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Ito Y, Sakaguchi H, Tsuda E, Kurosaki K. Effect of beta-blockers and exercise restriction on the prevention of sudden cardiac death in pediatric hypertrophic cardiomyopathy. J Cardiol 2024; 83:407-414. [PMID: 38043708 DOI: 10.1016/j.jjcc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Risk assessment tools and effective prevention strategies for sudden cardiac death (SCD) in pediatric patients with hypertrophic cardiomyopathy (HCM) have not been established. This study aimed to evaluate the efficacy of beta-blockers and exercise restriction for SCD prevention in this population. METHODS We retrospectively reviewed the medical records of patients aged <18 years who were diagnosed with HCM at our center between January 1996 and December 2021. SCD and aborted SCD were defined as SCD equivalents. We divided patients based on whether they were prescribed beta-blockers or exercise restriction and compared the outcomes among the groups. The primary outcome was the overall survival (OS), and the secondary outcome was the cumulative SCD equivalent rate. Outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazard analysis. We also compared patients according to the occurrence of SCD equivalents to identify SCD risk predictors. RESULTS Among the 43 included patients [mean age, 7.7 (1.6-12.1) years; 23 male individuals], SCD equivalents occurred in 13 patients over 11.2 (4.5-15.6) years of follow-up, among whom 12 were resuscitated and 1 died. The OS rate was significantly higher in the beta-blocker and exercise restriction groups than in the non-beta-blocker and non-exercise restriction groups (81.3 % vs. 19.1 %, p < 0.01 and 57.4 % vs. 12.7 %, p < 0.01, respectively). Among the 13 patients with SCD equivalents, 5 had 9 recurrent SCD equivalents. A significant difference was observed between the SCD equivalent and non-SCD equivalent groups in the history of suspected arrhythmogenic syncope (p < 0.01) in the univariable but not in the multivariable analysis. CONCLUSIONS Beta-blockers and exercise restriction may decrease the risk of SCD in pediatric patients with HCM and should be considered for SCD prevention in this population, particularly because predicting SCD in these patients remains challenging.
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Affiliation(s)
- Yuki Ito
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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2
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024:S0735-1097(24)00382-6. [PMID: 38727647 DOI: 10.1016/j.jacc.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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3
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Townsend M, Jeewa A, Khoury M, Cunningham C, George K, Conway J. Unique Aspects of Hypertrophic Cardiomyopathy in Children. Can J Cardiol 2024; 40:907-920. [PMID: 38244986 DOI: 10.1016/j.cjca.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a primary heart muscle disease characterized by left ventricular hypertrophy that can be asymptomatic or with presentations that vary from left ventricular outflow tract obstruction, heart failure from diastolic dysfunction, arrhythmias, and/or sudden cardiac death. Children younger than 1 year of age tend to have worse outcomes and often have HCM secondary to inborn errors of metabolism or syndromes such as RASopathies. For children who survive or are diagnosed after 1 year of age, HCM outcomes are often favourable and similar to those seen in adults. This is because of sudden cardiac death risk stratification and medical and surgical innovations. Genetic testing and timely cardiac screening are paving the way for disease-modifying treatment as gene-specific therapies are being developed.
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Affiliation(s)
- Madeleine Townsend
- Department of Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Aamir Jeewa
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Khoury
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Kristen George
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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4
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Kaski JP, Norrish G, Gimeno Blanes JR, Charron P, Elliott P, Tavazzi L, Tendera M, Laroche C, Maggioni AP, Baban A, Khraiche D, Ziolkowska L, Limongelli G, Ojala T, Gorenflo M, Anastasakis A, Mostafa S, Caforio ALP. Cardiomyopathies in children and adolescents: aetiology, management, and outcomes in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Registry. Eur Heart J 2024; 45:1443-1454. [PMID: 38427064 DOI: 10.1093/eurheartj/ehae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Childhood-onset cardiomyopathies are rare and poorly characterized. This study examined the baseline characteristics and 1-year follow-up of children with cardiomyopathy in the first European Cardiomyopathy Registry. METHODS Prospective data were collected on individuals aged 1-<18 years enrolled in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis long-term registry (June 2014-December 2016). RESULTS A total of 633 individuals aged ≤18 years with hypertrophic [HCM; n = 388 (61.3%)], dilated [DCM; n = 206 (32.5%)], restrictive [RCM; n = 28 (4.4%)], and arrhythmogenic right ventricular cardiomyopathy [ARVC; n = 11 (1.7%)] were enrolled by 23 referral centres in 14 countries. Median age at diagnosis was 4.0 [interquartile range (IQR) 0-10] years, and there was a male predominance [n = 372 (58.8%)] across all subtypes, with the exception of DCM diagnosed <10 years of age; 621 (98.1%) patients were receiving cardiac medication and 80 (12.6%) had an implantable cardioverter-defibrillator. A total of 253 patients (253/535, 47.3%) had familial disease. Genetic testing was performed in 414 (67.8%) patients with a pathogenic or likely pathogenic variant reported in 250 (60.4%). Rare disease phenocopies were reported in 177 patients (28.0%) and were most frequent in patients under 10 years [142 (30.9%) vs. 35 (19.6%); P = .003]. Over a median follow-up of 12.5 months (IQR 11.3-15.3 months), 18 patients (3.3%) died [HCM n = 9 (2.6%), DCM n = 5 (3.0%), RCM n = 4 (16.0%)]. Heart failure events were most frequent in RCM patients (36.0%). CONCLUSIONS The findings confirm the heterogeneous aetiology of childhood cardiomyopathies and show a high frequency of familial disease. Outcomes differed by cardiomyopathy subtype, highlighting a need for disease-specific evaluation and treatment.
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Affiliation(s)
- Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London Institute of Cardiovascular Science and Great Ormond Street Hospital NHS Foundation Trust, 20 Guilford Street, WC1N 1DZ London, United Kingdom
| | - Gabrielle Norrish
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London Institute of Cardiovascular Science and Great Ormond Street Hospital NHS Foundation Trust, 20 Guilford Street, WC1N 1DZ London, United Kingdom
| | | | - Philippe Charron
- Assistance Publique-Hôpitaux de Paris, ICAN, Inserm UMR1166, Sorbonne Université, Centre de Référence des Maladies Cardiaques Héréditaires ou Rares, Hôpital Pitié-Salpêtrière, Paris, France
| | - Perry Elliott
- Centre for Inherited Cardiovascular Diseases, University College London and St. Bartholomew's Hospital, London, United Kingdom
| | - Luigi Tavazzi
- Department of Cardiology, Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
- Department of Cardiology, ANMCO Research Center, Florence, Italy
| | - Anwar Baban
- Cardiogenetic Centre, Medical and Surgical Department of Pediatric Cardiology, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Diala Khraiche
- Pediatric and Congenital Cardiology Unit, Hôpital Necker Enfants Malades, M3C-Necker, Paris, France
| | - Lidia Ziolkowska
- Pediatric Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Giuseppe Limongelli
- Inherited and Heart Disease Unit, Monaldi Hospital, A.O. Colli (University of Campania 'Luigi Vanvitelli'), Naples, Italy
| | - Tiina Ojala
- Pediatric Cardiology, University of Helsinki and Helsinki University Hospital, Hospital for Children and Adolescents, Helsinki, Finland
| | - Matthias Gorenflo
- Pediatric Cardiology and Congenital Heart Diseases, University of Heidelberg, Heidelberg, Germany
| | - Aris Anastasakis
- Unit of Rare and Inherited CVD-Department of Cardiology, Kappa Unit, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Shaimaa Mostafa
- Benha Faculty of Medicine, Cardiovascular Department, Benha University, Benha, Egypt
| | - Alida L P Caforio
- Cardiology, Department of Cardiological, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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5
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Norrish G, Gasparini M, Field E, Cervi E, Kaski JP. Childhood-onset hypertrophic cardiomyopathy caused by thin-filament sarcomeric variants. J Med Genet 2024; 61:420-422. [PMID: 38296631 DOI: 10.1136/jmg-2023-109684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
Up to 20% of children with sarcomeric hypertrophic cardiomyopathy (HCM) have disease-causing variants in genes coding for thin-filament proteins. However, data on genotype-phenotype correlations for thin-filament disease are limited. This study describes the natural history and outcomes of children with thin-filament-associated HCM and compares it to thick-filament-associated disease.Longitudinal data were collected from 40 children under 18 years with a disease-causing variant in a thin-filament protein from a single quaternary referral centre. Twenty-one (female n=6, 35.5%) were diagnosed with HCM at a median age of 13.0 years (IQR 8.3-14.0). Over a median follow-up of 5.0 years (IQR 4.0-8.5), three (14.3%) experienced one or more major adverse cardiac events (MACE) (two patients had an out-of-hospital arrest and eight appropriate implantable cardiac defibrillator (ICD) therapies in three patients). One gene carrier died suddenly at age 9 years. Compared with those with thick-filament disease, children with thin-filament variants more commonly experienced non-sustained ventricular tachycardia [NSVT; n=6 (28.6%) vs n=14 (10.8%), p=0.024] or underwent ICD insertion (thin, n=13 (61.9%) vs thick, n=50 (38.5%), p=0.040). However, there was no difference in the incidence of MACE (thin 2.47/100 pt years (95% CI 0.80 to 7.66) vs thick 3.63/100 pt years (95% CI 2.25 to 5.84)) or an arrhythmic event (thin 1.65/100 pt years (95% CI 0.41 to 6.58) vs thick 2.55/100 pt years (95% CI 1.45 to 4.48), p value 0.43).This study suggests that adverse events in thin-filament disease are predominantly arrhythmic and may occur in the absence of hypertrophy, but overall short-term outcomes do not differ significantly from thick-filament disease.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Marisa Gasparini
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Ella Field
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elena Cervi
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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6
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Boleti O, Norrish G, Field E, Dady K, Summers K, Nepali G, Bhole V, Uzun O, Wong A, Daubeney PEF, Stuart G, Fernandes P, McLeod K, Ilina M, Ali MNL, Bharucha T, Donne GD, Brown E, Linter K, Jones CB, Searle J, Regan W, Mathur S, Boyd N, Reinhardt Z, Duignan S, Prendiville T, Adwani S, Kaski JP. Natural history and outcomes in paediatric RASopathy-associated hypertrophic cardiomyopathy. ESC Heart Fail 2024; 11:923-936. [PMID: 38217456 DOI: 10.1002/ehf2.14637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 01/15/2024] Open
Abstract
AIMS This study aimed to describe the natural history and predictors of all-cause mortality and sudden cardiac death (SCD)/equivalent events in children with a RASopathy syndrome and hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS This is a retrospective cohort study from 14 paediatric cardiology centres in the United Kingdom and Ireland. We included children <18 years with HCM and a clinical and/or genetic diagnosis of a RASopathy syndrome [Noonan syndrome (NS), NS with multiple lentigines (NSML), Costello syndrome (CS), cardiofaciocutaneous syndrome (CFCS), and NS with loose anagen hair (NS-LAH)]. One hundred forty-nine patients were recruited [111 (74.5%) NS, 12 (8.05%) NSML, 6 (4.03%) CS, 6 (4.03%) CFCS, 11 (7.4%) Noonan-like syndrome, and 3 (2%) NS-LAH]. NSML patients had higher left ventricular outflow tract (LVOT) gradient values [60 (36-80) mmHg, P = 0.004]. Over a median follow-up of 197.5 [inter-quartile range (IQR) 93.58-370] months, 23 patients (15.43%) died at a median age of 24.1 (IQR 5.6-175.9) months. Survival was 96.45% [95% confidence interval (CI) 91.69-98.51], 90.42% (95% CI 84.04-94.33), and 84.12% (95% CI 75.42-89.94) at 1, 5, and 10 years, respectively, but this varied by RASopathy syndrome. RASopathy syndrome, symptoms at baseline, congestive cardiac failure (CCF), non-sustained ventricular tachycardia (NSVT), and maximal left ventricular wall thickness were identified as predictors of all-cause mortality on univariate analysis, and CCF, NSVT, and LVOT gradient were predictors for SCD or equivalent event. CONCLUSIONS These findings highlight a distinct category of patients with Noonan-like syndrome with a milder HCM phenotype but significantly worse survival and identify potential predictors of adverse outcome in patients with RASopathy-related HCM.
