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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] [What about the content of this article? (0)] [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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Landstrom AP, Chahal CAA, Roden DM, Ho CY, Shah SH. A Customizable and Peer-Reviewed Curriculum for Cardiovascular Genetics and Genomics. Circulation 2024; 149:902-904. [PMID: 38498607 DOI: 10.1161/circulationaha.123.067681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Andrew P Landstrom
- Department of Pediatrics, Division of Pediatric Cardiology, and Department of Cell Biology, Duke University School of Medicine, Durham, NC (A.P.L.)
| | - C Anwar A Chahal
- University of Pennsylvania, Department of Cardiology, Philadelphia (C.A.A.C.)
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA (C.A.A.C.)
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.A.A.C.)
- Barts Heart Centre, West Smithfield, London, UK (C.A.A.C.)
| | - Dan M Roden
- Department of Medicine, Department of Pharmacology, and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (D.M.R.)
| | - Carolyn Y Ho
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.Y.H.)
| | - Svati H Shah
- Division of Cardiology, Department of Medicine, and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC (S.H.S.)
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Ireland CG, Ho CY. Genetic Testing in Hypertrophic Cardiomyopathy. Am J Cardiol 2024; 212S:S4-S13. [PMID: 38368035 DOI: 10.1016/j.amjcard.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 02/19/2024]
Abstract
Genetic testing is an important tool in the diagnosis and management of patients and families with hypertrophic cardiomyopathy (HCM). Modern testing can identify causative variants in 30 to >60% of patients, with probability of a positive test varying with baseline characteristics such as known family history of HCM. Patients diagnosed with HCM should be offered genetic counseling and genetic testing as appropriate. Standard multigene panels evaluate sarcomeric genes known to cause HCM as well as genetic conditions that can mimic HCM but require different management. Positive genetic testing (finding a pathogenic or likely pathogenic variant) helps to clarify diagnosis and assists in family screening. If there is high confidence that an identified variant is the cause of HCM, at-risk family members can pursue predictive testing to determine if they are truly at risk or if they can be dismissed from serial screening based on whether they inherited the family's causative variant. Interpreting test results can be complex, and providers should make use of multidisciplinary teams as well as evidence-based resources to obtain the best possible understanding of pathogenicity.
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Affiliation(s)
- Catherine G Ireland
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Topriceanu CC, Pereira AC, Moon JC, Captur G, Ho CY. Meta-Analysis of Penetrance and Systematic Review on Transition to Disease in Genetic Hypertrophic Cardiomyopathy. Circulation 2024; 149:107-123. [PMID: 37929589 PMCID: PMC10775968 DOI: 10.1161/circulationaha.123.065987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy and is classically caused by pathogenic or likely pathogenic variants (P/LP) in genes encoding sarcomere proteins. Not all subclinical variant carriers will manifest clinically overt disease because penetrance (proportion of sarcomere or sarcomere-related P/LP variant carriers who develop disease) is variable, age dependent, and not reliably predicted. METHODS A systematic search of the literature was performed. We used random-effects generalized linear mixed model meta-analyses to contrast the cross-sectional prevalence and penetrance of sarcomere or sarcomere-related genes in 2 different contexts: clinically-based studies on patients and families with HCM versus population or community-based studies. Longitudinal family/clinical studies were additionally analyzed to investigate the rate of phenotypic conversion from subclinical to overt HCM during follow-up. RESULTS In total, 455 full-text manuscripts and articles were assessed. In family/clinical studies, the prevalence of sarcomere variants in patients diagnosed with HCM was 34%. The penetrance across all genes in nonproband relatives carrying P/LP variants identified during cascade screening was 57% (95% CI, 52%-63%), and the mean age at HCM diagnosis was 38 years (95% CI, 36%-40%). Penetrance varied from ≈32% for MYL3 (myosin light chain 3) to ≈55% for MYBPC3 (myosin-binding protein C3), ≈60% for TNNT2 (troponin T2) and TNNI3 (troponin I3), and ≈65% for MYH7 (myosin heavy chain 7). Population-based genetic studies demonstrate that P/LP sarcomere variants are present in the background population but at a low prevalence of <1%. The penetrance of HCM in incidentally identified P/LP variant carriers was also substantially lower at ≈11%, ranging from 0% in Atherosclerosis Risk in Communities to 18% in UK Biobank. In longitudinal family studies, the pooled phenotypic conversion across all genes was 15% over an average of ≈8 years of follow-up, starting from a mean of ≈16 years of age. However, short-term gene-specific phenotypic conversion varied between ≈12% for MYBPC3 and ≈23% for MYH7. CONCLUSIONS The penetrance of P/LP variants is highly variable and influenced by currently undefined and context-dependent genetic and environmental factors. Additional longitudinal studies are needed to improve our understanding of true lifetime penetrance in families and in the community and to identify drivers of the transition from subclinical to overt HCM.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.-C.T., A.C.P., C.Y.H.). UCL Institute of Cardiovascular Science (C.-C.T., J.C.M., G.C.) and UCL MRC Unit for Lifelong Health and Ageing (G.C.), University College London, UK. Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK (C.-C.T., J.C.M.). The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Hampstead, London, UK (G.C.)
