group (P = 0.007). Pacing therapy was equally effective in patients aged 13–64 years (n = 44), as in patients ≥65 years (n = 44): resting gradient pre-procedure and at last follow-up were median (IQR) 65 (71) and 12 (20) mmHg for <65 year-olds (P < 0.001), and 75 (64) and 14 (38) mmHg, respectively, for ≥65 year-olds (P < 0.001). New York Heart Association class improved significantly in both age ranges to 1.6 ± 0.6 and 1.8 ± 0.7, respectively (P < 0.001; P < 0.001). Conclusion Short AV delay pacing provided lasting satisfactory relief of symptoms and outflow obstruction in the majority of patients, with low risk of requiring reintervention. Our findings support the view that pacing therapy should be considered a valid option to treat patients with HOCM.
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Affiliation(s)
- Davood Javidgonbadi
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B, Gothenburg, Sweden
| | - Nils-Johan Abdon
- Formerly Department of Medicine, Uddevalla Hospital, Fjällvägen 9, Uddevalla, Sweden (retired)
| | - Bert Andersson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B, Gothenburg, Sweden
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Rondvägen 10, Gothenburg, Sweden
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11
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Daubert C, Gadler F, Mabo P, Linde C. Pacing for hypertrophic obstructive cardiomyopathy: an update and future directions. Europace 2017; 20:908-920. [DOI: 10.1093/europace/eux131] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/18/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Claude Daubert
- Faculté de Médecine, Université de Rennes 1, France
- LTSI INSERM U1099, Rennes, France
| | - Fredrik Gadler
- Karolinska University Hospital, Heart and Vascular Theme, FoU Tema Hjärta Kärl S102, S- 17176 Stockholm, Sweden
- Karolinska Institutet, Department of Medicine, Stockholm, Sweden
| | - Philippe Mabo
- Faculté de Médecine, Université de Rennes 1, France
- LTSI INSERM U1099, Rennes, France
- Service de Cardiologie et Maladies vasculaires, Centre Hospitalier Universitaire de Rennes 35033, France
| | - Cecilia Linde
- Karolinska University Hospital, Heart and Vascular Theme, FoU Tema Hjärta Kärl S102, S- 17176 Stockholm, Sweden
- Karolinska Institutet, Department of Medicine, Stockholm, Sweden
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13
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King P, Flaker G, Weachter R, Chockalingam A. Dobutamine-induced midcavitary gradients do not cause dyspnea. HeartRhythm Case Rep 2015; 2:74-75. [PMID: 28491637 PMCID: PMC5412635 DOI: 10.1016/j.hrcr.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Phillip King
- University of Missouri Division of Cardiology, Columbia, Missouri
| | - Greg Flaker
- University of Missouri Division of Cardiology, Columbia, Missouri
| | - Richard Weachter
- University of Missouri Division of Cardiology, Columbia, Missouri
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Duchateau J, Cornolle C, Peyrou J, Ritter P, Pillois X, Réant P, Reynaud A, Landelle M, Lafitte S. Abnormal left ventricular contraction sequence in hypertrophic cardiomyopathy patients: first description of hypersynchrony and invert synchrony. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1632-1639. [PMID: 25747939 DOI: 10.1016/j.ultrasmedbio.2015.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to compare left ventricular contraction sequence in patients with hypertrophic cardiomyopathy (HCM) and healthy controls. Normal left ventricular contraction sequence in healthy controls exhibits an apex-to-base delay (ABD) contributing to efficient cardiac mechanics (physiologic asynchrony). Echocardiographic data from 20 controls and 40 HCM patients were prospectively analyzed. Endocardial longitudinal and circumferential strains and ABD were measured using custom-built software. HCM patients had increased circumferential (-36.4 ± 6.0 vs. -32.9 ± 5.0, p < 0.01) and decreased longitudinal (-19.3 ± 6.4 vs. -23.4 ± 5.7, p < 0.01) strains. In controls, physiologic ABD was observed (35.7 ± 18.1 ms). This delay was reduced in HCM patients (5.5 ± 22.7 ms, p < 0.01 vs. controls). There was no interaction between ABD and common clinical or echocardiographic parameters in the HCM population. Left ventricular contraction sequence can be modified in HCM patients, with the loss of the physiologic ABD. This phenomenon is independent from commonly measured parameters.
