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Muacevic A, Adler JR, Unlu S, Boyuk F. A Cardiac Magnetic Resonance Study: Comparison of Biventricular Longitudinal Function in Hypertrophic Cardiomyopathy Patients and Normal Individuals. Cureus 2023; 15:e34165. [PMID: 36843682 PMCID: PMC9949903 DOI: 10.7759/cureus.34165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is a genetic disease with an incidence of 0.2%-0.5%. It has a wide range of clinical presentations varying from coincidental diagnoses to heart failure, ventricular arrhythmias and sudden cardiac death. Mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) are M-mode-derived practical and reproducible measurements of systolic longitudinal displacement of the annular plane. These two measures may be used as markers of the left ventricular and right ventricular longitudinal functions. Currently, there are only a few studies on cardiac magnetic resonance (CMR)-derived TAPSE and MAPSE measurement comparison between the HCM group and normal control group. The aim of our study is to show the differences in CMR-derived TAPSE and MAPSE values between the HCM and normal population. METHODS We evaluated CMR exams of patients diagnosed with HCM and of normal individuals scanned between 2020 and 2021 retrospectively. The patients were from our own institution's and other hospitals' in- and out-patient departments. Data was collected on 36 HCM patients and 34 adults with no known history of cardiac and non-cardiac diseases. All CMR exams were performed on a 1.5 T (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany) scanner. CMR-derived MAPSE and TAPSE were measured on standard four-chamber steady-state free precession (SSFP) cine images and given in millimeters. RESULTS From February 2020 to December 2021, a total of 150 patients were diagnosed with hypertrophic cardiomyopathy. After exclusion, 36 patients with HCM were included in the study and the normal control group comprised 34 individuals. The mean age of the HCM group was 43.2 + 13.5 years, while it was 37.5 + 11.3 in the control group. The female ratio of the HCM group was found to be 36%, while it was 56% in the healthy control group. MAPSE values were significantly higher in the normal control group when compared to the HCM patient group (MAPSE: 14.5 ± 2.9 mm vs. 11.7 ± 3.2 mm; p<0.001), while TAPSE values did not depict a significant difference between the two groups (p=0.627). CONCLUSIONS This study suggests that MAPSE values are significantly lower in the HCM patient group in comparison with the normal control group on CMR scans. Although not statistically significant, TAPSE values are also lower in the HCM group.
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Hegde SM, Lester SJ, Solomon SD, Michels M, Elliott PM, Nagueh SF, Choudhury L, Zemanek D, Zwas DR, Jacoby D, Wang A, Ho CY, Li W, Sehnert AJ, Olivotto I, Abraham TP. Effect of Mavacamten on Echocardiographic Features in Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2021; 78:2518-2532. [PMID: 34915982 DOI: 10.1016/j.jacc.2021.09.1381] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND EXPLORER-HCM (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy) demonstrated that mavacamten, a cardiac myosin inhibitor, improves symptoms, exercise capacity, and left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (oHCM). OBJECTIVES The purpose of this study was to evaluate mavacamten's effect on measures of cardiac structure and function and its association with changes in other clinical measures. METHODS Key echocardiographic parameters from serial echocardiograms over 30 weeks from 251 symptomatic oHCM patients (mavacamten [n = 123], placebo [n = 128]) were assessed in a core laboratory. RESULTS More patients on mavacamten (80.9%; n = 76 of 94) vs placebo (34.0%; n = 33 of 97) showed complete resolution of mitral valve systolic anterior motion after 30 weeks (difference, 46.8%; P < 0.0001). Mavacamten also improved measures of diastolic function vs placebo, including left atrial volume index (LAVI) (mean ± SD baseline: 40 ± 12 mL/m2 vs 41 ± 14 mL/m2; mean change from baseline of -7.5 mL/m2 [95% CI: -9.0 to -6.1 mL/m2] vs -0.09 mL/m2 [95% CI: -1.6 to 1.5 mL/m2]; P < 0.0001) and lateral E/e' (baseline, 15 ± 6 vs 15 ± 8; change of -3.8 [95% CI: -4.7 to -2.8] vs 0.04 [95% CI: -0.9 to 1.0]; P < 0.0001). Among mavacamten-treated patients, improvement in resting, Valsalva, and post-exercise LVOT gradients, LAVI, and lateral E/e' was associated with reduction in N-terminal pro-B-type natriuretic peptide (P ≤ 0.03 for all). Reduction in LAVI was associated with improved peak exercise oxygen consumption (P = 0.04). CONCLUSIONS Mavacamten significantly improved measures of left ventricular diastolic function and systolic anterior motion. Improvement in LVOT obstruction, LAVI, and E/e' was associated with reduction in a biomarker of myocardial wall stress (N-terminal pro-B-type natriuretic peptide). These findings demonstrate improvement in important markers of the pathophysiology of oHCM with mavacamten. (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy; NCT03470545).