| | - Alexandre C. Pereira
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.-C.T., A.C.P., C.Y.H.). UCL Institute of Cardiovascular Science (C.-C.T., J.C.M., G.C.) and UCL MRC Unit for Lifelong Health and Ageing (G.C.), University College London, UK. Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK (C.-C.T., J.C.M.). The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Hampstead, London, UK (G.C.)
| | - James C. Moon
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.-C.T., A.C.P., C.Y.H.). UCL Institute of Cardiovascular Science (C.-C.T., J.C.M., G.C.) and UCL MRC Unit for Lifelong Health and Ageing (G.C.), University College London, UK. Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK (C.-C.T., J.C.M.). The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Hampstead, London, UK (G.C.)
| | - Gabriella Captur
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.-C.T., A.C.P., C.Y.H.). UCL Institute of Cardiovascular Science (C.-C.T., J.C.M., G.C.) and UCL MRC Unit for Lifelong Health and Ageing (G.C.), University College London, UK. Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK (C.-C.T., J.C.M.). The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Hampstead, London, UK (G.C.)
| | - Carolyn Y. Ho
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.-C.T., A.C.P., C.Y.H.). UCL Institute of Cardiovascular Science (C.-C.T., J.C.M., G.C.) and UCL MRC Unit for Lifelong Health and Ageing (G.C.), University College London, UK. Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK (C.-C.T., J.C.M.). The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Hampstead, London, UK (G.C.)
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Vissing CR, Axelsson Raja A, Day SM, Russell MW, Zahka K, Lever HM, Pereira AC, Colan SD, Margossian R, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Soslow JH, Becker JR, Seidman CE, Lakdawala NK, Cirino AL, McMurray JJV, MacRae CA, Solomon SD, Bundgaard H, Orav EJ, Ho CY. Cardiac Remodeling in Subclinical Hypertrophic Cardiomyopathy: The VANISH Randomized Clinical Trial. JAMA Cardiol 2023; 8:1083-1088. [PMID: 37672268 PMCID: PMC10483382 DOI: 10.1001/jamacardio.2023.2808] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/23/2023] [Indexed: 09/07/2023]
Abstract
Importance Valsartan has shown promise in attenuating cardiac remodeling in patients with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Genetic testing can identify individuals at risk of HCM in a subclinical stage who could benefit from therapies that prevent disease progression. Objective To explore the potential for valsartan to modify disease development, and to characterize short-term phenotypic progression in subclinical HCM. Design, Setting, and Participants The multicenter, double-blind, placebo-controlled Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy (VANISH) randomized clinical trial was conducted from April 2014 to July 2019 at 17 sites in 4 countries (Brazil, Canada, Denmark, and the US), with 2 years of follow-up. The prespecified exploratory VANISH cohort studied here included sarcomere variant carriers with subclinical HCM and early phenotypic manifestations (reduced E' velocity, electrocardiographic abnormalities, or an increased left ventricular [LV] wall thickness [LVWT] to cavity diameter ratio) but no LV hypertrophy (LVH). Data were analyzed between March and December 2022. Interventions Treatment with placebo or valsartan (80 mg/d for children weighing <35 kg, 160 mg/d for children weighing ≥35 kg, or 320 mg/d for adults aged ≥18 years). Main Outcomes and Measures The primary outcome was a composite z score incorporating changes in 9 parameters of cardiac remodeling (LV cavity volume, LVWT, and LV mass; left atrial [LA] volume; E' velocity and S' velocity; and serum troponin and N-terminal prohormone of brain natriuretic peptide levels). Results This study included 34 participants, with a mean (SD) age of 16 (5) years (all were White). A total of 18 participants (8 female [44%] and 10 male [56%]) were randomized to valsartan and 16 (9 female [56%] and 7 male [44%]) were randomized to placebo. No statistically significant effects of valsartan on cardiac remodeling were detected (mean change in composite z score compared with placebo: -0.01 [95% CI, -0.29 to 0.26]; P = .92). Overall, 2-year phenotypic progression was modest, with only a mild increase in LA volume detected (increased by 3.5 mL/m2 [95% CI, 1.4-6.0 mL/m2]; P = .002). Nine participants (26%) had increased LVWT, including 6 (18%) who developed clinically overt HCM. Baseline LA volume index (LAVI; 35 vs 28 mL/m2; P = .01) and average interventricular septum thickness (8.5 vs 7.0 mm; P = .009) were higher in participants who developed HCM. Conclusions and Relevance In this exploratory cohort, valsartan was not proven to slow progression of subclinical HCM. Minimal changes in markers of cardiac remodeling were observed, although nearly one-fifth of patients developed clinically overt HCM. Transition to disease was associated with greater baseline interventricular septum thickness and LAVI. These findings highlight the importance of following sarcomere variant carriers longitudinally and the critical need to improve understanding of factors that drive disease penetrance and progression. Trial Registration ClinicalTrials.gov Identifier: NCT01912534.