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Affiliation(s)
- Olga Boleti
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kathleen Dady
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - Kim Summers
- Institute of Cardiovascular Science, University College London, London, UK
| | - Gauri Nepali
- The Heart Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Vinay Bhole
- The Heart Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Orhan Uzun
- Children's Heart Unit, University Hospital of Wales, Cardiff, UK
| | - Amos Wong
- Children's Heart Unit, University Hospital of Wales, Cardiff, UK
| | - Piers E F Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Precylia Fernandes
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, UK
| | | | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, UK
| | - Caroline B Jones
- Department of Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Jonathan Searle
- Children's Heart Service, Evelina Children's Hospital, London, UK
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - William Regan
- Children's Heart Service, Evelina Children's Hospital, London, UK
| | - Sujeev Mathur
- Children's Heart Service, Evelina Children's Hospital, London, UK
| | - Nicola Boyd
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, UK
| | - Zdenka Reinhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, UK
| | - Sophie Duignan
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Terence Prendiville
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
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7
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Losi MA, Monda E, Lombardi R, Lioncino M, Canciello G, Rubino M, Todde G, Caiazza M, Borrelli F, Fusco A, Cirillo A, Perillo EF, Sepe J, Pacella D, de Simone G, Calabro P, Esposito G, Limongelli G. Prediction of incident atrial fibrillation in hypertrophic cardiomyopathy. Int J Cardiol 2024; 395:131575. [PMID: 37951419 DOI: 10.1016/j.ijcard.2023.131575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND AIM Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with significant effects on outcome. We aim to compare the left atrial (LA) diameter measurement with HCM-AF Score in predicting atrial fibrillation (AF) development in HCM. METHODS From the regional cohort of the Campania Region, Italy, 519 HCM patients (38% women, age45 ± 17 years) without history of AF, were enrolled in the study. The primary clinical endpoint was the development of AF, defined as at least 1 episode documented by ECG. RESULTS During the follow-up (mean 8 ± 6, IQ range 2.5-11.2 years), 99 patients (19%) developed AF. Patients who developed AF were more symptomatic, had higher prevalence of ICD implantation, had larger LA diameter, greater left ventricular (LV) maximal wall thickness and LV outflow tract obstruction (p < 0.01). Both LA diameter and HCM-AF score were higher in patients who developed AF versus those who did not (LA diameter 49 ± 7 versus 43 ± 6 mm; HCM-AF score 22 ± 4 versus 19 ± 4; p < 0.0001); however, ROC curve analysis demonstrated that LA diameter had a significant greater area under the curve than HCM-AF Score (p < 0.0001). At 5 years follow-up, a LA diameter > 46 mm, showed a similar accuracy in predicting AF development of HCM-AF score ≥ 22, which identifies patients at high risk to develop AF. CONCLUSION Our analysis shows that LA diameter, a worldwide and simple echocardiographic measure, is capable alone to predict AF development in HCM patients.
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Affiliation(s)
- Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Raffaella Lombardi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Gaetano Todde
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Felice Borrelli
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | | | - Joseph Sepe
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University Federico II, Naples, Italy
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Paolo Calabro
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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8
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Shafqat A, Shaik A, Koritala S, Mushtaq A, Sabbah BN, Nahid Elshaer A, Baqal O. Contemporary review on pediatric hypertrophic cardiomyopathy: insights into detection and management. Front Cardiovasc Med 2024; 10:1277041. [PMID: 38250029 PMCID: PMC10798042 DOI: 10.3389/fcvm.2023.1277041] [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: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiac disorder and is defined by the presence of left ventricular (LV) hypertrophy in the absence of a condition capable of producing such a magnitude of hypertrophy. Over the past decade, guidelines on the screening, diagnostic, and management protocols of pediatric primary (i.e., sarcomeric) HCM have undergone significant revisions. Important revisions include changes to the appropriate screening age, the role of cardiac MRI (CMR) in HCM diagnosis, and the introduction of individualized pediatric SCD risk assessment models like HCM Risk-kids and PRIMaCY. This review explores open uncertainties in pediatric HCM that merit further attention, such as the divergent American and European recommendations on CMR use in HCM screening and diagnosis, the need for incorporating key genetic and imaging parameters into HCM-Risk Kids and PRIMaCY, the best method of quantifying myocardial fibrosis and its prognostic utility in SCD prediction for pediatric HCM, devising appropriate genotype- and phenotype-based exercise recommendations, and use of heart failure medications that can reverse cardiac remodeling in pediatric HCM.
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Affiliation(s)
- Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Snygdha Koritala
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram, India
| | - Ali Mushtaq
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | | | - Ahmed Nahid Elshaer
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States
| | - Omar Baqal
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, United States
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9
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 185] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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10
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Cserne Szappanos H, Viola HM, Ito DW, Lim S, Mangala M, Holliday M, Barratt Ross S, Semsarian C, Hill A, Dixon RE, Hool LC. Cytoskeletal disarray increases arrhythmogenic vulnerability during sympathetic stimulation in a model of hypertrophic cardiomyopathy. Sci Rep 2023; 13:11296. [PMID: 37438479 PMCID: PMC10338442 DOI: 10.1038/s41598-023-38296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
Familial hypertrophic cardiomyopathy (FHC) patients are advised to avoid strenuous exercise due to increased risk of arrhythmias. Mice expressing the human FHC-causing mutation R403Q in the myosin heavy chain gene (MYH6) recapitulate the human phenotype, including cytoskeletal disarray and increased arrhythmia susceptibility. Following in vivo administration of isoproterenol, mutant mice exhibited tachyarrhythmias, poor recovery and fatigue. Arrhythmias were attenuated with the β-blocker atenolol and protein kinase A inhibitor PKI. Mutant cardiac myocytes had significantly prolonged action potentials and triggered automaticity due to reduced repolarization reserve and connexin 43 expression. Isoproterenol shortened cycle length, and escalated electrical instability. Surprisingly isoproterenol did not increase CaV1.2 current. We found alterations in CaV1.2-β1 adrenergic receptor colocalization assessed using super-resolution nanoscopy, and increased CaV1.2 phosphorylation in mutant hearts. Our results reveal for the first time that altered ion channel expression, co-localization and β-adrenergic receptor signaling associated with myocyte disarray contribute to electrical instability in the R403Q mutant heart.
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Affiliation(s)
| | - Helena M Viola
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Danica W Ito
- Department of Physiology and Membrane Biology, University of California, Davis, CA, USA
| | - Seakcheng Lim
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Melissa Mangala
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Mira Holliday
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Samantha Barratt Ross
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Adam Hill
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Rose E Dixon
- Department of Physiology and Membrane Biology, University of California, Davis, CA, USA
| | - Livia C Hool
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia.
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
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11
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Henderson CC, George-Durrett K, Kikano S, Slaughter JC, Chew JD, Parra D, Weiner J, Soslow J. Reference data for left ventricular filling and atrial function in children using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:30. [PMID: 37308942 PMCID: PMC10258747 DOI: 10.1186/s12968-023-00936-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Diastolic dysfunction is associated with morbidity and mortality in multiple pediatric disease processes. Cardiovascular magnetic resonance (CMR) provides a non-invasive method of studying left ventricular (LV) diastolic dysfunction through the assessment of LV filling curves and left atrial (LA) volume and function. However, there are no normative data for LV filling curves and the standard method is time-intensive. This study aims to compare an alternate, more rapid method of obtaining LV filling curves to standard methodology and report normative CMR diastolic function data for LV filling curves and LA volumes and function. METHODS Ninety-six healthy pediatric subjects (14.3 ± 3.4 years) with normal CMR defined by normal biventricular size and systolic function without late gadolinium enhancement were included. LV filling curves were generated by removing basal slices without myocardium present throughout the cardiac cycle and apical slices with poor endocardial delineation (compressed method), then re-generated including every phase of myocardium from apex to base (standard method). Indices of diastolic function included peak filling rate and time to peak filling. Systolic metrics included peak ejection rate and time to peak ejection. Both peak ejection and peak filling rates were indexed to end-diastolic volume. LA maximum, minimum and pre-contraction volumes were calculated using a biplane method. Inter-and intra-observer variability were assessed with intraclass correlation coefficient. Multivariable linear regression was used to assess the effects of body surface area (BSA), gender and age on metrics of diastolic function. RESULTS BSA had the largest effect on LV filling curves. Normal LV filling data are reported for both compressed and standard methods. The time to perform the compressed method was significantly shorter than the standard method (median 6.1 min vs. 12.5 min, p < 0.001). Both methods had strong to moderate correlation for all metrics. Intra-observer reproducibility was moderate to high for all LV filling and LA metrics except for time to peak ejection and peak filling. CONCLUSIONS We report reference values for LV filling metrics and LA volumes. The compressed method is more rapid and produces similar results to standard methodology, which may facilitate the use of LV filling in clinical CMR reporting.
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Affiliation(s)
| | - Kristen George-Durrett
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandra Kikano
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua D Chew
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Weiner
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
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12
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Kaski JP, Kammeraad JAE, Blom NA, Happonen JM, Janousek J, Klaassen S, Limongelli G, Östman-Smith I, Sarquella Brugada G, Ziolkowska L. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy. Cardiol Young 2023; 33:681-698. [PMID: 37102324 DOI: 10.1017/s1047951123000872] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Sudden cardiac death is the most common mode of death during childhood and adolescence in hypertrophic cardiomyopathy, and identifying those individuals at highest risk is a major aspect of clinical care. The mainstay of preventative therapy is the implantable cardioverter-defibrillator, which has been shown to be effective at terminating malignant ventricular arrhythmias in children with hypertrophic cardiomyopathy but can be associated with substantial morbidity. Accurate identification of those children at highest risk who would benefit most from implantable cardioverter-defibrillator implantation while minimising the risk of complications is, therefore, essential. This position statement, on behalf of the Association for European Paediatric and Congenital Cardiology (AEPC), reviews the currently available data on established and proposed risk factors for sudden cardiac death in childhood-onset hypertrophic cardiomyopathy and current approaches for risk stratification in this population. It also provides guidance on identification of individuals at risk of sudden cardiac death and optimal management of implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy.