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Affiliation(s)
- Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Lubna Choudhury
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Zemanek
- 2nd Department of Internal Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Donna R Zwas
- Heart Institute, Hadassah University Medical Center, Jerusalem, Israel
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut, USA
| | - Andrew Wang
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wanying Li
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi and the University of Florence, Florence, Italy
| | - Theodore P Abraham
- UCSF HCM Center of Excellence, University of California San Francisco, San Francisco, California, USA
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Prognostic Significance of the Mitral L-Wave in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2020; 130:130-136. [PMID: 32636017 DOI: 10.1016/j.amjcard.2020.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
A mitral L-wave indicates advanced diastolic dysfunction with elevated left ventricular filling pressure. Previous studies have reported that the presence of a mitral L-wave is associated with a poor prognosis in patients with heart failure. However, whether the L-wave can predict adverse events in patients with hypertrophic cardiomyopathy (HC) is still unclear. Therefore, we aimed to investigate the prevalence of a mitral L-wave in patients with HC, and the prognosis of patients with or without an L-wave. We analyzed 445 patients with HC. The end points of this study were HC-related death, such as sudden death or potentially lethal arrhythmic events, heart failure-related death, and stroke-related death. A mitral L-wave was defined as a distinct mid-diastolic flow velocity after the E wave with a peak velocity >20 cm/s. The prevalence of an L-wave was 32.4% in patients with HC. Patients with an L-wave were significantly younger, more likely to be women, had higher New York Heart Association functional class, and had a higher prevalence of atrial fibrillation than did patients without an L-wave. Patients with an L-wave had a significantly higher incidence of HC-related death compared with those without an L-wave (log-rank, p < 0.001). The L-wave was an independent determinant of HC-related death in multivariate analysis adjusted for imbalanced baseline variables (adjusted hazard ratio 2.38; 95% confidence interval 1.42 to 4.01; p = 0.001). In conclusion, the presence of a mitral L-wave may be associated with adverse outcome in patients with HC.
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Avegliano G, Politi MT, Costabel JP, Kuschnir P, Trivi M, Ronderos R. Differences in the extent of fibrosis in obstructive and nonobstructive hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2019; 20:389-396. [PMID: 30994509 DOI: 10.2459/jcm.0000000000000800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Left ventricular outflow tract (LVOT) obstruction is a key feature of hypertrophic cardiomyopathy (HCM) that identifies patients at increased risk of adverse outcomes. Previous studies have hypothesized that LVOT obstruction enhances myocardial fibrosis and increases left ventricular (LV) filling pressures, producing greater clinical deterioration. However, this hypothesis has not been demonstrated in a clinical cohort comparing obstructive and nonobstructive patients. METHODS Patients with HCM in whom Doppler echocardiography was performed within 30 days of cardiac MRI were enrolled, using the E/e' ratio to assess LV diastolic function and late gadolinium enhancement to evaluate the extent of fibrosis. Data were assorted according to LVOT obstruction status at rest. RESULTS The current study enrolled 67 patients who were mostly middle-aged (56.8 ± 13.2 years old) men (75%) with preserved ejection fraction. Obstructive HCM presented a significant association with a high fibrosis extent [odds ratio (OR) 3.33; P = 0.034] which was maintained after adjusting for sex and age (OR 4.37; P = 0.016) but not for maximum LV wall thickness (OR 2.13; P = 0.225). Obstructive HCM was also associated with a clinically significant E/e' ratio more than 14 (OR 7.8; P = 0.001) which decreased slightly after adjusting for age, sex and maximum LV thickness (OR 6.54; P = 0.014). There was a significant association between an E/e' ratio more than 14 and the extent of fibrosis (OR 1.29; P < 0.001) which was maintained after adjusting for age, sex and maximum LV wall thickness (OR 1.36; P = 0.001). CONCLUSION LVOT obstruction may play a role in the extent of fibrosis in HCM, possibly conditioning greater diastolic dysfunction.