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Affiliation(s)
- Christoffer Rasmus Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Axelsson Raja
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sharlene M. Day
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | | | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Renee Margossian
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Anne M. Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles Canter
- Washington University School of Medicine, St Louis, Missouri
| | - Richard G. Bach
- Washington University School of Medicine, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Anjali T. Owens
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lee Benson
- Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Amit R. Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Philip Thrush
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Jason R. Becker
- Division of Cardiology, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania
| | - Christine E. Seidman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Neal K. Lakdawala
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allison L. Cirino
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - John J. V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Calum A. MacRae
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott D. Solomon
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E. John Orav
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn Y. Ho
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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6
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Hong KN, Eshraghian EA, Arad M, Argirò A, Brambatti M, Bui Q, Caspi O, de Frutos F, Greenberg B, Ho CY, Kaski JP, Olivotto I, Taylor MRG, Yesso A, Garcia-Pavia P, Adler ED. International Consensus on Differential Diagnosis and Management of Patients With Danon Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1628-1647. [PMID: 37821174 DOI: 10.1016/j.jacc.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023]
Abstract
Danon disease is a rare X-linked autophagic vacuolar cardioskeletal myopathy associated with severe heart failure that can be accompanied with extracardiac neurologic, skeletal, and ophthalmologic manifestations. It is caused by loss of function variants in the LAMP2 gene and is among the most severe and penetrant of the genetic cardiomyopathies. Most patients with Danon disease will experience symptomatic heart failure. Male individuals generally present earlier than women and die of either heart failure or arrhythmia or receive a heart transplant by the third decade of life. Herein, the authors review the differential diagnosis of Danon disease, diagnostic criteria, natural history, management recommendations, and recent advances in treatment of this increasingly recognized and extremely morbid cardiomyopathy.
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Affiliation(s)
- Kimberly N Hong
- University of California-San Diego, San Diego, California, USA
| | | | - Michael Arad
- Leviev Heart Center, Sheba Hospital and Tel Aviv University, Tel Aviv, Israel
| | - Alessia Argirò
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Quan Bui
- University of California-San Diego, San Diego, California, USA
| | - Oren Caspi
- Rambam Medical Centre and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel
| | - Fernando de Frutos
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | - Barry Greenberg
- University of California-San Diego, San Diego, California, USA
| | - Carolyn Y Ho
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juan Pablo Kaski
- Great Ormond Street Hospital and University College London, London, United Kingdom
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Abigail Yesso
- Division of Cardiology/Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain.
| | - Eric D Adler
- University of California-San Diego, San Diego, California, USA.
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Abou Alaiwi S, Roston TM, Marstrand P, Claggett BL, Parikh VN, Helms AS, Ingles J, Lampert R, Lakdawala NK, Michels M, Owens AT, Rossano JW, Saberi S, Abrams DJ, Ashley EA, Semsarian C, Stendahl JC, Ware JS, Miller E, Ryan TD, Russell MW, Day SM, Olivotto I, Vissing CR, Ho CY. Left Ventricular Systolic Dysfunction in Patients Diagnosed With Hypertrophic Cardiomyopathy During Childhood: Insights From the SHaRe Registry. Circulation 2023; 148:394-404. [PMID: 37226762 PMCID: PMC10373850 DOI: 10.1161/circulationaha.122.062517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The development of left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM) is rare but serious and associated with poor outcomes in adults. Little is known about the prevalence, predictors, and prognosis of LVSD in patients diagnosed with HCM as children. METHODS Data from patients with HCM in the international, multicenter SHaRe (Sarcomeric Human Cardiomyopathy Registry) were analyzed. LVSD was defined as left ventricular ejection fraction <50% on echocardiographic reports. Prognosis was assessed by a composite of death, cardiac transplantation, and left ventricular assist device implantation. Predictors of developing incident LVSD and subsequent prognosis with LVSD were assessed using Cox proportional hazards models. RESULTS We studied 1010 patients diagnosed with HCM during childhood (<18 years of age) and compared them with 6741 patients with HCM diagnosed as adults. In the pediatric HCM cohort, median age at HCM diagnosis was 12.7 years (interquartile range, 8.0-15.3), and 393 (36%) patients were female. At initial SHaRe site evaluation, 56 (5.5%) patients with childhood-diagnosed HCM had prevalent LVSD, and 92 (9.1%) developed incident LVSD during a median follow-up of 5.5 years. Overall LVSD prevalence was 14.7% compared with 8.7% in patients with adult-diagnosed HCM. Median age at incident LVSD was 32.6 years (interquartile range, 21.3-41.6) for the pediatric cohort and 57.2 years (interquartile range, 47.3-66.5) for the adult cohort. Predictors of developing incident LVSD in childhood-diagnosed HCM included age <12 years at HCM diagnosis (hazard ratio [HR], 1.72 [CI, 1.13-2.62), male sex (HR, 3.1 [CI, 1.88-5.2), carrying a pathogenic sarcomere variant (HR, 2.19 [CI, 1.08-4.4]), previous septal reduction therapy (HR, 2.34 [CI, 1.42-3.9]), and lower initial left ventricular ejection fraction (HR, 1.53 [CI, 1.38-1.69] per 5% decrease). Forty percent of patients with LVSD and HCM diagnosed during childhood met the composite outcome, with higher rates in female participants (HR, 2.60 [CI, 1.41-4.78]) and patients with a left ventricular ejection fraction <35% (HR, 3.76 [2.16-6.52]). CONCLUSIONS Patients with childhood-diagnosed HCM have a significantly higher lifetime risk of developing LVSD, and LVSD emerges earlier than for patients with adult-diagnosed HCM. Regardless of age at diagnosis with HCM or LVSD, the prognosis with LVSD is poor, warranting careful surveillance for LVSD, especially as children with HCM transition to adult care.