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Affiliation(s)
- Josselin Duchateau
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Claire Cornolle
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Jérome Peyrou
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Philippe Ritter
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Xavier Pillois
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Patricia Réant
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Amélie Reynaud
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Mathieu Landelle
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France
| | - Stéphane Lafitte
- Unité des cardiopathies valvulaires et laboratoire d'échocardiographie, Hôpital Cardiologique du Haut Lévèque, Pessac, France.
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Seki A, Nishii K, Hagiwara N. Gap junctional regulation of pressure, fluid force, and electrical fields in the epigenetics of cardiac morphogenesis and remodeling. Life Sci 2014; 129:27-34. [PMID: 25447447 DOI: 10.1016/j.lfs.2014.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/16/2014] [Accepted: 10/29/2014] [Indexed: 01/25/2023]
Abstract
Epigenetic factors of pressure load, fluid force, and electrical fields that occur during cardiac contraction affect cardiac development, morphology, function, and pathogenesis. These factors are orchestrated by intercellular communication mediated by gap junctions, which synchronize action potentials and second messengers. Misregulation of the gap junction protein connexin (Cx) alters cardiogenesis, and can be a pathogenic factor causing cardiac conduction disturbance, fatal arrhythmia, and cardiac remodeling in disease states such as hypertension and ischemia. Changes in Cx expression can occur even when the DNA sequence of the Cx gene itself is unaltered. Posttranslational modifications might reduce arrhythmogenic substrates, improve cardiac function, and promote remodeling in a diseased heart. In this review, we discuss the epigenetic features of gap junctions that regulate cardiac morphology and remodeling. We further discuss potential clinical applications of current knowledge of the structure and function of gap junctions.
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Affiliation(s)
- Akiko Seki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Support Center for Women Health Care Professionals and Researchers, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Kiyomasa Nishii
- Department of Anatomy and Neurobiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Kojima T, Imai Y, Tsushima K, Uno K, Fujiu K, Iiri T, Nishimatsu H, Suzuki T, Sugiyama H, Asada K, Nakao T, Yamashita H, Hirata Y, Nagai R. Temporary Dual-Chamber Pacing Can Stabilize Hemodynamics During Noncardiac Surgery in a Patient With Left Ventricular Hypertrophy and Outflow Obstruction. J Cardiothorac Vasc Anesth 2014; 28:124-127. [DOI: 10.1053/j.jvca.2012.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Indexed: 11/11/2022]
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Maron BJ, Josephson ME. Long-term consequences of the right ventricular pacing mania of the 1990s for obstructive hypertrophic cardiomyopathy. Am J Cardiol 2014; 113:191-2. [PMID: 24239321 DOI: 10.1016/j.amjcard.2013.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 09/10/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
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Comparison of long-term effect of dual-chamber pacing and alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. ScientificWorldJournal 2013; 2013:629650. [PMID: 24319378 PMCID: PMC3844225 DOI: 10.1155/2013/629650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/12/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction. Nonpharmacological treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM) comprises surgical myectomy (SME), alcohol septal ablation (ASA), and dual-chamber (DDD) pacing. The aim of the study was to compare the long-term effect of DDD pacing and ASA in symptomatic HOCM patients. Patients and Methods. We evaluated retrospective data from three cardiocenters; there were 24 patients treated with DDD pacing included and 52 treated with ASA followed for 101 ± 49 and 87 ± 23 months, respectively. Results. In the group treated with DDD pacing, the left ventricle outflow tract gradient (LVOTG) decreased from 82 ± 44 mmHg to 21 ± 21 mmHg, and NYHA class improved from 2.7 ± 0.5 to 2.1 ± 0.6 (both P < 0.001). In the ASA-treated group, a decline in LVOTG from 73 ± 38 mmHg to 24 ± 26 mmHg and reduction in NYHA class from 2.8 ± 0.5 to 1.7 ± 0.8 were observed (both P < 0.001). The LVOTG change was similar in both groups (P = 0.264), and symptoms were more affected by ASA (P = 0.001). Conclusion. ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more expressed in patients treated with ASA.