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Affiliation(s)
- Gustavo Avegliano
- Cardiac Imaging Department.,Cardiomyopathy Unit, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Juan P Costabel
- Cardiomyopathy Unit, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Marcelo Trivi
- Cardiomyopathy Unit, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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Lu DY, Haileselassie B, Ventoulis I, Liu HY, Liang HY, Pozios I, Canepa M, Phillip S, Abraham MR, Abraham T. E/e′ ratio and outcome prediction in hypertrophic cardiomyopathy: the influence of outflow tract obstruction. Eur Heart J Cardiovasc Imaging 2017; 19:101-107. [DOI: 10.1093/ehjci/jex134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/04/2017] [Indexed: 01/05/2023] Open
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Jain P, Patel PA, Fabbro M. Hypertrophic Cardiomyopathy and Left Ventricular Outflow Tract Obstruction: Expecting the Unexpected. J Cardiothorac Vasc Anesth 2017; 32:467-477. [PMID: 28967624 DOI: 10.1053/j.jvca.2017.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 12/16/2022]
Abstract
Hypertrophic cardiomyopathy is an increasingly recognized clinical disease that carries perioperative risk. Patients may or may not carry a preoperative diagnosis, but provocable left ventricular outflow tract gradients place them at risk for hemodynamic compromise under surgical conditions. Early recognition of obstructive patterns and rapid management alterations in the face of instability are imperative for the treatment of these patients. This review focuses on the diagnostic criteria, risk factors, and management strategies for the perioperative hypertrophic cardiomyopathy patient. Finally, novel diagnostic modalities are discussed.
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Affiliation(s)
- Pankaj Jain
- Miller School of Medicine, University of Miami, Miami, FL.
| | - Prakash A Patel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Miller School of Medicine, University of Miami, Miami, FL
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Ziółkowska L, Petryka J, Boruc A, Kawalec W. Comparison of echocardiography with tissue Doppler imaging and magnetic resonance imaging with delayed enhancement in the assessment of children with hypertrophic cardiomyopathy. Arch Med Sci 2017; 13:328-336. [PMID: 28261285 PMCID: PMC5332448 DOI: 10.5114/aoms.2016.60404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/19/2015] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION In children with hypertrophic cardiomyopathy (HCM) there often occurs a non-ischemic pattern of myocardial fibrosis, which could be the cause of impaired left ventricular (LV) diastolic function assessed by tissue Doppler imaging (TDI). The aim of the study was to determine the prevalence of myocardial fibrosis in children with HCM, and to evaluate its relationship with echocardiographic parameters including LV diastolic dysfunction. MATERIAL AND METHODS Sixty-three children with HCM, mean age 12.2 ±4.5 years, underwent magnetic resonance imaging (MRI) and echocardiographic study from January 2010 to April 2014. The results of MRI, echocardiography, and TDI velocities were analyzed and compared between children with and without myocardial fibrosis. Moreover, correlations between the results of echocardiography and MRI were assessed. RESULTS Our results showed a significant correlation between magnetic resonance and echocardiographic measurements of septal wall thickness, posterior wall thickness, LV mass and left atrial dimension. Children with myocardial fibrosis (60%) had a significantly thicker interventricular septum (21.3 vs. 1.8 mm; p < 0.0001) and larger left atrial dimension (36.7 vs. 27.8 mm; p = 0.0004) and volume index (42.0 vs. 26.6 ml/m²; p = 0.0011). Tissue Doppler imaging demonstrated significantly decreased lateral E' (9.02 vs. 13.53 cm/s; p < 0.0001) and septal E' (7.05 vs. 9.36 cm/s; p = 0.0082) velocities and a significantly increased transmitral lateral (10.34 vs. 6.68; p = 0.0091) and septal (13.1 vs. 9.8; p = 0.046) E/E' ratio in children with myocardial fibrosis. CONCLUSIONS Myocardial fibrosis in children with hypertrophic cardiomyopathy was associated with markers for disease severity such as larger septum thickness, enlargement of the left atrium as well as impairment of left ventricular diastolic function. Tissue Doppler imaging is a helpful tool to detect the presence of left ventricular diastolic dysfunction in children with hypertrophic cardiomyopathy and myocardial fibrosis.