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Affiliation(s)
- Sarah Abou Alaiwi
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Thomas M. Roston
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
- University of British Columbia, Vancouver, Canada (T.M.R.)
| | - Peter Marstrand
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Denmark (P.M.)
| | - Brian Lee Claggett
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Victoria N. Parikh
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Adam S. Helms
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and University of New South Wales, Sydney, Australia (J.I.)
| | - Rachel Lampert
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - Neal K. Lakdawala
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Anjali T. Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (J.W.R.)
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Dominic J. Abrams
- Center for Cardiovascular Genetics, Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, MA (D.J.A.)
| | - Euan A. Ashley
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S.)
| | - John C. Stendahl
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - James S. Ware
- Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK (J.S.W.)
| | - Erin Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Thomas D. Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Mark W. Russell
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Sharlene M. Day
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy (I.O.)
| | - Christoffer R. Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (C.R.V.)
| | - Carolyn Y. Ho
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
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8
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Ostrominski JW, Guo R, Elliott PM, Ho CY. Cardiac Myosin Inhibitors for Managing Obstructive Hypertrophic Cardiomyopathy: JACC: Heart Failure State-of-the-Art Review. JACC Heart Fail 2023; 11:735-748. [PMID: 37407153 DOI: 10.1016/j.jchf.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 07/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is frequently caused by pathogenic variants in genes encoding sarcomere proteins and is characterized by left ventricular (LV) hypertrophy, hypercontractility, and-in many cases-left ventricular outflow tract (LVOT) obstruction. Despite standard management, obstructive HCM (oHCM) can still cause substantial morbidity, highlighting the critical need for more effective disease-specific therapeutic approaches. Over the past decade, improved understanding of the molecular pathobiology of HCM has culminated in development of cardiac myosin inhibitors (CMIs), a novel drug class that in recent randomized clinical trials has been shown to decrease LVOT obstruction, improve exercise capacity, and ameliorate symptom burden in patients with oHCM. Although promising, areas of uncertainty remain, including the long-term safety and efficacy of CMIs and whether they have the potential to modify progression of disease. Herein, we review key milestones in the clinical development of CMIs, contextualize CMIs with established oHCM therapies, and discuss future challenges and opportunities for the use of CMIs across the HCM spectrum.
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Affiliation(s)
- John W Ostrominski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ruby Guo
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Perry M Elliott
- Centre for Heart Muscle Disease, Institute of Cardiological Sciences, University College London and St Bartholomew's Hospital, London, United Kingdom
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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9
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Lampert R, Ackerman MJ, Marino BS, Burg M, Ainsworth B, Salberg L, Tome Esteban MT, Ho CY, Abraham R, Balaji S, Barth C, Berul CI, Bos M, Cannom D, Choudhury L, Concannon M, Cooper R, Czosek RJ, Dubin AM, Dziura J, Eidem B, Emery MS, Estes NAM, Etheridge SP, Geske JB, Gray B, Hall K, Harmon KG, James CA, Lal AK, Law IH, Li F, Link MS, McKenna WJ, Molossi S, Olshansky B, Ommen SR, Saarel EV, Saberi S, Simone L, Tomaselli G, Ware JS, Zipes DP, Day SM. Vigorous Exercise in Patients With Hypertrophic Cardiomyopathy. JAMA Cardiol 2023; 8:595-605. [PMID: 37195701 PMCID: PMC10193262 DOI: 10.1001/jamacardio.2023.1042] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 05/18/2023]
Abstract
Importance Whether vigorous intensity exercise is associated with an increase in risk of ventricular arrhythmias in individuals with hypertrophic cardiomyopathy (HCM) is unknown. Objective To determine whether engagement in vigorous exercise is associated with increased risk for ventricular arrhythmias and/or mortality in individuals with HCM. The a priori hypothesis was that participants engaging in vigorous activity were not more likely to have an arrhythmic event or die than those who reported nonvigorous activity. Design, Setting, and Participants This was an investigator-initiated, prospective cohort study. Participants were enrolled from May 18, 2015, to April 25, 2019, with completion in February 28, 2022. Participants were categorized according to self-reported levels of physical activity: sedentary, moderate, or vigorous-intensity exercise. This was a multicenter, observational registry with recruitment at 42 high-volume HCM centers in the US and internationally; patients could also self-enroll through the central site. Individuals aged 8 to 60 years diagnosed with HCM or genotype positive without left ventricular hypertrophy (phenotype negative) without conditions precluding exercise were enrolled. Exposures Amount and intensity of physical activity. Main Outcomes and Measures The primary prespecified composite end point included death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator. All outcome events were