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An elevated cibenzoline level interacted with cyclosporine caused ventricular tachyarrhythmia and high defibrillation threshold in hypertrophic cardiomyopathy. Int J Cardiol 2013; 168:e24-6. [DOI: 10.1016/j.ijcard.2013.05.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/04/2013] [Indexed: 11/22/2022]
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20
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 561] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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21
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Timmer SAJ, Knaapen P. Coronary microvascular function, myocardial metabolism, and energetics in hypertrophic cardiomyopathy: insights from positron emission tomography. Eur Heart J Cardiovasc Imaging 2012; 14:95-101. [DOI: 10.1093/ehjci/jes242] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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23
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Gillis AM, Russo AM, Ellenbogen KA, Swerdlow CD, Olshansky B, Al-Khatib SM, Beshai JF, McComb JM, Nielsen JC, Philpott JM, Shen WK. HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection. J Am Coll Cardiol 2012; 60:682-703. [DOI: 10.1016/j.jacc.2012.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Hypertrophic cardiomyopathy is a fascinating disease of marked heterogeneity. Hypertrophic cardiomyopathy was originally characterized by massive myocardial hypertrophy in the absence of known etiology, a dynamic left ventricular outflow obstruction, and increased risk of sudden death. It is now well accepted that multiple mutations in genes encoding for the cardiac sarcomere are responsible for the disease. Complex morphologic and pathophysiologic differences, disparate natural history studies, and novel treatment strategies underscore the challenge to the practicing cardiologist when faced with the management of the hypertrophic cardiomyopathy patient.
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25
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Katayama T, Tsuruya Y, Ishikawa S. Complete atrioventricular block and infective endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Intern Med 2012; 51:749-53. [PMID: 22466832 DOI: 10.2169/internalmedicine.51.6446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 62-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) had complete atrioventricular (AV) block and subsequent cardiac standstill. A previous electrocardiogram revealed a bifascicular block pattern. Because he also suffered from infective endocarditis of the native aortic valve, surgical therapy (dual-chamber permanent pacing, myectomy of the left ventricular outflow tract, and valve replacement) was performed. Complete AV block unrelated to a procedure is a rare complication in patients with HOCM, but it may be life-threatening. Therefore, a pre-existing cardiac conduction disturbance should be specifically recognized as the aura of a higher degree of AV block.
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Affiliation(s)
- Takuji Katayama
- Division of Cardiology, Tokyo Kita Social Insurance Hospital, Japan.
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26
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW, Jacobs AK, Smith SC, Anderson JL, Albert NM, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Krumholz HM, Kushner FG, Nishimura RA, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2011; 142:e153-203. [DOI: 10.1016/j.jtcvs.2011.10.020] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e212-60. [PMID: 22075469 DOI: 10.1016/j.jacc.2011.06.011] [Citation(s) in RCA: 825] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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28
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder. This autosomal dominant condition is defined by left ventricular hypertrophy and associated with functional limitation and premature death. In fact, many individuals are asymptomatic and the annual mortality in most modern series is 1% or less. However, severe symptoms may develop at any age, and the risk of premature death from arrhythmia, stroke, and progressive systolic impairment may complicate asymptomatic disease. The clinical management of patients with HCM therefore encompasses (1) genetic counseling including discussion of indications for genetic testing and cascade family screening, (2) assessment of prognostic risk from ventricular arrhythmia, stroke, and heart failure, and (3) symptom management. This article describes the interventional treatments in the management of severe symptoms associated with left ventricular outflow tract obstruction (LVOTO).
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Affiliation(s)
- Saidi A Mohiddin
- The Heart Muscle Disease Clinic, London Chest Hospital, Barts and The London NHS Trust, London, UK.
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29
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LENARCZYK RADOSŁAW, WOŹNIAK ALEKSANDRA, KOWALSKI OSKAR, SOKAL ADAM, PRUSZKOWSKA-SKRZEP PATRYCJA, SREDNIAWA BEATA, SZULIK MARIOLA, ZIELIŃSKA TERESA, KUKULSKI TOMASZ, STABRYŁA JOANNA, MAZUREK MICHAŁ, BIAŁKOWSKI JACEK, KALARUS ZBIGNIEW. Effect of Cardiac Resynchronization on Gradient Reduction in Patients with Obstructive Hypertrophic Cardiomyopathy: Preliminary Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1544-52. [DOI: 10.1111/j.1540-8159.2011.03193.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Abstract
Hypertrophic cardiomyopathy has important differences in children compared with adults, particularly with regard to the range of causes and the outcomes in infants. Survival is highly dependent on etiology, particularly in the youngest patients, and pursuit of the specific cause is therefore necessary. The clinical utility of defining the genotype in children with familial hypertrophic cardiomyopathy exceeds that at other ages and has a highly favorable cost/benefit ratio. Although most of the available information concerning treatment and prevention of sudden death is derived in adults, management of children requires consideration of the differences in age-specific risk/benefit ratios.