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Affiliation(s)
- Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London Institute of Cardiovascular Science, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Janneke A E Kammeraad
- Erasmus MC - Sophia Children's Hospital, Department of Paediatric Cardiology, Rotterdam, the Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, University of Leiden, Leiden, the Netherlands
- Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Juha-Matti Happonen
- Department of Paediatric Cardiology, Helsinki University Children's Hospital, Helsinki, Finland
| | - Jan Janousek
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Thakkar K, Karajgi AR, Kallamvalappil AM, Avanthika C, Jhaveri S, Shandilya A, Anusheel, Al-Masri R. Sudden cardiac death in childhood hypertrophic cardiomyopathy. Dis Mon 2023; 69:101548. [PMID: 36931945 DOI: 10.1016/j.disamonth.2023.101548] [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: 03/17/2023]
Abstract
The most prevalent cause of mortality in children with hypertrophic cardiomyopathy (HCM) is sudden cardiac death (SCD), which happens more frequently than in adult patients. Risk stratification tactics have generally been drawn from adult practice, however emerging data has revealed significant disparities between children and adult cohorts, implying the need for pediatric-specific risk stratification methodologies. We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until October 2021. The following search strings and Medical Subject Heading (MeSH) terms were used: "HCM," "SCD," "Sudden Cardiac Death," and "Childhood Onset HCM." We explored the literature on the risk of SCD in HCM for its epidemiology, pathophysiology, the role of various genes and their influence, associated complications leading to SCD and preventive and treatment modalities. Childhood-onset HCM is linked to significant life-long morbidity and mortality, including a higher SCD rate in children than in adults. The present focus is on symptom relief and avoiding illness-related consequences, but the prospect of future disease-modifying medicines offers an intriguing opportunity to alter disease expression and outcomes in these young individuals. Current preventive recommendations promote implantable cardioverter defibrillator placement based on cumulative risk factor thresholds, although they have been demonstrated to have weak discriminating capacity. This article addresses questions and discusses the etiology, risk factors, and method to risk stratification for SCD in children with HCM.
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Affiliation(s)
- Keval Thakkar
- G.M.E.R.S. Medical College and General Hospital, Gandhinagar, India
| | | | | | - Chaithanya Avanthika
- Karnataka Institute of Medical /Sciences, PB Rd, Vidya Nagar, Hubli, Karnataka, India.
| | | | | | - Anusheel
- Ryazan State I P Pavlov Medical Institute, Ryazan, Russia
| | - Rayan Al-Masri
- Jordan University of Science and technology, Irbid, Jordan
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14
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Left Ventricular Hypertrophy and Ventricular Tachyarrhythmia: The Role of Biomarkers. Int J Mol Sci 2023; 24:ijms24043881. [PMID: 36835293 PMCID: PMC9958550 DOI: 10.3390/ijms24043881] [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: 12/27/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Left ventricular hypertrophy (LVH) refers to a complex rebuilding of the left ventricle that can gradually lead to serious complications-heart failure and life-threatening ventricular arrhythmias. LVH is defined as an increase in the size of the left ventricle (i.e., anatomically), therefore the basic diagnosis detecting the increase in the LV size is the domain of imaging methods such as echocardiography and cardiac magnetic resonance. However, to evaluate the functional status indicating the gradual deterioration of the left ventricular myocardium, additional methods are available approaching the complex process of hypertrophic remodeling. The novel molecular and genetic biomarkers provide insights on the underlying processes, representing a potential basis for targeted therapy. This review summarizes the spectrum of the main biomarkers employed in the LVH valuation.
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15
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Baban A, Cicenia M, Travaglini L, Calì F, Vasco G, Francalanci P, Novelli A, Adorisio R, Amodeo A, Dallapiccola B, Bertini E, Drago F. Remember Friedreich ataxia even in a toddler with apparently isolated dilated (not hypertrophic!) cardiomyopathy. Revisited. Minerva Pediatr (Torino) 2023; 75:117-123. [PMID: 33820410 DOI: 10.23736/s2724-5276.21.05969-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Friedreich ataxia (FRDA) is the most common form of ataxia in late childhood. Neurological manifestations often precede cardiac involvement, presenting mainly as hypertrophic cardiomyopathy. We describe a toddler with apparently isolated severe heart failure, successfully managed with heart transplant (HT). Although well described in adolescents and adults, onset of FRDA is very uncommon in toddlers and neurological ataxic features are predominant. The presenting symptom of cardiomyopathy is very rare. Similar history is rarely reported in literature, that we described, including an aggressive cardiomyopathy in children younger than 5 years-old. RESULTS: Our patient was diagnosed with FRDA at a postoperative stage due to minimal neurological manifestations. Moreover, the novelty of this study lies in demonstrating a major DNA triplet repeat expansion in skeletal muscle compared to DNA from peripheral blood leukocytes. These results support the concept that triplet repeat expansion is variable among different tissues in FRDA, and in our case it was more expanded in the post mitotic muscular tissue than in blood cells. We believe on the importance of taking in consideration this rare condition even in a toddler with apparently isolated cardiomyopathy and especially when conventional investigations give negative results. We discuss potential trigger effect of HT as a precipitating factor in manifesting neurological symptoms. This observation corresponds to our experience and relates to three patients described so far (the third patient died suddenly). Early onset cardiomyopathy with FRDA should increase awareness of this rare condition and we highlight HT successful outcome. Further reports are needed to delineate this rare condition in youngsters.
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Affiliation(s)
- Anwar Baban
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Unit of Pediatric Cardiology and Arrhythmia/Syncope, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Marianna Cicenia
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Unit of Pediatric Cardiology and Arrhythmia/Syncope, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Lorena Travaglini
- European Reference Network for Rare Neurological Disorders HCP, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children Research Hospital IRCCS, Rome, Italy
| | - Federica Calì
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Unit of Pediatric Cardiology and Arrhythmia/Syncope, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Gessica Vasco
- Department of Neurosciences, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Paola Francalanci
- Department of Pathology, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Rachele Adorisio
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Unit of Pediatric Cardiology and Arrhythmia/Syncope, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Antonio Amodeo
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Heart Failure and Transplant, Mechanical Circulatory Support Complex Unit, Bambino Gesù Research Hospital and Research Institute, Rome, Italy
| | - Bruno Dallapiccola
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Unit of Pediatric Cardiology and Arrhythmia/Syncope, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Enrico Bertini
- European Reference Network for Rare Neurological Disorders HCP, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children Research Hospital IRCCS, Rome, Italy
| | - Fabrizio Drago
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart HCP, Unit of Pediatric Cardiology and Arrhythmia/Syncope, Bambino Gesù Children Hospital and Research Institute, Rome, Italy -
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16
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Pagano M, Fumagalli C, Girolami F, Passantino S, Gozzini A, Brambilla A, Spinelli V, Morrone A, Procopio E, Pochiero F, Donati MA, Olivotto I, Favilli S. Clinical profile and outcome of cardiomyopathies in infants and children seen at a tertiary centre. Int J Cardiol 2023; 371:516-522. [PMID: 36130621 DOI: 10.1016/j.ijcard.2022.09.034] [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] [Received: 04/29/2022] [Revised: 07/12/2022] [Accepted: 09/15/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Due to their rare prevalence and marked heterogeneity, pediatric cardiomyopathies (CMPs) are little known and scarcely reported. We report the etiology, clinical profile and outcome of a consecutive cohort of children diagnosed with CMP and followed at Meyer Children's Hospital over a decade. PATIENTS AND METHODS We retrospectively reviewed patients consecutively referred from May 2008 to May 2019 for pediatric onset CMP (<18 years). Heart disease caused by arrhythmic disorders, toxic agents, rheumatic conditions and maternal disease were excluded. RESULTS We enrolled 110 patients (65 males), diagnosed at a median age of 27 [4-134] months; 35% had an infant onset (<1 year of age). A positive family history was more often associated with childhood-onset (38.8%). Hypertrophic cardiomyopathy (HCM; 48 patients) was the most frequent phenotype, followed by dilated cardiomyopathy (DCM; 35 patients). While metabolic and idiopathic etiologies were preponderant in infants, metabolic and sarcomeric diseases were most frequent in the childhood-onset group. Major adverse cardiac events (MACE) occurred in 31.8% of patients, including hospitalization for acute heart failure in 25.5% of patients, most commonly due to DCM. Overall, the most severe outcomes were documented in patients with metabolic diseases. CONCLUSIONS In a consecutive cohort of pediatric patients with CMP, those with infantile onset and with a metabolic etiology had the worst prognosis. Overall, MACE occurred in 41% of the entire population, most commonly associated with DCM, inborn errors of metabolism and genetic syndromes. Systematic NGS genetic testing was critical for etiological diagnosis and management.
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Affiliation(s)
- M Pagano
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy.
| | - C Fumagalli
- Cardiomyopathies Unit, Careggi University Hospital (AOUC), Florence, Italy
| | - F Girolami
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - S Passantino
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - A Gozzini
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - A Brambilla
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - V Spinelli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - A Morrone
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Meyer Children's Hospital, Neuroscience Department, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | - E Procopio
- Metabolic and Muscular Unit, Meyer Children's Hospital, Neuroscience Department, Florence, Italy
| | - F Pochiero
- Metabolic and Muscular Unit, Meyer Children's Hospital, Neuroscience Department, Florence, Italy
| | - M A Donati
- Metabolic and Muscular Unit, Meyer Children's Hospital, Neuroscience Department, Florence, Italy
| | - I Olivotto
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy; Cardiomyopathies Unit, Careggi University Hospital (AOUC), Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - S Favilli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
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17
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Brignole M, Cecchi F, Anastasakis A, Crotti L, Deharo JC, Elliott PM, Fedorowski A, Kaski JP, Limongelli G, Maron MS, Olivotto I, Ommen SR, Parati G, Shen W, Ungar A, Wilde A. Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management. Int J Cardiol 2023; 370:330-337. [PMID: 36309161 DOI: 10.1016/j.ijcard.2022.10.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/09/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
Syncopal events in patients with hypertrophic cardiomyopathy (HCM) are of concern as they are a vital consideration in algorithms for risk stratification for sudden cardiac death (SCD) and ICD implantation. However, the cause of syncope is often under-investigated and/or unexplained. Current syncope guidelines do not provide a detailed definition of unexplained syncope. To address this important gap, an international panel of experts in the field of both syncope and HCM wrote a consensus document with the aim of providing practical guidance for the diagnosis and management of syncope in patients with HCM.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Risk Assessment
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Syncope/diagnosis
- Syncope/etiology
- Syncope/therapy
- Risk Factors
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Affiliation(s)
- Michele Brignole
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy.
| | - Franco Cecchi
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Kallithea, Greece
| | - Lia Crotti
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, Hospital S. Luca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Jean Claude Deharo
- Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France; Aix Marseille Université, C2VN, Marseille, France.
| | - Perry M Elliott
- Institute of Cardiological Sciences, University College London, UK.
| | - Artur Fedorowski
- Dept. of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | - Juan Pablo Kaski
- Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital, London, UK.