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Affiliation(s)
- Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Joanna Petryka
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Agnieszka Boruc
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Wanda Kawalec
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
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Abstract
The differentiation between hypertrophic and restrictive cardiomyopathies is often challenging in the routine clinical setting. Advances in the field of multimodal imaging have improved the diagnostics of these diseases and understanding of the underlying pathophysiology. Each imaging method, such as echocardiography, cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT) and coronary angiography including cardiac catheterization for pressure measurements, is of significant value in clinical diagnostics and also regarding therapeutic approaches and prognostic implications. This review gives an overview of developments of the past few years, describes recent insights and puts these findings into a scientific context. Particularly CMR has added valuable information to current knowledge by its unique potential of contrast-enhanced tissue characterization. Another promising CMR tool, parametric mapping has appeared on the horizon and may further deepen our understanding of cardiac pathophysiology as well as offer new therapeutic options to patients.
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Doesch C, Sperb A, Sudarski S, Lossnitzer D, Rudic B, Tülümen E, Heggemann F, Schimpf R, Schoenberg SO, Borggrefe M, Papavassiliu T. Mitral annular plane systolic excursion is an easy tool for fibrosis detection by late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Arch Cardiovasc Dis 2015; 108:356-66. [PMID: 25863428 DOI: 10.1016/j.acvd.2015.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/13/2014] [Accepted: 01/26/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) causes various degrees of fibrosis resulting in left ventricular function impairment, which can be measured using mitral annular plane systolic excursion (MAPSE). AIMS To determine the values for septal, lateral and average MAPSE using cardiovascular magnetic resonance (CMR) in healthy controls and patients with HCM; and to investigate whether MAPSE correlated with the extent of fibrosis. METHODS Patients with HCM and healthy controls underwent CMR. RESULTS In 50 healthy controls, septal and lateral MAPSE were comparable and showed excellent intra- and inter-observer reliability. Patients with HCM had significantly reduced septal, lateral and average MAPSE compared to healthy controls. Furthermore, in patients with HCM, septal MAPSE measurements were significantly reduced compared to lateral ones. Correspondingly, the septal myocardial segments showed significantly more late gadolinium enhancement (LGE) than lateral ones. No significant differences were found between echocardiographic and CMR MAPSE measurements in healthy controls and patients with HCM. Patients who suffered a major adverse cardiac event or stroke revealed a significantly reduced MAPSE and a significantly greater LGE extent compared to event-free patients with HCM. CONCLUSIONS MAPSE measurement using CMR is feasible, reproducible and comparable to echocardiography in healthy controls and patients with HCM. The asymmetric and mainly septal distribution of myocardial hypertrophy and fibrosis detected by LGE in patients with HCM was reflected by significantly reduced septal versus lateral MAPSE. Therefore, reduced MAPSE seems to be an easily determinable marker of fibrosis accumulation leading to left ventricular mechanical dysfunction and also seems to have a prognostic implication.
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Affiliation(s)
- Christina Doesch
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany.