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Affiliation(s)
- Steven D Colan
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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31
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Cullington D, Esmail S, Hurren S, Cleland JGF, Clark AL, Alamgir MF. Unmasking the truth. BMJ Case Rep 2011; 2011:3193. [PMID: 22715233 DOI: 10.1136/bcr.07.2010.3193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In the emergency setting, shortness of breath is a frequent presenting complaint to physicians worldwide. The differential diagnosis is often broad and requires careful analysis of investigations to reach the correct diagnosis. The authors present a case of acute heart failure with a number of unusual presenting features that suggested an uncommon aetiology.
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Affiliation(s)
- D Cullington
- Cardiology Department, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Kingston-Upon-Hull, UK.
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32
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Abstract
With increasing awareness of the condition and particular attention being paid to family screening, the number of patients being diagnosed with hypertrophic cardiomyopathy is increasing. Although the majority of patients remain at low risk for sudden cardiac death, all patients need to undergo rigorous and ongoing risk factor stratification in order to best identify those at high risk. Although implantable cardioverter-defibrillators have proven to be effective in the prevention of sudden cardiac death, careful consideration of device implantation in high-risk patients is necessary in view of the potential for device complications and their impact on quality of life.
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34
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Zaidi Q, Zaky H, Aljassim O. Pacing for hypertrophic obstructive cardiomyopathy does it work? J Saudi Heart Assoc 2009; 21:165-7. [PMID: 23960567 DOI: 10.1016/j.jsha.2009.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 06/07/2009] [Indexed: 10/20/2022] Open
Abstract
Sixty-nine years old lady presented with sudden cardiac arrest, she was found to have hypertrophic obstructive cardiomyopathy, she refused septal myomectomy and had a dual chamber ICD implanted, she was put on right ventricular apical pacing with short AV interval, after pacing her max pressure gradient across left ventricular out flow tract (LVOT) dropped from 117 mmHg to 21 mmHg and her symptoms much improved over a follow up period of 1 year.
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Affiliation(s)
- Q Zaidi
- Cardiology and Cardiothoracic Surgery Center, Dubai Hospital, P.O. Box 21910, Dubai, United Arab Emirates
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35
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Mathew V, Chaliki H, Nishimura RA. Atrioventricular sequential pacing in cardiac amyloidosis: an acute Doppler echocardiographic and catheterization hemodynamic study. Clin Cardiol 2009; 20:723-5. [PMID: 9259166 PMCID: PMC6655520 DOI: 10.1002/clc.4960200811] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Congestive heart failure due to cardiac amyloidosis is often refractory to conventional medical management and is associated with a high mortality rate. Recently, dual-chamber pacemaker implantation has been proposed as a therapeutic option in the management of patients with certain forms of cardiomyopathy with persistent heart failure symptoms, despite optimal medical therapy. The present study evaluates the acute hemodynamic response to atrioventricular (AV) pacing in patients with cardiac amyloidosis who presented with refractory heart failure symptoms. METHODS Three patients with medically refractory heart failure due to cardiac involvement of amyloidosis underwent a simultaneous cardiac catheterization/Doppler echocardiography study with acute AV sequential pacing at varying AV intervals. RESULTS During pacing at various AV intervals, all patients showed an increased in their filling pressures and either no change or decline in their cardiac index. CONCLUSION The current study demonstrates an absence of acute hemodynamic with AV sequential pacing in patients with amyloid heart disease and medically refractory heart failure symptoms.
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Affiliation(s)
- V Mathew
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Graham-Cryan MA, Rowe G, Hathaway L, Biddle S, Tripodi D, Fananapazir L. Obstructive Hypertrophic Cardiomyopathy. ACTA ACUST UNITED AC 2008; 19:133-40. [PMID: 15539974 DOI: 10.1111/j.0889-7204.2003.03400.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a primary disease of cardiac muscle characterized by a thickening of the left ventricular wall and often predominantly affecting the interventricular septum. This paper presents a case study of a 53-year-old female with a dynamic and obstructive form of HCM. The study includes a case presentation, clinical findings, investigations, and management. Patient findings were obtained before and after alcohol septal ablation, a novel interventional therapy. The article reviews the various forms of HCM and describes the currently available treatment modalities for obstructive HCM. Further research will be necessary to determine the comparative efficacy between past, present, and future therapies.