adjudicated by an events committee blinded to the patient's exercise category. Results Among the 1660 total participants (mean [SD] age, 39 [15] years; 996 male [60%]), 252 (15%) were classified as sedentary, and 709 (43%) participated in moderate exercise. Among the 699 individuals (42%) who participated in vigorous-intensity exercise, 259 (37%) participated competitively. A total of 77 individuals (4.6%) reached the composite end point. These individuals included 44 (4.6%) of those classified as nonvigorous and 33 (4.7%) of those classified as vigorous, with corresponding rates of 15.3 and 15.9 per 1000 person-years, respectively. In multivariate Cox regression analysis of the primary composite end point, individuals engaging in vigorous exercise did not experience a higher rate of events compared with the nonvigorous group with an adjusted hazard ratio of 1.01. The upper 95% 1-sided confidence level was 1.48, which was below the prespecified boundary of 1.5 for noninferiority. Conclusions and Relevance Results of this cohort study suggest that among individuals with HCM or those who are genotype positive/phenotype negative and are treated in experienced centers, those exercising vigorously did not experience a higher rate of death or life-threatening arrhythmias than those exercising moderately or those who were sedentary. These data may inform discussion between the patient and their expert clinician around exercise participation.
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Affiliation(s)
- Rachel Lampert
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael J. Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio
- Lurie Children’s Hospital, Chicago, Illinois
| | - Matthew Burg
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Lisa Salberg
- Hypertrophic Cardiomyopathy Association, Denville, New Jersey
| | | | - Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Roselle Abraham
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland
| | - Cheryl Barth
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Charles I. Berul
- Division of Cardiology, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Martijn Bos
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - David Cannom
- Division of Cardiology, PIH Health Good Samaritan Hospital, Los Angeles, California
| | - Lubna Choudhury
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Robert Cooper
- Department of Cardiology, Liverpool Heart and Chest Hospital/Liverpool John Moores University, Liverpool, United Kingdom
| | - Richard J. Czosek
- Department of Pediatrics, Heart Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Anne M. Dubin
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin Eidem
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Michael S. Emery
- Department of Cardiovascular Medicine, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - N. A. Mark Estes
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan P. Etheridge
- Department of Pediatrics, Primary Children’s Hospital, Salt Lake City, Utah
| | - Jeffrey B. Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Belinda Gray
- Faculty of Medicine and Health, Royal Prince Alfred Hospital/Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Hall
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Cynthia A. James
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ashwin K. Lal
- Department of Pediatrics, Primary Children’s Hospital, Salt Lake City, Utah
| | - Ian H. Law
- Department of Pediatrics, University of Iowa, Iowa City
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Mark S. Link
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Department of Internal Medicine, University of Texas, Southwestern, Dallas
| | - William J. McKenna
- Institute of Cardiovascular Medicine, University College London, London, United Kingdom
| | - Silvana Molossi
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston
| | - Brian Olshansky
- Department of Internal Medicine, University of Iowa, Iowa City
| | - Steven R. Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth V. Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio
- Department of Pediatric Cardiology, St Luke’s Health System, Boise, Idaho
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Laura Simone
- Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Gordon Tomaselli
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - James S. Ware
- National Heart and Lung Institute & MRC London Institute of Medical Sciences, Imperial College London/ Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust
| | - Douglas P. Zipes
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sharlene M. Day
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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10
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Heydari B, Satriano A, Jerosch-Herold M, Kolm P, Kim DY, Cheng K, Choi YL, Antiochos P, White JA, Mahmod M, Chan K, Raman B, Desai MY, Ho CY, Dolman SF, Desvigne-Nickens P, Maron MS, Friedrich MG, Schulz-Menger J, Piechnik SK, Appelbaum E, Weintraub WS, Neubauer S, Kramer CM, Kwong RY. 3-Dimensional Strain Analysis of Hypertrophic Cardiomyopathy: Insights From the NHLBI International HCM Registry. JACC Cardiovasc Imaging 2023; 16:478-491. [PMID: 36648040 PMCID: PMC10802851 DOI: 10.1016/j.jcmg.