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi VanvitellI", AO Dei Colli-Monaldi Hospital, Naples, Italy
| | - Martin S Maron
- HCM Center, Lahey Hospital and Medical Center, Burlington, MA, USA.
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Steve R Ommen
- Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Dept of Cardiology, University of Milano Bicocca, Milan, Italy.
| | - Win Shen
- Mayo Clinic Arizona, Phoenix, AZ, USA.
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence andFlorence, Italy.
| | - Arthur Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische Centra, Amsterdam,location AMC, the Netherlands.
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18
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Tashiro N, Muneuchi J, Ezaki H, Kobayashi M, Yamada H, Sugitani Y, Watanabe M. Ventricular Repolarization Dispersion is a Potential Risk for the Development of Life-Threatening Arrhythmia in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2022; 43:1455-1461. [PMID: 35284943 DOI: 10.1007/s00246-022-02867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
The risk stratification and early interventions are necessary in patients with hypertrophic cardiomyopathy (HCM), as life-threatening arrhythmia (LTA) is a leading cause of death. This study aimed to explore whether an interval between the peak of the T wave to the end terminal of the T wave (Tp-e), which represents ventricular repolarization dispersion, could predict the risk for LTA in children with HCM. We analyzed electrocardiography at the first and last visits in children (aged < 15 years) with HCM, and compared Tp-e interval and the ratio of Tp-e interval to QT interval (Tp-e/QT) between children with and without LTA. We studied 25 children with HCM. During the follow-up of 85 (38-146) months, there were 7 children with LTA. The 5-year sudden cardiac death (SCD) risk was 1.4 (1.1-2.5) %, which suggested that our cohort consisted of patients at a lower risk for SCD. Age was significantly older in children with LTA compared to those without it (12.5 vs.1.0 years, P = 0.037), although sex, the presence of family history and symptoms at diagnosis, the maximum left ventricular wall thickness Z-score did not differ between the groups. At the last electrocardiography before LTA, corrected Tp-e interval and Tp-e/QT ratio were significantly greater in patients with LTA compared to those in patients without LTA (corrected Tp-e: 103 vs. 78 ms, P = 0.020; Tp-e/QT: 0.28 vs. 0.22, P = 0.046). Corrected Tp-e and Tp-e/QT ratio cutoff values of 91 ms and 0.28 yielded as the predictors for LTA with sensitivity of 85% and 72%, specificity of 71% and 89%, respectively. Prolonged absolute and corrected Tp-e intervals and an increase in the Tp-e/QT ratio can be useful predictors for LTA in children with HCM. We offer temporal assessments of ventricular repolarization dispersion to stratify the risk for the development of LTA/SCD among children with HCM.
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Affiliation(s)
- Naoko Tashiro
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan.
| | - Hiroki Ezaki
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Masaru Kobayashi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Hiromu Yamada
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
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Willy K, Köbe J, Reinke F, Rath B, Ellermann C, Wolfes J, Wegner FK, Leitz PR, Lange PS, Eckardt L, Frommeyer G. Usefulness of the MADIT-ICD Benefit Score in a Large Mixed Patient Cohort of Primary Prevention of Sudden Cardiac Death. J Pers Med 2022; 12:jpm12081240. [PMID: 36013189 PMCID: PMC9410275 DOI: 10.3390/jpm12081240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Decision-making in primary prevention is not always trivial and many clinical scenarios are not reflected in current guidelines. To help evaluate a patient’s individual risk, a new score to predict the benefit of an implantable defibrillator (ICD) for primary prevention, the MADIT-ICD benefit score, has recently been proposed. The score tries to predict occurrence of ventricular arrhythmias and non-arrhythmic death based on data from four previous MADIT trials. We aimed at examining its usefulness in a large single-center register of S-ICD patients with various underlying cardiomyopathies. Methods and results: All S-ICD patients with a primary preventive indication for ICD implantation from our large single-center database were included in the analysis (n = 173). During a follow-up of 1227 ± 978 days, 27 patients developed sustained ventricular arrhythmias, while 6 patients died for non-arrhythmic reasons. There was a significant correlation for patients with ischemic cardiomyopathy (ICM) (n = 29, p = 0.04) to the occurrence of ventricular arrhythmia. However, the occurrence of ventricular arrhythmias could not sufficiently be predicted by the MADIT-ICD VT/VF score (p = 0.3) in patients with (n = 142, p = 0.19) as well as patients without structural heart disease (n = 31, p = 0.88) and patients with LV-EF < 35%. Of the risk factors included in the risk score calculation, only non-sustained ventricular tachycardias were significantly associated with sustained ventricular arrhythmias (p = 0.02). Of note, non-arrhythmic death could effectively be predicted by the proposed non-arrhythmic mortality score as part of the benefit score (p = 0.001, r = 0.3) also mainly driven by ICM patients. Age, diabetes mellitus, and a BMI < 23 kg/m2 were key predictors of non-arrhythmic death implemented in the score. Conclusion: The MADIT-ICD benefit score adds a new option to evaluate expected benefit of ICD implantation for primary prevention. In a large S-ICD cohort of primary prevention, the value of the score was limited to patients with ischemic cardiomyopathy. Future research should evaluate the performance of the score in different subgroups and compare it to other risk scores to assess its value for daily clinical practice.
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Affiliation(s)
- Kevin Willy
- Correspondence: ; Tel.: +49-251-83-44949; Fax: +49-251-83-49965
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Chan W, Yang S, Wang J, Tong S, Lin M, Lu P, Yao R, Wu L, Chen L, Guo Y, Shen J, Liu T, Li F, Chen H, Zhang H, Wang S, Fu L. Clinical characteristics and survival of children with hypertrophic cardiomyopathy in China: A multicentre retrospective cohort study. EClinicalMedicine 2022; 49:101466. [PMID: 35747179 PMCID: PMC9157015 DOI: 10.1016/j.eclinm.2022.101466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Few data on paediatric hypertrophic cardiomyopathy (HCM) are available in developing countries. A multicentre, retrospective, cohort study was conducted to profile the clinical characteristics and survival of children with HCM in China. METHODS We collected longitudinal data on children with HCM aged 0-18 years at three participating institutions between January 1, 2010 and December 31, 2019. Patients were identified by searching for the diagnosis using ICD-10 codes from the electronic medical records database. HCM was diagnosed morphologically with echocardiography or cardiovascular magnetic resonance imaging. The exclusion criteria were secondary aetiologies of myocardial hypertrophy. The primary outcomes were all-cause death or heart transplantation. The Kaplan-Meier method was used to estimate the survival rate of different groups. FINDINGS A total of 564 children were recruited, with a median age at diagnosis of 1.0 year (interquartile range, IQR: 0.4-8.0 years), followed for a median of 2.6 years (1977 patient-years, IQR:0.5, 5.9 years). The underlying aetiology was sarcomeric (382, 67.7%), inborn errors of metabolism (IEMs) (108, 19.2%), and RASopathies (74, 13.1%). A total of 149 patients (26.4%) died and no patients underwent heart transplantation during follow-up. The survival probability was 71.1% (95% confidence interval [CI], 66.3%-75.3%) at 5 years. Patients with IEMs or those diagnosed during infancy had the poorest outcomes, with an estimated 5-year survival rate of 16.9% (95% CI, 7.7%-29.1%) and 56.0% (95% CI, 48.8%-62.5%), respectively. Heart failure was the leading cause of death in the cohort (90/149, 60.4%), while sudden cardiac death was the leading cause in patients with sarcomeric HCM (32/66, 48.5%). INTERPRETATION There is a high proportion of patients with IEM and a low proportion of patients with neuromuscular disease in children with HCM in China. Overall, mortality remains high in China, especially in patients with IEMs and those diagnosed during infancy. FUNDING National Natural Science Fund of China (81770380, 81974029), China Project of Shanghai Municipal Science and Technology Commission (20MC1920400, 21Y31900301).
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Affiliation(s)
- Wenxiu Chan
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jian Wang
- Research Division of Birth Defects, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shilu Tong
- Department of Clinical epidemiology and Biostatistics, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Minyin Lin
- Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Pengtao Lu
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Ruen Yao
- Research Division of Birth Defects, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lanping Wu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lijun Chen
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ying Guo
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Tingliang Liu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Fen Li
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Huiwen Chen
- Shanghai Clinical Research Centre for Rare Paediatric Disease, Shanghai 200127, China
| | - Hao Zhang
- Shanghai Clinical Research Centre for Rare Paediatric Disease, Shanghai 200127, China
- Corresponding author at: Shanghai Clinical Research Centre for Rare Paediatric Disease, No. 1678 Dongfang Road, Shanghai 200127, China.
| | - Shushui Wang
- Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
- Corresponding author at: Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China.
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Research Division of Cardiovascular Disease, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Corresponding author at: Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, No. 1678 Dongfang Road, Shanghai 200127, China.
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21
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Ali LA, Marrone C, Martins DS, Khraiche D, Festa P, Martini N, Santoro G, Todiere G, Panaioli E, Bonnet D, Boddaert N, Aquaro GD, Raimondi F. Prognostic factors in hypertrophic cardiomyopathy in children: An MRI based study. Int J Cardiol 2022; 364:141-147. [PMID: 35718011 DOI: 10.1016/j.ijcard.2022.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/07/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical and prognostic role of cardiac magnetic resonance (CMR) in adult population with hypertrophic cardiomyopathy (HCM) have been largely assessed. We sought to investigate the role of CMR for predicting cardiovascular events in children with HCM. METHODS CMR was performed in 116 patients with HCM (37 sarcomeric mutations, 31 other mutations, mean age 10.4 ± 4.3 yrs). CMR protocol included cine imaging for evaluation of morphology and function and late gadolinium enhancement (LGE). Hard cardiac events (sustained VT, resuscitated cardiac arrest, sudden cardiac death, end-stage heart failure, heart transplant and appropriate ICD intervention) were recorded through a median follow-up of 4 (1-7) years. RESULTS During follow-up 21 heart cardiac events occurred. At maximal-rank statistic the optimal cut-point for LGE extent for predicting events was ≥2%. Syncope, non-sustained ventricular tachycardia (NSVT) and LGE extent ≥2% were independent predictors of events. At Harrel's C statistic combination of LGE extent ≥2% and syncope was the strongest model for predicting events. HR of patients with LGE extent ≥2% and no history of syncope was 3.6 (1.1-12.2) that increased to 37.6 (5.4-161) in those with LGE extent ≥2% and syncope. The median time dependent AUC of LGE extent (0.88, 95% CI 0.86-0.89) was significantly higher than that of syncope (0.63, 95% CI 0.61-0.66, p < 0.0001) and NSVT (0.52, 95% CI 0.50-0.53, p < 0.0001). CONCLUSIONS In children with HCM, LGE and syncope were independent predictors of hard cardiac events at follow-up.