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Affiliation(s)
- Melissa A Graham-Cryan
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive MSC 1650, Room 7B-15, Bethesda, MD 20892-1650, USA.
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Clinical and Echocardiographic Variables Fail to Predict Response to Dual-Chamber Pacing for Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2008; 21:796-800. [DOI: 10.1016/j.echo.2007.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Indexed: 11/24/2022]
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38
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1101] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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39
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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Benditt DG, Sakaguchi S. Syncope. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Komsuoglu B, Vural A, Agacdiken A, Ural D. Effect of biventricular pacing on left ventricular outflow tract pressure gradient in a patient with hypertrophic cardiomyopathy and normal interventricular conduction. J Cardiovasc Electrophysiol 2006; 17:207-9. [PMID: 16533259 DOI: 10.1111/j.1540-8167.2005.00291.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of hypertrophic obstructive cardiomyopathy (HOCM) that was markedly improved by biventricular pacing. A 55-year-old woman with HOCM presented with palpitation and presyncope. Electrophysiologic study revealed an atrioventricular nodal reentrant tachycardia. After radiofrequency catheter ablation, a Mobitz type II atrioventricular block developed and a permanent pacemaker implantation was decided. Cardiac catheterization showed a left ventricular outflow tract (LVOT) gradient of 130 mmHg. Right dual-chamber and atrial-synchronous left ventricular epicardial pacing failed to reduce the gradient. After biventricular pacing, LVOT gradient decreased to 20 mmHg. Biventricular pacing may be an alternative therapy for patients with HOCM.
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Affiliation(s)
- Baki Komsuoglu
- Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
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43
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Topilski I, Sherez J, Keren G, Copperman I. Long-term effects of dual-chamber pacing with periodic echocardiographic evaluation of optimal atrioventricular delay in patients with hypertrophic cardiomyopathy >50 years of age. Am J Cardiol 2006; 97:1769-75. [PMID: 16765132 DOI: 10.1016/j.amjcard.2006.01.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 01/02/2006] [Accepted: 01/02/2006] [Indexed: 11/23/2022]
Abstract
Various treatment modalities have been introduced to reduce the subaortic pressure gradient in patients with obstructive hypertrophic cardiomyopathy, including pacemaker insertion. Complete ventricular capture during pacing is essential and requires optimization of the atrioventricular interval (AVI). In this study, a protocol using echocardiographic examination assessing the changes in the left ventricular outflow tract (LVOT) gradient in different AVIs, pacing rates, and pacing modes was used for optimal pacemaker programming. Twenty-five patients with obstructive hypertrophic cardiomyopathy were implanted with DDD pacemakers and evaluated prospectively. The LVOT gradient was measured during periodic evaluations every 3 to 6 months. Gradient measurements were done with 5 different AVIs and 3 different rate combinations. After each evaluation, the optimal AVI, pacing rate, and mode were set on the basis of the minimal LVOT gradient not associated with systolic arterial cuff pressure reduction. Follow-up ranged from 18 to 126 months. Peak LVOT gradient immediately decreased in 92% of patients. During follow-up, the optimal AVI was prolonged in most patients. Sixty-four percent of patients showed a clear relation between pacemaker modifications and gradient reduction. In 75% of these patients, optimal gradient reduction required repeated AVI and pacing rate programming on the basis of echocardiographic evaluation. Symptoms decreased in 92% of patients, and New York Heart Association class improved significantly (3.1+/-0.7 vs 1.3+/-0.4, p<0.001) during follow-up. The symptomatic reduction was positively correlated with the LVOT gradient reduction. In conclusion, DDD pacing is effective in reducing the LVOT gradient and improving functional capacity in adult patients with hypertrophic cardiomyopathy. Pacemaker programming with the periodic echocardiographic evaluation of the optimal AVI, pacing rate, and mode is imperative for optimal results.