| | - Amelie Sperb
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Sonja Sudarski
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Boris Rudic
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Felix Heggemann
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Rainer Schimpf
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
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Hartmannova H, Kubanek M, Sramko M, Piherova L, Noskova L, Hodanova K, Stranecky V, Pristoupilova A, Sovova J, Marek T, Maluskova J, Ridzon P, Kautzner J, Hulkova H, Kmoch S. Isolated X-linked hypertrophic cardiomyopathy caused by a novel mutation of the four-and-a-half LIM domain 1 gene. ACTA ACUST UNITED AC 2013; 6:543-51. [PMID: 24114807 DOI: 10.1161/circgenetics.113.000245] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy with severe left ventricular diastolic dysfunction has been associated with marked exercise intolerance and poor prognosis. However, molecular pathogenesis of this phenotype remains unexplained in a large proportion of cases. METHODS AND RESULTS We performed whole exome sequencing as an initial genetic test in a large Czech family with 3 males affected by nonobstructive hypertrophic cardiomyopathy with severe left ventricular diastolic dysfunction in end-stage disease. A novel frameshift mutation of four-and-a-half LIM domain 1 gene (FHL1) (c.599_600insT; p.F200fs32X) was detected in these individuals. The mutation does not affect transcription, splicing, and stability of FHL1 mRNA and results in production of truncated FHL1 protein, which is contrary to heart tissue homogenate not detectable in frozen tissue sections of myocardial biopsy of affected males. The identified mutation cosegregated also with abnormal ECG and with 1 case of apical hypertrophic cardiomyopathy in heterozygous females. Although skeletal muscle involvement is a common finding in FHL1-related diseases, we could exclude myopathy in all mutation carriers. CONCLUSIONS We identified a novel FHL1 mutation causing isolated hypertrophic cardiomyopathy with X-chromosomal inheritance.
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Affiliation(s)
- Hana Hartmannova
- Institute of Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Kitaoka H, Kubo T, Hayashi K, Yamasaki N, Matsumura Y, Furuno T, Doi YL. Tissue Doppler imaging and prognosis in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 14:544-9. [DOI: 10.1093/ehjci/jes200] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Girasis C, Vassilikos V, Efthimiadis GK, Papadopoulou SL, Dakos G, Dalamaga EG, Chouvarda I, Giannakoulas G, Kamperidis V, Paraskevaidis S, Maglaveras N, Karvounis HI, Parcharidis GE, Styliadis IH. Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis. Eur Heart J Cardiovasc Imaging 2012; 14:425-34. [DOI: 10.1093/ehjci/jes172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate left ventricular hypertrophy (LVH) in the setting of a nondilated left ventricle. HCM is often associated with asymmetric LVH, a family history of HCM, sarcomeric genetic mutations, and an increased risk of sudden cardiac death. There is a wide clinical variability in HCM presenting during childhood and a relative lack of data on the pediatric population. This review will cover HCM presenting in infancy, childhood, and adolescence.
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Affiliation(s)
- Shiraz A Maskatia
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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Restrictive physiology is associated with poor outcomes in children with hypertrophic cardiomyopathy. Pediatr Cardiol 2012; 33:141-9. [PMID: 21892651 DOI: 10.1007/s00246-011-0106-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/20/2011] [Indexed: 12/25/2022]
Abstract
Pediatric patients with hypertrophic cardiomyopathy (HCM) and restrictive physiology (RP) with poor outcomes have been identified, but data on their course are limited. Our goal was to delineate the clinical features and course of children with HCM and RP. An institutional review of 119 patients identified between 1985 and 2010 with the diagnosis of HCM was performed. The diagnosis of RP was based on >1 echocardiogram along with at least one of the following: left atrial enlargement without evidence of left ventricle dilation, E/E' ratio ≥ 10, and E/A ratio ≥ 3. Outcomes analysis was performed using Cox or Poisson regression when appropriate. RP was present in 50 (42%) patients. In patients without RP, 10-year freedom-from-death or aborted sudden cardiac death (aSCD), and death or heart transplant (HT), were 93.6 and 98.5%, respectively. In patients with RP, 10-year freedom-from-death or aSCD, and death or HT, were 59.0 and 71.2%, respectively. RP conferred a 3.5-fold increase in incidence rate of hospitalization (P = 0.01), a 3.8-fold increase in hazard of death or aSCD (P = 0.02), and a 5.7-fold increase in hazard of death or HT (P = 0.04). Assessment for RP is of paramount importance in children with HCM because those without RP have a good prognosis, and those with RP account for the majority of poor outcomes.