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Affiliation(s)
- Lamia Ait Ali
- Institute of Clinical Physiology CNR, UO Massa and Fondazione G. Monasterio. CNR-Regione Toscana. Italy
| | | | - Duarte Saraiva Martins
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Diala Khraiche
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | | | | | | | | | - Elena Panaioli
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Damien Bonnet
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | | | - Francesca Raimondi
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France and Azienda Ospedaliero Universitaria Meyer, Florence, Italy.
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22
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Kohli U, Saarel EV, Shah M. Extreme Left Ventricular Hypertrophy in Pediatric Hypertrophic Cardiomyopathy: Good News or Bad News? Circ Arrhythm Electrophysiol 2022; 15:e011033. [PMID: 35491875 DOI: 10.1161/circep.122.011033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University School of Medicine and West Virginia University Medicine Children's Hospital, Morgantown (U.K.)
| | | | - Maully Shah
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia (M.S.)
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23
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Norrish G, Ding T, Field E, Cervi E, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Vignati G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, O'Mahony C, Omar RZ, Elliott PM, Kaski JP. Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e010075. [PMID: 35491873 PMCID: PMC7612749 DOI: 10.1161/circep.121.010075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. METHODS The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). RESULTS MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. CONCLUSIONS In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
| | - Tao Ding
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | | | | | | | | | | | | | - Elena Biagini
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | - Luca Ragni
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | | | - Sophie Duignan
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Adrián Fernández
- Fundación Favaloro University Hospital, Buenos Aires, Argentina (A.F.)
| | | | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic (P.K.)
| | - Piers E F Daubeney
- Royal Brompton and Harefield NHS Trust, London, United Kingdom (P.E.F.D.)
| | | | - Sergi Cesar
- Sant Joan de Deu, Barcelona, Spain (G.S.-B., S.C.)
| | - Sabine Klaassen
- Department of Pediatric Cardiology (S.K.), Charite-Universitatsmedizin Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine (S.K.), Charite-Universitatsmedizin Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (S.K.)
| | - Tiina H Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Finland (T.H.O.)
| | - Vinay Bhole
- Birmingham Children's Hospital, United Kingdom (V.B.)
| | - Constancio Medrano
- Fondazione Toscana G. Monasterio, Massa-Pisa, Italy (C.M.).,Hospital General Universitario Gregorio Marañón, Madrid, Spain (C.M.)
| | - Orhan Uzun
- University Hospital of Wales, Cardiff (O.U.)
| | | | - Ferran Gran
- Val d'Hebron University Hospital, Barcelona, Spain (F.G.)
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Italy (G.S.)
| | | | - Graham Stuart
- Bristol Royal Hospital for Children, United Kingdom (G.S.)
| | | | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan (H.Y.)
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom (T.B.)
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Dept di Medicina Interna, UOC Cardiologica, Milano, Italy (M.C.)
| | - Caroline B Jones
- Alder Hey Children's Hospital, Liverpool, United Kingdom (C.B.J.)
| | | | - Toru Kubo
- Kochi Medical School Hospital, Japan (T.K.)
| | | | - Anca Popoiu
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes" Timisoara, Children's Hospital 'Louis Turcanu,' Romania (A.P.)
| | | | - Sujeev Mathur
- Evelina Children's Hospital, London, United Kingdom (S.M.)
| | | | | | | | - Costas O'Mahony
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Rumana Z Omar
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Perry M Elliott
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
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24
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Baessato F, Romeo C, Rabbat MG, Pontone G, Meierhofer C. A Comprehensive Assessment of Cardiomyopathies through Cardiovascular Magnetic Resonance: Focus on the Pediatric Population. Diagnostics (Basel) 2022; 12:diagnostics12051022. [PMID: 35626178 PMCID: PMC9139185 DOI: 10.3390/diagnostics12051022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/26/2022] Open
Abstract
Cardiomyopathies (CMPs) are a heterogeneous group of diseases that involve the myocardium and result in systolic or diastolic impairment of the cardiac muscle, potentially leading to heart failure, malignant arrhythmias, or sudden cardiac death. Occurrence in pediatric age is rare but has been associated with worse outcomes. Non-invasive cardiac imaging techniques, integrated with clinical, genetic, and electrocardiographic data, have shown a pivotal role in the clinical work-up of such diseases by defining structural alterations and assessing potential complications. Above all modalities, cardiovascular magnetic resonance (CMR) has emerged as a powerful tool complementary to echocardiography to confirm diagnosis, provide prognostic information and guide therapeutic strategies secondary to its high spatial and temporal resolution, lack of ionizing radiation, and good reproducibility. Moreover, CMR can provide in vivo tissue characterization of the myocardial tissue aiding the identification of structural pathologic changes such as replacement or diffuse fibrosis, which are predictors of worse outcomes. Large prospective randomized studies are needed for further validation of CMR in the context of childhood CMPs. This review aims to highlight the role of advanced imaging with CMR in CMPs with particular reference to the dilated, hypertrophic and non-compacted phenotypes, which are more commonly seen in children.
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Affiliation(s)
- Francesca Baessato
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany;
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy;
- Correspondence:
| | - Cristina Romeo
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy;
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University Medical Center, Chicago, IL 60153, USA;
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany;
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25
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Warming PE, Ågesen FN, Lynge TH, Jabbari R, Smits RL, van Valkengoed IG, Welten SJ, van der Heijden AA, Elders PJ, Blom MT, Jouven X, Schwartz PJ, Albert CM, Beulens JW, Rutters F, Tan HL, Empana JP, Tfelt-Hansen J. Harmonization of the definition of sudden cardiac death in longitudinal cohorts of the European Sudden Cardiac Arrest network - towards Prevention, Education, and New Effective Treatments (ESCAPE-NET) consortium. Am Heart J 2022; 245:117-125. [PMID: 34936862 DOI: 10.1016/j.ahj.2021.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of sudden cardiac death (SCD) in the general population is substantial and SCD frequently occurs among people with few or no known risk factors for cardiac disease. Reported incidences of SCD vary due to differences in definitions and methodology between cohorts. This study aimed to develop a method for adjudicating SCD cases in research settings and to describe uniform case definitions of SCD in an international consortium harmonizing multiple longitudinal study cohorts. METHODS The harmonized SCD definitions include both case definitions using data from multiple sources (eg, autopsy reports, medical history, eyewitnesses) as well as a method using only information from registers (eg, cause of death registers, ICD-10 codes). Validation of the register-based method was done within the consortium using the multiple sources definition as gold standard and presenting sensitivity, specificity, accuracy and positive predictive value. RESULTS Consensus definitions of "definite," "possible" and "probable" SCD for longitudinal study cohorts were reached. The definitions are based on a stratified approach to reflect the level of certainty of diagnosis and degree of information. The definitions can be applied to both multisource and register-based methods. Validation of the method using register-information in a cohort comprising 1335 cases yielded a sensitivity of 74%, specificity of 88%, accuracy of 86%, and positive predictive value of 54%. CONCLUSIONS This study demonstrated that a harmonization of SCD classification across different methodological approaches is feasible. The developed classification can be used to study SCD in longitudinal cohorts and to merge cohorts with different levels of information.
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26
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Rosu RO, Lupsor A, Necula A, Cismaru G, Cainap SS, Iacob D, Lazea C, Cismaru A, Negru AG, Pop D, Gusetu G. Anatomical-MRI Correlations in Adults and Children with Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12020489. [PMID: 35204578 PMCID: PMC8870875 DOI: 10.3390/diagnostics12020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is the most frequent hereditary cardiovascular disease and the leading cause of sudden cardiac death in young individuals. Advancements in CMR imaging have allowed for earlier identification and more accurate prognosis of HCM. Interventions aimed at slowing or stopping the disease’s natural course may be developed in the future. CMR has been validated as a technique with high sensitivity and specificity, very few contraindications, a low risk of side effects, and is overall a good tool to be employed in the management of HCM patients. The goal of this review is to evaluate the magnetic resonance features of HCM, starting with distinct phenotypic variants of the disease and progressing to differential diagnoses of athlete’s heart, hypertension, and infiltrative cardiomyopathies. HCM in children has its own section in this review, with possible risk factors that are distinct from those in adults; delayed enhancement in children may play a role in risk stratification in HCM. Finally, a number of teaching points for general cardiologists who recommend CMR for patients with HCM will be presented.
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Affiliation(s)
- Radu Ovidiu Rosu
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Ana Lupsor
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Correspondence: (A.L.); (G.C.); Tel.: +40-004-072-192-6230 (G.C.)
| | - Alexandru Necula
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Correspondence: (A.L.); (G.C.); Tel.: +40-004-072-192-6230 (G.C.)
| | - Simona Sorana Cainap
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 2nd Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Daniela Iacob
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 3rd Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Cecilia Lazea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 1st Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400370 Cluj-Napoca, Romania
| | - Andrei Cismaru
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, 400337 Cluj-Napoca, Romania
| | - Alina Gabriela Negru
- Department of Cardiology, ‘Victor Babeș’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Dana Pop
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Gabriel Gusetu
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
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Silvetti MS, Tamburri I, Campisi M, Saputo FA, Cazzoli I, Cantarutti N, Cicenia M, Adorisio R, Baban A, Ravà L, Drago F. ICD Outcome in Pediatric Cardiomyopathies. J Cardiovasc Dev Dis 2022; 9:jcdd9020033. [PMID: 35200687 PMCID: PMC8875861 DOI: 10.3390/jcdd9020033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Pediatric patients with cardiomyopathies are at risk of malignant arrhythmias and sudden cardiac death (SCD). An ICD may prevent SCD. The aim of this study was to evaluate ICD implantation outcomes, and to compare transvenous and subcutaneous ICDs (S-ICDs) implanted in pediatric patients with cardiomyopathies. Methods: The study is single center and retrospective, and includes pediatric patients with cardiomyopathies who required ICD implantation (2010–2021). Outcomes were recorded for appropriate/inappropriate ICD therapy and surgical complications. Transvenous ICD and S-ICD were compared. Data are presented as median values (25th–75th centiles). Results: Forty-four patients with cardiomyopathies (hypertrophic 39%, arrhythmogenic 32%, dilated 27%, and restrictive 2%) underwent transvenous (52%) and S-ICD (48%) implantation at 14 (12–17) years of age, mostly for primary prevention (73%). The follow-up period was 29 (14–60) months. Appropriate ICD therapies were delivered in 25% of patients, without defibrillation failures. Lower age at implantation and secondary prevention were significant risk factors for malignant ventricular arrhythmias that required appropriate ICD therapies. ICD-related complications were surgical complications (18%) and inappropriate shocks (7%). No significant differences in outcomes were recorded, either when comparing transvenous and S-ICD or comparing the different cardiomyopathies. Conclusions: In pediatric patients with cardiomyopathy, ICD therapy is effective, with a low rate of inappropriate shocks. Neither ICD type (transvenous and S-ICDs) nor the cardiomyopathies subgroup revealed divergent outcomes.