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Affiliation(s)
- Ian Topilski
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Hozumi T, Ito T, Suwa M, Sakai Y, Kitaura Y. Effects of dual-chamber pacing on regional myocardial deformation in patients with hypertrophic obstructive cardiomyopathy. Circ J 2005; 70:63-8. [PMID: 16377926 DOI: 10.1253/circj.70.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study examined the effects of dual-chamber pacing (DDD) on regional myocardial deformation, as determined by echocardiographic strain and strain rate (SR) imaging, in patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS Fourteen patients (11 men, 3 women; mean age 55 +/-16 years) who had been on long-term DDD (mean period 7.4 +/- 2.1 years) underwent strain and SR imaging. Before and after DDD, the peak strain (%) and SR (s(-1)) during systole were assessed in 8 segments in 4 left ventricular (LV) walls. With DDD turned on, peak strain and SR were significantly increased in the basal anteroseptal (strain -10.2 +/- 6.8 to -1.0 +/- 6.4, p<0.005; SR -0.76 +/- 0.46 to 0.05 +/- 0.58, p<0.001) and septal segments (strain -11.2 +/- 8.9 to -2.2 +/- 7.7, p<0.005; SR -0.85 +/- 0.54 to -0.19 +/- 0.75, p<0.05), but not in the basal posterior (strain -15.0 +/- 13.0 to -13.4 +/- 9.2, p=NS; SR -1.37 +/- 0.57 to -1.93 +/- 0.65, p=NS) and lateral segments (strain -18.1 +/- 10.2 to -15.7 +/- 5.6, p=NS; SR -1.33 +/- 0.68 to -0.84 +/- 0.88, p=NS). These findings were associated with a modest, but significant, change in the LV pressure gradient (24 +/- 12 mmHg to 14 +/- 7 mmHg, p<0.001). CONCLUSIONS In patients with HOCM, DDD appeared to produce myocardial lengthening in the basal septum during systole, which may have implications for the mechanism of reducing LV outflow obstruction during DDD.
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Affiliation(s)
- Tomomi Hozumi
- Third Division, Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
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Ito T, Suwa M, Sakai Y, Hozumi T, Kitaura Y. Usefulness of tissue Doppler imaging for demonstrating altered septal contraction sequence during dual-chamber pacing in obstructive hypertrophic cardiomyopathy. Am J Cardiol 2005; 96:1558-62. [PMID: 16310440 DOI: 10.1016/j.amjcard.2005.07.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 07/06/2005] [Accepted: 07/06/2005] [Indexed: 11/24/2022]
Abstract
Dual-chamber pacing reduces left ventricular (LV) outflow obstruction in patients with obstructive hypertrophic cardiomyopathy (HC), the mechanism of which lies in pacing-induced paradoxic septal motion. This study was conducted to test the hypothesis that tissue Doppler imaging (TDI) could demonstrate changes in the septal contraction sequence during dual-chamber pacing in patients with HC. TDI was performed in 16 patients (5 women; mean age 63+/-11 years) who underwent dual-chamber pacing for 7.6+/-2.1 year. With and without pacing, the time to peak systolic myocardial velocity was measured from the basal, mid, and distal segments in the 4 different LV walls. Without pacing, there was almost no longitudinal segmental asynchrony. During pacing, however, marked longitudinal segmental asynchrony appeared, especially in the anteroseptal wall (from p=NS to p<0.01 by analysis of variance) and the ventricular septum (from p<0.05 to p<0.01), with the time to peak velocity extremely prolonged at the distal segments. This was associated with a modest but significant decrease in the LV pressure gradient (from 20+/-8 to 14+/-7 mm Hg, p<0.01). In patients with obstructive HC, altered septal contraction sequence accounts for the reduced LV outflow obstruction during dual-chamber pacing, which was clearly demonstrated by TDI.
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Affiliation(s)
- Takahide Ito
- The Third Division, Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.
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Hirasawa Y, Kawai A, Niinami H, Aomi S, Nishida H, Endo M, Koyanagi H, Tanimoto K, Ishizuka N. Characteristics of hypertrophic obstructive cardiomyopathy refractory to medical treatment and selection of surgical methods. J Card Surg 2005; 20:8-15. [PMID: 15673404 DOI: 10.1111/j.0886-0440.2005.200328.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Treatment for hypertrophic obstructive cardiomyopathy (HOCM) has been reported; however, there has been no report on the characteristics of medication-responsive and -refractory hypertrophic obstructive cardiomyopathy (HOCM). Using the classification of systolic anterior movement (SAM) which has been previously reported, we tried to identify the characteristics and use them to treat HOCM appropriately. METHODS The clinical, echocardiographic, catheterization, and surgical data of 29 hospitalized patients with HOCM during 1980 to 1999 were analyzed retrospectively. We classified SAM in all patients by echocardiography. Nineteen patients improved with medical treatment (medical group), and 10 patients underwent surgical treatment because of ineffectiveness of medication (surgical group). We studied the relation between types of SAM and medical/surgical groups, and examined the relation between types of SAM and the surgical methods. RESULTS Type I SAM was significantly more frequent in the medical group, while type II SAM was more frequent in the surgical group (p = 0.047). Patients in the surgical group underwent mitral valve replacement (MVR), myectomy, or a combination of MVR and myectomy. Left ventricular outflow gradient (LVOG) of over 100 mmHg was recognized in almost all patients with type II SAM. CONCLUSIONS It was suggested that patients with medication-responsive HOCM tended to have type I SAM and those with refractory HOCM tended to have type II SAM. We consider that in type I SAM, if the position of the papillary muscles changed with medication or myectomy, shift of the chordae and type I SAM were reduced or disappeared. However, in type II SAM, even if the position of the papillary muscles changed, SAM did not disappear because lifting of the mitral leaflets remained. It is therefore suggested that patients with type II SAM should undergo at least MVR.