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abnormal global longitudinal strain (GLS) has been independently associated with adverse cardiac outcomes in both obstructive and nonobstructive hypertrophic cardiomyopathy. OBJECTIVES The goal of this study was to understand predictors of abnormal GLS from baseline data from the National Heart, Lung, and Blood Institute (NHLBI) Hypertrophic Cardiomyopathy Registry (HCMR). METHODS The study evaluated comprehensive 3-dimensional left ventricular myocardial strain from cine cardiac magnetic resonance in 2,311 patients from HCMR using in-house validated feature-tracking software. These data were correlated with other imaging markers, serum biomarkers, and demographic variables. RESULTS Abnormal median GLS (> -11.0%) was associated with higher left ventricular (LV) mass index (93.8 ± 29.2 g/m2 vs 75.1 ± 19.7 g/m2; P < 0.0001) and maximal wall thickness (21.7 ± 5.2 mm vs 19.3 ± 4.1 mm; P < 0.0001), lower left (62% ± 9% vs 66% ± 7%; P < 0.0001) and right (68% ± 11% vs 69% ± 10%; P < 0.01) ventricular ejection fractions, lower left atrial emptying functions (P < 0.0001 for all), and higher presence and myocardial extent of late gadolinium enhancement (6 SD and visual quantification; P < 0.0001 for both). Elastic net regression showed that adjusted predictors of GLS included female sex, Black race, history of syncope, presence of systolic anterior motion of the mitral valve, reverse curvature and apical morphologies, LV ejection fraction, LV mass index, and both presence/extent of late gadolinium enhancement and baseline N-terminal pro-B-type natriuretic peptide and troponin levels. CONCLUSIONS Abnormal strain in hypertrophic cardiomyopathy is associated with other imaging and serum biomarkers of increased risk. Further follow-up of the HCMR cohort is needed to understand the independent relationship between LV strain and adverse cardiac outcomes in hypertrophic cardiomyopathy.
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | | | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James A White
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Chan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Martin S Maron
- Lahey Hospital & Medical Center, Boston, Massachusetts, USA
| | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Stefan Neubauer
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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11
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Kim Y, Mastali M, Van Eyk JE, Orav EJ, Vissing CR, Day SM, Raja AA, Russell MW, Zahka K, Lever HM, Pereira AC, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Bundgaard H, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Soslow JH, Becker JR, Seidman CE, Ho CY. Transforming Growth Factor-β Analysis of the VANISH Trial Cohort. Circ Heart Fail 2023; 16:e010314. [PMID: 36999957 PMCID: PMC10121916 DOI: 10.1161/circheartfailure.122.010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Yuri Kim
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
| | - Mitra Mastali
- Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer E. Van Eyk
- Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - E. John Orav
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christoffer R. Vissing
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sharlene M. Day
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mark W. Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Kenneth Zahka
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Harry M. Lever
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anne M. Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Canter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard G. Bach
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anjali T. Owens
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lee Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R. G. Taylor
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amit R. Patel
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Philip Thrush
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jonathan H. Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason R. Becker
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christine E. Seidman
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | | | - Carolyn Y. Ho
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
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12
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Sucharov CC, Neltner B, Pietra AE, Karimpour-Fard A, Patel J, Ho CY, Miyamoto SD. Circulating MicroRNAs Identify Early Phenotypic Changes in Sarcomeric Hypertrophic Cardiomyopathy. Circ Heart Fail 2023:e010291. [PMID: 36880380 DOI: 10.1161/circheartfailure.122.010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Pathogenic germline variation in genes encoding the sarcomere is the predominant cause of disease. However diagnostic features, including unexplained left ventricular hypertrophy, typically do not develop until late adolescence or after. The early stages of disease pathogenesis and the mechanisms underlying the transition to a clinically overt phenotype are not well understood. In this study, we investigated if circulating microRNAs (miRNAs) could stratify disease stage in sarcomeric HCM. METHODS We performed arrays for 381 miRNAs using serum from HCM sarcomere variant carriers with and without a diagnosis of HCM and healthy controls. To identify differentially expressed circulating miRNAs between groups, multiple approaches were used including random forest, Wilcoxon rank sum test, and logistic regression. The abundance of all miRNAs was normalized to miRNA-320. RESULTS Of 57 sarcomere variant carriers, 25 had clinical HCM and 32 had subclinical HCM with normal left ventricular wall thickness (21 with early phenotypic manifestations and 11 with no discernible phenotypic manifestations). Circulating miRNA profile differentiated healthy controls from sarcomere variant carriers with subclinical and clinical disease. Additionally, circulating miRNAs differentiated clinical HCM from subclinical HCM without early phenotypic changes; and subclinical HCM with and without early phenotypic changes. Circulating miRNA profiles did not differentiate clinical HCM from subclinical HCM with early phenotypic changes, suggesting biologic similarity between these groups. CONCLUSIONS Circulating miRNAs may augment the clinical stratification of HCM and improve understanding of the transition from health to disease in sarcomere gene variant carriers.