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Kitaoka H, Kubo T, Okawa M, Takenaka N, Sakamoto C, Baba Y, Hayashi K, Yamasaki N, Matsumura Y, Doi YL. Tissue Doppler Imaging and Plasma BNP Levels to Assess the Prognosis in Patients with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2011; 24:1020-5. [DOI: 10.1016/j.echo.2011.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Indexed: 01/29/2023]
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Pagourelias ED, Efthimiadis GK, Parcharidou DG, Gossios TD, Kamperidis V, Karoulas T, Karvounis H, Styliadis IH. Prognostic value of right ventricular diastolic function indices in hypertrophic cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:809-17. [DOI: 10.1093/ejechocard/jer126] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kawasaki T, Yamano M, Kuribayashi T, Kaimoto S, Miki S, Kamitani T, Matsubara H, Sugihara H. Three-layer ultrasonic tissue characterization of the ventricular septum is predictive of prognosis in patients with non-obstructive hypertrophic cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:90-7. [DOI: 10.1093/ejechocard/jeq108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pagourelias ED, Efthimiadis GK, Parcharidou DG, Pliakos C, Styliadis IH. Prognostic implications of the Doppler restrictive filling pattern in hypertrophic cardiomyopathy. Am J Cardiol 2010; 105:1358. [PMID: 20403495 DOI: 10.1016/j.amjcard.2010.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 01/06/2010] [Accepted: 01/13/2010] [Indexed: 11/17/2022]
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Kubo T, Kitaoka H, Okawa M, Hirota T, Hoshikawa E, Hayato K, Yamasaki N, Matsumura Y, Yabe T, Nishinaga M, Takata J, Doi YL. Clinical profiles of hypertrophic cardiomyopathy with apical phenotype--comparison of pure-apical form and distal-dominant form. Circ J 2009; 73:2330-6. [PMID: 19838003 DOI: 10.1253/circj.cj-09-0438] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) with an apical phenotype, in which hypertrophy of the myocardium predominantly involves the apex of the left ventricle, is not uncommon in Japan, but its morphologic variations are not well recognized. The aim of this study was to investigate if these variations have different clinical characteristics although they are still confused to be the same. METHODS AND RESULTS Patients with the apical phenotype were divided into 2 groups, the "pure-apical" form and the "distal-dominant" form, and their clinical profiles were compared. From the study cohort of 264 patients with HCM, 80 (30%) were classified as having the apical phenotype: 51 with the pure-apical form and 29 with the distal-dominant form. The age at diagnosis was approximately 60 years, and in both groups the majority were male. The distal-dominant group had a significantly larger left atrial diameter (43 vs 39 mm) and higher ratio of proven familial HCM (28 vs 6%), and were more symptomatic (New York Heart Association >or=3) at presentation (17 vs 0%). The event-free rate of cardiovascular events in patients with the distal-dominant form was significantly worse (log-rank P=0.012) than that in patients with the pure-apical form (follow-up period: asymptotically approximately 5 years). CONCLUSIONS The 2 phenotypes of apical HCM should be recognized and distinguished clinically.
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Affiliation(s)
- Toru Kubo
- Department of Medicine and Geriatrics, Kochi Medical School, Nankoku, Japan
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Utility of tissue Doppler imaging to predict exercise capacity in hypertrophic cardiomyopathy: Comparison with B-type natriuretic peptide. J Cardiol 2009; 53:361-7. [DOI: 10.1016/j.jjcc.2008.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/13/2008] [Accepted: 12/16/2008] [Indexed: 11/19/2022]
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21
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Minoshima M, Noda A, Nishizawa T, Hara Y, Sugiura M, Iino S, Nagata K, Koike Y, Murohara T. Endomyocardial Radial Strain Imaging and Left Ventricular Relaxation Abnormalities in Patients With Hypertrophic Cardiomyopathy or Hypertensive Left Ventricular Hypertrophy. Circ J 2009; 73:2294-9. [DOI: 10.1253/circj.cj-08-0879] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Akiko Noda
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Takao Nishizawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yuki Hara
- Department of Pathophysiology Laboratory Sciences
| | - Mari Sugiura
- Department of Pathophysiology Laboratory Sciences
| | - Shigeo Iino
- Department of Clinical Laboratory, Nagoya University Hospital
| | - Kohzo Nagata