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Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
- Correspondence: ; Tel.: +39-06-6859-1
| | - Ilaria Tamburri
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Marta Campisi
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Ilaria Cazzoli
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Marianna Cicenia
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Rachele Adorisio
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Anwar Baban
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Lucilla Ravà
- Epidemiology Institute, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
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Study on Risk Factors for Death from Cardiomyopathy and Effectiveness of Health Information Management. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3922611. [PMID: 34917304 PMCID: PMC8670898 DOI: 10.1155/2021/3922611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
Objective To explore risk factors for death from cardiomyopathy and the effectiveness of health information management (HIM). Methods A total of 80 patients with cardiomyopathy admitted in ICU of our hospital (January 2016–January 2020) were selected as study subjects, and the clinical data of the patients were retrospectively analyzed. The patients were divided into the survival group (n = 72) and the death group (n = 14) according to the treatment outcome. Then, according to the management mode, the survival group was further equally divided into the conventional group and the HIM group to investigate the influence of risk factors on prognosis of patients with cardiomyopathy and the effectiveness of HIM. Results No significant difference was found in baseline body mass, myocardial enzymes, troponin, infection factors, history of heart disease, and gender between the survival group and the death group (P > 0.05). Compared with the survival group, the patients of the death group were older (P < 0.05), LVEF of the death group was obviously lower (P < 0.05), and the scores of APACHE II and SOFA of the death group were obviously higher (P < 0.05). Further logistic regression analysis of the univariate factors influencing the risk of death from cardiomyopathy led to the conclusion that LVEF was an independent risk factor for death in patients with cardiomyopathy. LVEF below 24.69% examined by echocardiography had a high predictive value, with a sensitivity of 98.6% and a specificity of 78.6%. No obvious difference was found in general data between the conventional group and the HIM group (P > 0.05). Compared with the conventional group, the disease remission rate, complication rate, awareness rate of health knowledge, ICU length of stay, and scores of self-management efficacy of the HIM group were obviously better (P < 0.05). No significant difference was found in 5-year mean survival rate between the conventional group and the HIM group (P > 0.05). Conclusion Older age, lower LVEF, and higher scores of APACHE II and SOFA are all risk factors for death from cardiomyopathy. Lower LVEF is an independent risk factor, and LVEF below 24.69% is an important indicator of increased risk of death. Moreover, HIM can effectively improve short-term treatment efficacy but has little effect on the long-term survival rate.
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Xia K, Sun D, Wang R, Zhang Y. Factors associated with the risk of cardiac death in children with hypertrophic cardiomyopathy: a systematic review and meta-analysis. Heart Lung 2021; 52:26-36. [PMID: 34837725 DOI: 10.1016/j.hrtlng.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies on risk factors of sudden cardiac death (CD) or CD in children with hypertrophic cardiomyopathy (HCM) are lacking. OBJECTIVES To assess factors associated with the risk of sudden CD or CD in HCM children. METHODS Pubmed, Embase, Cochrane Library, and Web of Science databases were searched. RESULTS The results indicated that children with previous adverse cardiac events during childhood and with a history of syncope had an increased risk of sudden CD or CD. Non-sustained ventricular tachycardia (VT) in HCM children was associated with sudden CD or CD. Children with left ventricular hypertrophy (LVH) were at higher risk of sudden CD or CD. And left ventricular outflow tract (LVOT) obstruction was a potential risk factor for sudden CD in children with HCM (all P<0.05). CONCLUSION Optimal care and appropriate monitoring is necessary for HCM children with higher risk of sudden CD or CD.
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Affiliation(s)
- Kun Xia
- Department of Cardiovascular Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430019, P.R. China
| | - Dongming Sun
- Department of Cardiovascular Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430019, P.R. China
| | - Ruigeng Wang
- Department of Cardiovascular Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430019, P.R. China
| | - Yong Zhang
- Department of Cardiovascular Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430019, P.R. China.
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Girolami F, Passantino S, Verrillo F, Palinkas ED, Limongelli G, Favilli S, Olivotto I. The Influence of Genotype on the Phenotype, Clinical Course, and Risk of Adverse Events in Children with Hypertrophic Cardiomyopathy. Heart Fail Clin 2021; 18:1-8. [PMID: 34776071 DOI: 10.1016/j.hfc.2021.07.013] [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] [Indexed: 11/04/2022]
Abstract
Genetic testing in children with hypertrophic cardiomyopathy (HCM) can modify clinical management and lifestyle counseling. However, predicting long-term outcome and response to management in individual patients remains challenging, because of the peculiar genetic heterogeneity of the disease in the pediatric age range. Children with HCM secondary to an inborn error of metabolism or malformation syndromes tend to have a worse outcome compared with those with the classic sarcomeric form. Among the latter, adverse genetic features are represented by the identification of a pathogenic variant in MYH7, often associated with severe hypertrophy, a complex genotype, or a de novo variant.
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Affiliation(s)
- Francesca Girolami
- Cardiology Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139 Florence, Italy.
| | - Silvia Passantino
- Cardiology Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Federica Verrillo
- Department of Translational Medical Sciences, Inherited & Rare Cardiovascular Diseases, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Eszter Dalma Palinkas
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Cardiomyopathy Unit, University of Florence, Florence, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited & Rare Cardiovascular Diseases, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Silvia Favilli
- Cardiology Unit, Meyer Children's Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, University of Florence, Florence, Italy
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Abstract
Sudden cardiac death (SCD) is the most common cause of death in childhood hypertrophic cardiomyopathy (HCM) and occurs more frequently than in adult patients. Risk stratification strategies have traditionally been extrapolated from adult practice, but newer evidence has highlighted important differences between childhood and adult cohorts, with the implication that pediatric-specific risk stratification strategies are required. Current guidelines use cumulative risk factor thresholds to recommend implantable cardioverter defibrillator (ICD) implantation but have been shown to have limited discriminatory ability. Newer pediatric models that allow clinicians to calculate individualized estimates of 5-year risk allowing, for the first time, personalization of ICD implantation decision-making have been developed. This article describes the pathophysiology, risk factors, and approach to risk stratification for SCD in childhood HCM and highlights unanswered questions.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Institute of Cardiovascular Sciences University College London, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Institute of Cardiovascular Sciences University College London, UK.
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Monda E, Lioncino M, Rubino M, Caiazza M, Cirillo A, Fusco A, Pacileo R, Fimiani F, Amodio F, Borrelli N, Colonna D, D'Onofrio B, Frisso G, Drago F, Castelletti S, Sarubbi B, Calabrò P, Russo MG, Limongelli G. The Risk of Sudden Unexpected Cardiac Death in Children: Epidemiology, Clinical Causes, and Prevention. Heart Fail Clin 2021; 18:115-123. [PMID: 34776073 DOI: 10.1016/j.hfc.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
"Sudden unexplained death (SUD) is a tragic event for both the family and community, particularly when it occurs in young individuals. Sudden cardiac death (SCD) represents the leading form of SUD and is defined as an unexpected event without an obvious extracardiac cause, occurring within 1 hour after the onset of symptoms. In children, the main causes of SCD are inherited cardiac disorders, whereas coronary artery diseases (congenital or acquired), congenital heart diseases, and myocarditis are rare. The present review examines the current state of knowledge regarding SCD in children, discussing the epidemiology, clinical causes, and prevention strategies."
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Affiliation(s)
- Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Roberta Pacileo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Fabio Fimiani
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Federica Amodio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Nunzia Borrelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Diego Colonna
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Barbara D'Onofrio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Fabrizio Drago
- Istituto Auxologico Italiano, IRCCS-Center for Cardiac Arrhythmias of Genetic Origin, Via Pier Lombardo 22, 20135 Milan, Italy
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS-Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Berardo Sarubbi
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Maria Giovanna Russo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
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Östman‐Smith I, Sjöberg G, Alenius Dahlqvist J, Larsson P, Fernlund E. Sudden cardiac death in childhood hypertrophic cardiomyopathy is best predicted by a combination of electrocardiogram risk-score and HCMRisk-Kids score. Acta Paediatr 2021; 110:3105-3115. [PMID: 34314540 DOI: 10.1111/apa.16045] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
AIM To compare risk algorithms (HCMRisk-Kids, ECG Risk-score) in hypertrophic cardiomyopathy (HCM) without syndrome association (ns-HCM) and with Noonan-like syndromes (RAS-HCM). METHODS A national paediatric HCM cohort (n = 151), presenting <19 years of age, mean follow-up 13.3 years, from all Swedish centres of Paediatric Cardiology (presenting 1972-2015), with 41 RAS-HCM patients (61% males), and 110 ns-HCM patients (68% familial; 65% males). The end-point was a composite of sudden cardiac death and resuscitated cardiac arrest (SCD/CA). Risk-factors were studied with Cox-hazard regression, and receiver operating characteristic curve analysis (C-statistic). RESULTS There were 33 SCD/CA, 27/110 in ns-HCM and 6/41 in RAS-HCM (p = 0.27). In ns-HCM HCMRisk-Kids ≥6% at diagnosis had C-statistic of 0.69 for predicting SCD/CA during first 5 years of follow-up and positive predictive value (PPV) of 22%. After 7 years of age (HCMRisk-Kids7plus), C-statistic was 0.76. ECG Risk-score ≥6 at diagnosis had C-statistic 0.87 and PPV of 31%. Independent risk factors for SCD/CA were HCMRisk-Kids7plus score (p = 0.005) and ECG risk-score (p < 0.001), whereas early beta-blocker dose (p = 0.001) and myectomy (p = 0.004) reduced risk. The sum of HCMRisk-Kids7yplus and ECG Risk-score7yplus ≥14 best predicted SCD/CA within 5 years in ns-HCM with C-statistic of 0.90 [0.83-0.96], sensitivity 100% and PPV 38%. CONCLUSION Combining the ECG Risk-score with HCMRisk-Kids improves risk stratification in ns-HCM and shows promise in RAS-HCM.