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Affiliation(s)
- Carmen C Sucharov
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (C.C.S., B.N.)
| | - Bonnie Neltner
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (C.C.S., B.N.)
| | - Ashley E Pietra
- Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora (A.E.P., S.D.M.)
| | - Anis Karimpour-Fard
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora (A.K.-F.)
| | - Joshen Patel
- Department of Medicine, Division of Cardiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (J.P., C.Y.H.)
| | - Carolyn Y Ho
- Department of Medicine, Division of Cardiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (J.P., C.Y.H.)
| | - Shelley D Miyamoto
- Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora (A.E.P., S.D.M.)
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13
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Tadros R, Zheng SL, Grace C, Jordà P, Francis C, Jurgens SJ, Thomson KL, Harper AR, Ormondroyd E, West DM, Xu X, Theotokis PI, Buchan RJ, McGurk KA, Mazzarotto F, Boschi B, Pelo E, Lee M, Noseda M, Varnava A, Vermeer AM, Walsh R, Amin AS, van Slegtenhorst MA, Roslin N, Strug LJ, Salvi E, Lanzani C, de Marvao A, Roberts JD, Tremblay-Gravel M, Giraldeau G, Cadrin-Tourigny J, L'Allier PL, Garceau P, Talajic M, Pinto YM, Rakowski H, Pantazis A, Baksi J, Halliday BP, Prasad SK, Barton PJ, O'Regan DP, Cook SA, de Boer RA, Christiaans I, Michels M, Kramer CM, Ho CY, Neubauer S, Matthews PM, Wilde AA, Tardif JC, Olivotto I, Adler A, Goel A, Ware JS, Bezzina CR, Watkins H. Large scale genome-wide association analyses identify novel genetic loci and mechanisms in hypertrophic cardiomyopathy. medRxiv 2023:2023.01.28.23285147. [PMID: 36778260 PMCID: PMC9915807 DOI: 10.1101/2023.01.28.23285147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an important cause of morbidity and mortality with both monogenic and polygenic components. We here report results from the largest HCM genome-wide association study (GWAS) and multi-trait analysis (MTAG) including 5,900 HCM cases, 68,359 controls, and 36,083 UK Biobank (UKB) participants with cardiac magnetic resonance (CMR) imaging. We identified a total of 70 loci (50 novel) associated with HCM, and 62 loci (32 novel) associated with relevant left ventricular (LV) structural or functional traits. Amongst the common variant HCM loci, we identify a novel HCM disease gene, SVIL, which encodes the actin-binding protein supervillin, showing that rare truncating SVIL variants cause HCM. Mendelian randomization analyses support a causal role of increased LV contractility in both obstructive and non-obstructive forms of HCM, suggesting common disease mechanisms and anticipating shared response to therapy. Taken together, the findings significantly increase our understanding of the genetic basis and molecular mechanisms of HCM, with potential implications for disease management.
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Affiliation(s)
- Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sean L Zheng
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christopher Grace
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Paloma Jordà
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Catherine Francis
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sean J Jurgens
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kate L Thomson
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford Genetics Laboratories, Churchill Hospital, Oxford, UK
| | - Andrew R Harper
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Elizabeth Ormondroyd
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Dominique M West
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Xiao Xu
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Pantazis I Theotokis
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rachel J Buchan
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Kathryn A McGurk
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Francesco Mazzarotto
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | | | - Michael Lee
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Michela Noseda
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Amanda Varnava
- National Heart & Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, Imperial College London, London, UK
| | - Alexa Mc Vermeer
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Clinical Genetics, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
| | - Roddy Walsh
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ahmad S Amin
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marjon A van Slegtenhorst
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole Roslin
- The Centre for Applied Genomics, Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lisa J Strug
- Departments of Statistical Sciences and Computer Science, Data Sciences Institute, University of Toronto, Toronto, ON, Canada
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
- Ontario Regional Centre, Canadian Statistical Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Erika Salvi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Lanzani
- Genomics of Renal Diseases and Hypertension Unit, Nephrology Operative Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Chair of Nephrology, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio de Marvao
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Maxime Tremblay-Gravel
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Genevieve Giraldeau
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Philippe L L'Allier
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Patrick Garceau
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Yigal M Pinto
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Antonis Pantazis
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - John Baksi
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Brian P Halliday
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sanjay K Prasad
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Paul Jr Barton
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Stuart A Cook
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Imke Christiaans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michelle Michels
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Paul M Matthews
- Department of Brain Sciences and UK Dementia Research Institute, Imperial College London, London, UK
| | - Arthur A Wilde
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- ECGen, Cardiogenetics Focus Group of EHRA, France
| | - Jean-Claude Tardif
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anuj Goel