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Yasuo Koike
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Motoyasu M, Kurita T, Onishi K, Uemura S, Tanigawa T, Okinaka T, Takeda K, Nakano T, Ito M, Sakuma H. Correlation between late gadolinium enhancement and diastolic function in hypertrophic cardiomyopathy assessed by magnetic resonance imaging. Circ J 2008; 72:378-83. [PMID: 18296832 DOI: 10.1253/circj.72.378] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diastolic dysfunction is common in patients with overt hypertrophic cardiomyopathy (HCM). Steady-state cine magnetic resonance imaging (MRI) enables measurement of the diastolic function of the left ventricle (LV), and late gadolinium enhanced MRI can delineate the presence and extent of fibrosis in HCM. The purpose of this study was to determine the relationship between the extent of myocardial fibrosis demonstrated by late gadolinium-enhanced MRI and diastolic dysfunction. METHODS AND RESULTS Seventeen patients (13 men, mean age 57.7+/-9.8 years) with HCM were studied. The severity index of late gadolinium enhancement was determined by scoring the extent of enhanced tissue in 30 myocardial segments. The peak filling rate (PFR), LV ejection fraction and LV mass were determined by cine MRI. Contrast-enhanced MRI demonstrated late gadolinium enhancement in 97 of 510 segments (19%) and 13 of the 17 patients (77%). The severity index of late gadolinium enhancement demonstrated a significant negative correlation with PFR (r= -0.86, p<0.01) and with the LV ejection fraction (r= -0.59, p<0.05). No significant correlation was observed between the severity index of late gadolinium enhancement and LV mass (r=0.23, p=0.30). CONCLUSION The extent of myocardial fibrosis revealed by late gadolinium-enhanced MRI has a strong relationship to diastolic dysfunction in patients with HCM.
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Affiliation(s)
- Munenobu Motoyasu
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
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Akakabe Y, Kawasaki T, Yamano M, Miki S, Kamitani T, Kuribayashi T, Matsubara H, Sugihara H. Septal q Wave as a Marker of Septal Ischemia in Hypertrophic Cardiomyopathy. Circ J 2008; 72:953-7. [DOI: 10.1253/circj.72.953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | - Hiroaki Matsubara
- Department of Cardiovascular Medicine, Kyoto Prefectural University Graduate School of Medicine
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Levy-Favatier F, Leroux A, Antoine B, Nedelec B, Delpech M. Upregulation of rat P23 (a member of the YjgF protein family) by fasting, glucose diet and fatty acid feeding. Cell Mol Life Sci 2005; 61:2886-92. [PMID: 15558217 DOI: 10.1007/s00018-004-4231-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In a previous study, we identified and purified a 99-amino-acid rat liver-kidney perchloric-acid-soluble 23-kDa protein (P23) which displays 30% identity with a highly conserved domain of heat shock proteins (HSPs), as well as an AT-rich 3' untranslated region, which has also been described to play a role in H70 mRNA life span and protein expression. An identical perchloric-acid-soluble protein inhibiting protein synthesis in a rabbit reticulocyte lysate system was also found 2 years later by another group. More recently, the novel, the YjgF, protein family has been described, comprising, 24 full-length homologues, including P23, highly conserved through evolution, and consisting of approximately 130 residues each and sharing a common ternary structure. Independent studies from different laboratories have provided various hypothetical functions for each of these proteins. The high degree of evolutionary conservation may suggest that these proteins play an important role in cellular regulation. Although the function of none of these proteins is known precisely, we present experimental evidence which, combined with the relationship to glucose-regulating protein revealed here, and the relationship to fatty-acid-binding protein revealed by others, allow us to propose a role for P23. In rat liver, P23 expression is developmentally regulated and modulated by dietary glucose, and its mRNA is induced by starvation, in the presence of fatty-acids and in 3-MeDAB-induced hepatomas. The mRNA encoding mouse liver P23 is also hormonally modulated in a mouse line AT1F8. These data indicate that P23 protein might be a key controller of intermediary metabolism during fasting.
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Affiliation(s)
- F Levy-Favatier
- Laboratoire de Physiologie Respiratoire, UFR Cochin, 24 rue du Fbg St Jacques, 75014, Paris, France.
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