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Affiliation(s)
- Ingegerd Östman‐Smith
- Department of Pediatric Cardiology Queen Silvia Children´s HospitalSahlgrenska AcademyGothenburg University Gothenburg Sweden
| | - Gunnar Sjöberg
- Department of Women´s and Children´s Health Karolinska Institute Stockholm Sweden
| | | | - Per Larsson
- Department of Pediatric Cardiology Uppsala University Children´s Hospital Uppsala Sweden
| | - Eva Fernlund
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Division of Pediatrics, Crown Princess Victoria Children´s Hospital Linköping University Hospital Linköping Sweden
- Department of Clinical Sciences Lund Lund University Skåne University Hospital, Pediatric Cardiology Lund Sweden
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Shah MJ, Silka MJ, Silva JNA, Balaji S, Beach CM, Benjamin MN, Berul CI, Cannon B, Cecchin F, Cohen MI, Dalal AS, Dechert BE, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril PJ, Karpawich PP, Kim JJ, Krishna MR, Kubuš P, LaPage MJ, Mah DY, Malloy-Walton L, Miyazaki A, Motonaga KS, Niu MC, Olen M, Paul T, Rosenthal E, Saarel EV, Silvetti MS, Stephenson EA, Tan RB, Triedman J, Bergen NHV, Wackel PL. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC) Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). JACC Clin Electrophysiol 2021; 7:1437-1472. [PMID: 34794667 DOI: 10.1016/j.jacep.2021.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California, USA.
| | | | | | | | - Monica N Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York University Grossman School of Medicine, New York, New York, USA
| | | | - Aarti S Dalal
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois, USA
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter P Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan, USA
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | | | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary C Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Melissa Olen
- Nicklaus Children's Hospital, Miami, Florida, USA
| | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Reina B Tan
- New York University Langone Health, New York, New York, USA
| | | | - Nicholas H Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Cardiol Young 2021; 31:1738-1769. [PMID: 34338183 DOI: 10.1017/s1047951121003413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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36
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Leoni C, Blandino R, Delogu AB, De Rosa G, Onesimo R, Verusio V, Marino MV, Lanza GA, Rigante D, Tartaglia M, Zampino G. Genotype-cardiac phenotype correlations in a large single-center cohort of patients affected by RASopathies: Clinical implications and literature review. Am J Med Genet A 2021; 188:431-445. [PMID: 34643321 DOI: 10.1002/ajmg.a.62529] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/11/2021] [Accepted: 09/21/2021] [Indexed: 11/07/2022]
Abstract
Congenital heart disease (CHD) and hypertrophic cardiomyopathy (HCM) are common features in patients affected by RASopathies. The aim of this study was to assess genotype- phenotype correlations, focusing on the cardiac features and outcomes of interventions for cardiac conditions, in a single-center cohort of 116 patients with molecularly confirmed diagnosis of RASopathy, and compare these findings with previously published data. All enrolled patients underwent a comprehensive echocardiographic examination. Relevant information was also retrospectively collected through the analysis of clinical records. As expected, significant associations were found between PTPN11 mutations and pulmonary stenosis (both valvular and supravalvular) and pulmonary valve dysplasia, and between SOS1 mutations and valvular defects. Similarly, HRAS mutations were significantly associated with HCM. Potential associations between less prevalent mutations and cardiac defects were also observed, including RIT1 mutations and HCM, SOS2 mutations and septal defects, and SHOC2 mutations and septal and valve abnormalities. Patients with PTPN11 mutations were the most likely to require both a primary treatment (transcatheter or surgical) and surgical reintervention. Other cardiac anomalies less reported until recently in this population, such as isolated functional and structural mitral valve diseases, as well as a sigmoid-shaped interventricular septum in the absence of HCM, were also reported. In conclusion, our study confirms previous data but also provides new insights on cardiac involvement in RASopathies. Further research concerning genotype/phenotype associations in RASopathies could lead to a more rational approach to surgery and the consideration of drug therapy in patients at higher risk due to age, severity, anatomy, and comorbidities.
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Affiliation(s)
- Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Rita Blandino
- Unit of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelica Bibiana Delogu
- Unit of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella De Rosa
- Unit of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Valeria Verusio
- Unit of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Vittoria Marino
- Unit of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Antonio Lanza
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Yoshinaga M, Horigome H, Ayusawa M, Yasuda K, Kogaki S, Doi S, Tateno S, Ohta K, Hokosaki T, Nishihara E, Iwamoto M, Sumitomo N, Ushinohama H, Izumida N, Tauchi N, Kato Y, Kato T, Chisaka T, Higaki T, Yoneyama T, Abe K, Nozaki Y, Komori A, Kawai S, Ninomiya Y, Tanaka Y, Nuruki N, Sonoda M, Ueno K, Hazeki D, Nomura Y, Sato S, Hirono K, Hosokawa S, Takechi F, Ishikawa Y, Hata T, Ichida F, Ohno S, Makita N, Horie M, Matsushima S, Tsutsui H, Ogata H, Takahashi H, Nagashima M. Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents. Circ J 2021; 86:118-127. [PMID: 34615813 DOI: 10.1253/circj.cj-21-0376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The usefulness of electrocardiographic (ECG) voltage criteria for diagnosing hypertrophic cardiomyopathy (HCM) in pediatric patients is poorly defined.Methods and Results:ECGs at the 1st grade (mean [±SD] age 6.6±0.3 years) were available for 11 patients diagnosed with HCM at around the 7th grade (13.2±0.3 years). ECGs were available for another 64 patients diagnosed with HCM in the 1st (n=15), 7th (n=32), and 10th (n=17) grades. Fifty-one voltage criteria were developed by grade and sex using 62,841 ECGs from the general population. Voltage criteria were set at the 99.95th percentile (1/2,000) point based on the estimated prevalence of childhood HCM (2.9 per 100,000 [1/34,483]) to decrease false negatives. Conventional criteria were from guidelines for school-aged children in Japan. Of 11 patients before diagnosis, 2 satisfied conventional criteria in 1st grade; 5 (56%) of the remaining 9 patients fulfilled 2 voltage criteria (R wave in limb-lead I [RI]+S wave in lead V3 [SV3] and R wave in lead V3 [RV3]+SV3). Robustness analysis for sensitivity showed RV3+SV3 was superior to RI+SV3. For all patients after diagnosis, RI+SV4 was the main candidate. However, conventional criteria were more useful than voltage criteria. CONCLUSIONS Early HCM prediction was possible using RV3+SV3 in >50% of patients in 1st grade. Voltage criteria may help diagnose prediagnostic or early HCM, and prevent tragic accidents, although further prospective studies are required.
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Affiliation(s)
- Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Hitoshi Horigome
- Department of Child Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Mamoru Ayusawa
- Department of Pediatrics, Nihon University Itabashi Hospital
| | - Kazushi Yasuda
- Department of Pediatric Cardiology, Kids' Heart Center, Aichi Children's Health and Medical Center
| | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | - Shozaburo Doi
- Department of Pediatrics, National Hospital Organization Disaster Medical Center
| | - Sigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Kunio Ohta
- Department of Pediatrics, Kanazawa University
| | | | | | - Mari Iwamoto
- Children's Center, Saiseikai Yokohamashi Tobu Hospital
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | | | | | - Yoshiaki Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Taichi Kato
- Department of Pediatrics/Developmental Pediatrics, Nagoya University Graduate School of Medicine
| | | | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine
| | | | | | | | - Akiko Komori
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | - Satoru Kawai
- Department of Pediatric Cardiology, Kids' Heart Center, Aichi Children's Health and Medical Center
| | - Yumiko Ninomiya
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Yuji Tanaka
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Norihito Nuruki
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center
| | - Masahiro Sonoda
- Department of Cardiovascular Medicine, National Hospital Organization Kagoshima Medical Center
| | - Kentaro Ueno
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences
| | | | | | - Seiichi Sato
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Susumu Hosokawa
- Department of Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University
| | - Fumie Takechi
- Department of Pediatrics, Chiba Cardiovascular Center
| | - Yuichi Ishikawa
- Department of the Cardiovascular System, Fukuoka Children's Hospital
| | - Tadayoshi Hata
- Department of Pediatrics, Fujita Health University School of Medicine
| | | | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute
| | - Naomasa Makita
- Omics Research Center, National Cerebral and Cardiovascular Center
| | - Minoru Horie
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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Prevention of sudden cardiac death in childhood-onset hypertrophic cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101412] [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: 11/30/2022]
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39
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Monda E, Sarubbi B, Russo MG, Caiazza M, Mazzaccara C, Magrelli J, Rubino M, Esposito A, Perna A, Passariello A, Bossone E, Romeo E, Colonna D, Esposito MV, D'Argenio V, Salvatore F, Pacileo G, Crotti L, Frisso G, Limongelli G. Unexplained sudden cardiac arrest in children: clinical and genetic characteristics of survivors. Eur J Prev Cardiol 2021; 28:1134-1137. [PMID: 32715753 DOI: 10.1177/2047487320940863] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Berardo Sarubbi
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Maria Giovanna Russo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Cristina Mazzaccara
- CEINGE, Biotecnologie Avanzate, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University Federico II, Italy
| | - Jessica Magrelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Augusto Esposito
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Alessia Perna
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Annalisa Passariello
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | | | | | | | | | - Valeria D'Argenio
- CEINGE, Biotecnologie Avanzate, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Italy
| | - Francesco Salvatore
- CEINGE, Biotecnologie Avanzate, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University Federico II, Italy
| | - Giuseppe Pacileo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Italy
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Italy
| | - Giulia Frisso
- CEINGE, Biotecnologie Avanzate, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University Federico II, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Italy
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Italy
- Institute of Cardiovascular Sciences, University College of London and St Bartholomew's Hospital, UK
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40
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Shah MJ, Silka MJ, Silva JA, Balaji S, Beach C, Benjamin M, Berul C, Cannon B, Cecchin F, Cohen M, Dalal A, Dechert B, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril P, Karpawich P, Kim J, Krishna MR, Kubuš P, Malloy-Walton L, LaPage M, Mah D, Miyazaki A, Motonaga K, Niu M, Olen M, Paul T, Rosenthal E, Saarel E, Silvetti MS, Stephenson E, Tan R, Triedman J, Von Bergen N, Wackel P. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. Heart Rhythm 2021; 18:1888-1924. [PMID: 34363988 DOI: 10.1016/j.hrthm.2021.07.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California.
| | | | | | - Cheyenne Beach
- Yale University School of Medicine, New Haven, Connecticut
| | - Monica Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York Univeristy Grossman School of Medicine, New York, New York
| | | | - Aarti Dalal
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | - Doug Mah
- Harvard Medical School, Boston, Massachussetts
| | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Reina Tan
- New York University Langone Health, New York, New York
| | - John Triedman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nicholas Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. Indian Pacing Electrophysiol J 2021; 21:367-393. [PMID: 34333141 PMCID: PMC8577100 DOI: 10.1016/j.ipej.2021.07.005] [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] [Indexed: 01/10/2023] Open
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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42
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Dixon DL, de Las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e23-e106. [PMID: 33926766 DOI: 10.1016/j.jtcvs.2021.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF REVIEW The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed. RECENT FINDINGS Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particularly concerning in pediatric patients' where weight gain and linear growth is likely to lead to more significant hemodynamic changes in shorter periods of time. Some studies have even shown that risk factors concerning in adults may actually be protective in pediatric patients. Additionally, large gaps still remain between genotype and phenotype expression in HCM. SUMMARY A better understanding of the relationship between cause, phenotype, and outcomes is needed to truly be able to determine risk for SCD in childhood HCM. Larger studies, including newer technologies and quantitative models, similar to the European HCM Risk-SCD model, which allows for a quantitative risk diagnosis, are needed as well.
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Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease. J Clin Med 2021; 10:jcm10081554. [PMID: 33917168 PMCID: PMC8067842 DOI: 10.3390/jcm10081554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023] Open
Abstract
In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD.