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Affiliation(s)
- Yujiro Hirasawa
- Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
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Yufu K, Takahashi N, Ooie T, Shigematsu S, Hara M, Sako H, Miyamoto S, Hadama T, Tsuchiya T, Honda T, Yoshimatsu H, Saikawa T. Improved hypertrophic obstructive cardiomyopathy by left ventricular apex epicardial pacing. Intern Med 2004; 43:295-9. [PMID: 15168771 DOI: 10.2169/internalmedicine.43.295] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of severe hypertrophic obstructive cardiomyopahy (HOCM) that was markedly improved by left ventricular (LV) apex epicardial pacing. A 55-year-old woman with HOCM had suffered from dyspnea. Cardiac catheter examination showed a resting pressure gradient across the LV outflow tract of 198 mmHg despite combined medication. During the examination, right dual-chamber pacing could not sufficiently reduce the pressure gradient. Therefore, we treated the patient with LV apex epicardial pacing. The procedure decreased the pressure gradient to 10 mmHg. Clinical symptoms were markedly improved. LV apex epicardial pacing may be an alternative therapy for patients with HOCM who are refractory to other medical treatment.
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Affiliation(s)
- Kunio Yufu
- Department of Internal Medicine I, School of Medicine, Oita Medical University, Oita
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Hamada M. A new strategy for the attenuation of left ventricular pressure gradient in patients with HOCM. Intern Med 2004; 43:273-4. [PMID: 15168765 DOI: 10.2169/internalmedicine.43.273] [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] [Indexed: 11/06/2022] Open
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Ohtani K, Satoh A, Eto S, Satoh T, Ichinose K, Satoh S, Takahashi T, Koda M, Kinjo M, Yonesaka S. Dual-chamber pacing in hypertrophic obstructive cardiomyopathy with biventricular outflow tract obstruction and severe drug-refractory symptoms in a 9-year-old girl. Pediatr Int 2003; 45:743-6. [PMID: 14651555 DOI: 10.1111/j.1442-200x.2003.01806.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katsuki Ohtani
- Department of Pediatric Cardiology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. ksky@
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Kovacic JC, Muller D. Hypertrophic cardiomyopathy: state-of-the-art review, with focus on the management of outflow obstruction. Intern Med J 2003; 33:521-9. [PMID: 14656256 DOI: 10.1046/j.1445-5994.2003.00475.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Significant advances in our understanding and management of hypertrophic cardiomyopathy have been made in the last decade, as the complex genetics and phenotype-genotype correlations that characterize the disease are gradually unravelled. The well-described clinical heterogeneity of hypertrophic cardiomyopathy is now understood to be based on profound genetic variability, with at least 10 genes and over 150 mutations implicated. Several new therapeutic tools have entered clinical practice. The implantable cardioverter-defibrillator is now strongly indicated in those at high risk of sudden arrhythmic death. Our ability to abort sudden death in this subgroup has placed added emphasis on risk stratification in newly diagnosed patients. New procedures have also been developed for the relief of outflow obstruction in patients with refractory symptoms and a significant subaortic outflow gradient. Although not as efficacious as the 'gold-standard' surgical myectomy-myotomy, dual-chamber pacemaker implantation can be of modest benefit in select patients. Percutaneous transluminal septal myocardial ablation is an emerging catheter-based procedure for the relief of left ventricular outflow obstruction. Long-term follow-up data are still awaited. However, intermediate-term results suggest equivalent efficacy to surgical myectomy-myotomy.
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Affiliation(s)
- J C Kovacic
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.
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