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Rodriguez-Gonzalez M, Pérez-Reviriego ÁA, Castellano-Martinez A, Cascales-Poyatos HM. Disopyramide as coadjuvant treatment in obstructive hypertrophic cardiomyopathy. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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46
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Gallo G, Mastromarino V, Limongelli G, Calcagni G, Maruotti A, Ragni L, Valente F, Musumeci MB, Adorisio R, Rubino M, Autore C, Magrì D. Insights from Cardiopulmonary Exercise Testing in Pediatric Patients with Hypertrophic Cardiomyopathy. Biomolecules 2021; 11:biom11030376. [PMID: 33801562 PMCID: PMC7999553 DOI: 10.3390/biom11030376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
The usefulness of cardiopulmonary exercise test (CPET) in adult hypertrophic cardiomyopathy (HCM) patients is well-known, whereas its role in pediatric HCM patients has not yet been explored. The present study investigates possible insights from a CPET assessment in a cohort of pediatric HCM outpatients in terms of functional and prognostic assessment. Sixty consecutive pediatric HCM outpatients aged <18 years old were enrolled, each of them undergoing a full clinical assessment including a CPET; a group of 60 healthy subjects served as controls. A unique composite end-point of heart failure (HF) related and sudden cardiac death (SCD) or SCD-equivalent events was also explored. During a median follow-up of 53 months (25th–75th: 13–84 months), a total of 13 HF- and 7 SCD-related first events were collected. Compared to controls, HCM patients showed an impaired functional capacity with most of them showing peak oxygen uptake (pVO2) values of <80% of the predicted, clearly discrepant with functional New York Heart Association class assessment. The composite end-point occurred more frequently in patients with the worst CPETs’ profiles. At the univariate analysis, pVO2% was the variable with the strongest association with adverse events at follow-up (C-index = 0.72, p = 0.025) and a cut-off value equal to 60% was the most accurate in identifying those patients at the highest risk. In a pediatric HCM subset, the CPET assessment allows a true functional capacity estimation and it might be helpful in identifying early those patients at high risk of events.
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Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Vittoria Mastromarino
- Paediatric Cardiology and ACHD Unit, S. Orsola, Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (L.R.)
| | - Giuseppe Limongelli
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy; (G.C.); (R.A.)
| | - Antonello Maruotti
- Department of Scienze Economiche, Politiche e delle Lingue Moderne, Libera Università SS Maria Assunta, 00193 Rome, Italy;
- Department of Mathematics, University of Bergen, 5052 Bergen, Norway
- School of Computing, University of Portsmouth, Portsmouth PO2 8QD, UK
| | - Luca Ragni
- Paediatric Cardiology and ACHD Unit, S. Orsola, Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (L.R.)
| | - Fabio Valente
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Maria Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy; (G.C.); (R.A.)
| | - Marta Rubino
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
- Correspondence: ; Tel.: +39-(0)6-3377-5563; Fax: +39-(0)6-3377-5061
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Mori AA, Castro LRD, Bortolin RH, Bastos GM, Oliveira VFD, Ferreira GM, Hirata TDC, Fajardo CM, Sampaio MF, Moreira DAR, Pachón-Mateos JC, Correia EDB, Sousa AGDMR, Brión M, Carracedo A, Hirata RDC, Hirata MH. Association of variants in MYH7, MYBPC3 and TNNT2 with sudden cardiac death-related risk factors in Brazilian patients with hypertrophic cardiomyopathy. Forensic Sci Int Genet 2021; 52:102478. [PMID: 33588347 DOI: 10.1016/j.fsigen.2021.102478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy (LVH) and is one of the major causes of sudden cardiac death (SCD). An exon-targeted gene sequencing strategy was used to investigate the association of functional variants in sarcomeric genes (MYBPC3, MYH7 and TNNT2) with severe LVH and other SCD-related risk factors in Brazilian HCM patients. Clinical data of 55 HCM patients attending a Cardiology Hospital (Sao Paulo city, Brazil) were recorded. Severe LVH, aborted SCD, family history of SCD, syncope, non-sustained ventricular tachycardia and abnormal blood pressure in response to exercise were evaluated as SCD risk factors. Blood samples were obtained for genomic DNA extraction and the exons and untranslated regions of the MYH7, MYBPC3 and TNNT2 were sequenced using Nextera® and MiSEq® reagents. Variants were identified and annotated using in silico tools, and further classified as pathogenic or benign according to the American College of Medical Genetics and Genomics guidelines. Variants with functional effects were identified in MYBPC3 (n = 9), MYH7 (n = 6) and TNNT2 (n = 4). The benign variants MYBPC3 p.Val158Met and TNNT2 p.Lys263Arg were associated with severe LVH (p < 0.05), and the MYH7 p.Val320Met (pathogenic) was associated with family history of SCD (p = 0.037). Increased risk for severe LVH was found in carriers of MYBPC3 Met158 (c.472 A allele, OR = 13.5, 95% CI = 1.80-101.12, p = 0.011) or combined variants (MYBPC3, MYH7 and TNNT2: OR = 12.39, 95% CI = 2.14-60.39, p = 0.004). Carriers of TNNT2 p.Lys263Arg and combined variants had higher values of septum thickness than non-carriers (p < 0.05). Molecular modeling analysis showed that MYBPC3 158Met reduces the interaction of cardiac myosin-binding protein C (cMyBP-C) RASK domain (amino acids Arg215-Ala216-Ser217-Lys218) with tropomyosin. In conclusion, the variants MYBPC3 p.Val158Met, TNNT2 p.Lys263Arg and MYH7 p.Val320Met individually or combined contribute to the risk of sudden cardiac death and other outcomes of hypertrophic cardiomyopathy.
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Affiliation(s)
- Augusto Akira Mori
- School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Gisele Medeiros Bastos
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil; Real e Benemerita Associação Portuguesa de Beneficiencia, Sao Paulo, Brazil
| | | | - Glaucio Monteiro Ferreira
- School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil; Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
| | | | | | - Marcelo Ferraz Sampaio
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil; Real e Benemerita Associação Portuguesa de Beneficiencia, Sao Paulo, Brazil
| | | | | | | | | | - Maria Brión
- Genetica Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Grupo de Medicina Genômica, Universidad de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genômica, Universidad de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain; Centro Nacional de Genotipado-CeGen-USC-PRB3-ISCIII, Santiago de Compostela, Spain
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Evolution of risk stratification and sudden death prevention in hypertrophic cardiomyopathy: Twenty years with the implantable cardioverter-defibrillator. Heart Rhythm 2021; 18:1012-1023. [PMID: 33508516 DOI: 10.1016/j.hrthm.2021.01.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common inherited myocardial disorder, once regarded as largely untreatable with ominous prognosis and most visibly as a common cause of sudden death (SD) in the young. Over the last several years, HCM has been transformed into a contemporary treatable disease with management options that significantly alter clinical course. With the use of implantable cardioverter-defibrillators (ICDs) in the HCM patient population, a new paradigm has emerged, with primary prevention device therapy reliably terminating potentially lethal ventricular tachyarrhythmias (3%-4% per year) and being largely responsible for a >10-fold decrease in disease-related mortality (to 0.5% per year), independent of age. An evidenced-based and guideline directed clinical risk stratification algorithm has evolved, including variables identified with cardiac magnetic resonance. One or more risk markers judged major and relevant within a patient's clinical profile can be considered sufficient to recommend a primary prevention implant (associated with a measure of physician judgment and shared decision-making). ICD decisions using the prospective individual risk marker strategy have been associated with 95% sensitivity for identifying patients who subsequently experienced appropriate ICD therapy, (albeit often delayed substantially for >5 or >10 years after implant), but without heart failure deterioration or HCM death following device intervention. A rigid mathematically derived statistical risk model proposed by the European Society of Cardiology is associated with low sensitivity (ie, 33%) for predicting SD events. Introduction of prophylactically inserted ICDs to HCM 20 years ago has significantly altered the clinical course and landscape of this disease. SD prevention has reduced HCM mortality significantly, making preservation of life and the potential for normal longevity a reality for most patients.
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Tunca Sahin G, Ozgur S, Kafali HC, Sevinc Sengul F, Haydin S, Guzeltas A, Ergul Y. Clinical characteristics of hypertrophic cardiomyopathy in children: An 8-year single center experience. Pediatr Int 2021; 63:37-45. [PMID: 32682351 DOI: 10.1111/ped.14393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/14/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the second most common pediatric cardiomyopathy. Although there is a large body of literature about HCM in adults, there is limited information on HCM in childhood. We evaluated various aspects of pediatric HCM patients treated at our center. METHODS We identified 152 pediatric patients with HCM between October 2011 and October 2019. Clinical history, invasive (ICD, pacemaker, electrophysiologic study, catheter ablation therapy) and non-invasive (ECG, holter moniterization, echocardiography, cardiac MR, genetic study, medicam treatment) data were collected and evaluated. RESULTS The mean ± standard deviation age of patients was 8.9 ± 5.7 years (1 month-18 years) and 67.8% were male. The most frequent clinical symptoms were murmur and palpitations. Three cases (2%) had aborted sudden death as the first manifestation of HCM. Of these patients, 120 (78.9%) had non-syndromic HCM and 32 (27.2%) had syndromic HCM. Asymmetric septal hypertrophy was common (48.3%) in the non-syndromic group, whereas concentric hypertrophy was common (56.2%) in syndromic group. Left ventricular outflow tract obstruction (LVOTO) occurred in 39 (25.6%) patients. Nine (5.9%) patients underwent electrophysiologic study and/or ablation and 16 patients underwent surgical intervention. Implantable cardioverter defibrillator (ICD) insertion was performed in 38 patients (26 transvenous, 12 epicardial). ICDs were inserted in three (7.9%) patients for secondary prevention; in the remaining patients (92.1%) the devices were placed for primary prevention. Mean SD follow-up time was 27.1 ± 22 months. Five (3.3%) patients died during the follow-up. No patient had heart transplantation or a long-term assistive device. CONCLUSION The etiology of HCM is heterogeneous and present at any age. It is important to determine the timing of surgery and potential risks for sudden cardiac arrest. As most cases of HCM are familial, evaluation of family members at risk should be a routine component of clinical management.
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Affiliation(s)
- Gulhan Tunca Sahin
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Senem Ozgur
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Hasan Candas Kafali
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Fatma Sevinc Sengul
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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50
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Abstract
Paediatric cardiomyopathies are a heterogenous group of rare disorders, characterised by mechanical and electrical abnormalities of the heart muscle. The overall annual incidence of childhood cardiomyopathies is estimated at about 1 per 100,000 children and is significantly higher during the first 2 years of life. Dilated cardiomyopathies account for approximately half of the cases. Hypertrophic cardiomyopathies form the second largest group, followed by the less common left ventricular non-compaction and restrictive phenotypes. Infectious, metabolic, genetic, and syndromic conditions account for the majority of cases. Congestive heart failure is the typical manifestation in children with dilated cardiomyopathy, whereas presenting symptoms are more variable in other phenotypes. The natural history is largely influenced by the type of cardiomyopathy and its underlying aetiology. Results from a national population-based study revealed 10-year transplant-free survival rates of 80, 62, and 48% for hypertrophic, dilated and left ventricular non-compaction cardiomyopathies, respectively. Long-term survival rates of children with a restrictive phenotype have largely been obscured by early listing for heart transplantation. In general, the majority of adverse events, including death and heart transplantation, occur during the first 2 years after the initial presentation. This review provides an overview of childhood cardiomyopathies with a focus on epidemiology, natural history, and outcomes.
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Affiliation(s)
- Anika Rath
- Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Robert Weintraub
- Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia.,Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Melbourne University, Melbourne, VIC, Australia
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