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - James S Ware
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Program in Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Connie R Bezzina
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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14
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Aung N, Lopes LR, van Duijvenboden S, Harper AR, Goel A, Grace C, Ho CY, Weintraub WS, Kramer CM, Neubauer S, Watkins HC, Petersen SE, Munroe PB. Genome-Wide Analysis of Left Ventricular Maximum Wall Thickness in the UK Biobank Cohort Reveals a Shared Genetic Background With Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2023; 16:e003716. [PMID: 36598836 PMCID: PMC9946169 DOI: 10.1161/circgen.122.003716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Left ventricular maximum wall thickness (LVMWT) is an important biomarker of left ventricular hypertrophy and provides diagnostic and prognostic information in hypertrophic cardiomyopathy (HCM). Limited information is available on the genetic determinants of LVMWT. METHODS We performed a genome-wide association study of LVMWT measured from the cardiovascular magnetic resonance examinations of 42 176 European individuals. We evaluated the genetic relationship between LVMWT and HCM by performing pairwise analysis using the data from the Hypertrophic Cardiomyopathy Registry in which the controls were randomly selected from UK Biobank individuals not included in the cardiovascular magnetic resonance sub-study. RESULTS Twenty-one genetic loci were discovered at P<5×10-8. Several novel candidate genes were identified including PROX1, PXN, and PTK2, with known functional roles in myocardial growth and sarcomere organization. The LVMWT genetic risk score is predictive of HCM in the Hypertrophic Cardiomyopathy Registry (odds ratio per SD: 1.18 [95% CI, 1.13-1.23]) with pairwise analyses demonstrating a moderate genetic correlation (rg=0.53) and substantial loci overlap (19/21). CONCLUSIONS Our findings provide novel insights into the genetic underpinning of LVMWT and highlight its shared genetic background with HCM, supporting future endeavours to elucidate the genetic etiology of HCM.
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Affiliation(s)
- Nay Aung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield (N.A., L.R.L., S.E.P.)
| | - Luis R Lopes
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield (N.A., L.R.L., S.E.P.)
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London (L.R.L.)
| | - Stefan van Duijvenboden
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
| | - Andrew R Harper
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
| | - Anuj Goel
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
| | - Christopher Grace
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
| | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | | | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville (C.M.K.)
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, United Kingdom (S.N., H.C.W.)
| | - Hugh C Watkins
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, United Kingdom (S.N., H.C.W.)
| | - Steffen E Petersen
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield (N.A., L.R.L., S.E.P.)
| | - Patricia B Munroe
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
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15
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Butters A, Arnott C, Sweeting J, Claggett B, Atherton J, Semsarian C, Lakdawala NK, Ho CY, Ingles J. Sex disaggregated analysis of risk factors for adverse outcomes in hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patient sex has been associated with differences in disease penetrance and clinical expression in HCM. We sought to investigate sex-disaggregated differences in risk factors for adverse outcomes in a large international HCM registry.
Methods
This is a retrospective study of HCM patients from the Sarcomeric Human Cardiomyopathy Registry. Cox proportional hazards models were fit with a sex interaction term to determine significant differences between sexes.
Results
6647 (38% women) probands with HCM were included. After a mean follow-up of 6.4 years from first encounter, women had a higher risk of heart failure (HF) composite (HR 1.77; 95% CI 1.56–1.99, p<0.0001), and death (1.22; 1.03–1.45, p=0.02) compared to men. No sex difference existed for ventricular arrhythmia composite (p=0.2) or atrial fibrillation (p=0.6). Sarcomere positive status (Sarc+) and causative variants in MYBPC3 reduced the risk of the HF composite for women, while for men there was no change in risk (P-heterogeneity=0.016 and <0.0001, respectively). Baseline LVEF <35% and larger LA size increased the risk of the HF composite for both sexes but to a greater magnitude in men (P-heterogeneity=0.0003 and 0.04 respectively) (Figure 1). Sarc+ increased the risk of death in men but not women (P-heterogeneity=0.041). Having the HF composite increased the risk of death by 45% in and 240% in men (P-heterogeneity=0.003) (Figure 2).
Conclusion
There are important sex differences in the risk of heart failure and death in those with HCM, with significant heterogeneity of outcomes based on subgroups defined by genetic and imaging factors.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Sarcomeric Human Cardiomyopathy Registry (SHaRe) is supported by an unrestricted research grant from Bristol Myer Squibb, including funds to individual sites for database support.
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Affiliation(s)
- A Butters
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW , Sydney , Australia
| | - C Arnott
- The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - J Sweeting
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW , Sydney , Australia
| | - B Claggett
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston , United States of America
| | - J Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital , Sydney , Australia
| | - C Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney , Sydney , Australia
| | - N K Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston , United States of America
| | - C Y Ho
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston , United States of America
| | - J Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW , Sydney , Australia
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16
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Gimeno JR, Olivotto I, Rodríguez AI, Ho CY, Fernández A, Quiroga A, Espinosa MA, Gómez‐González C, Robledo M, Tojal‐Sierra L, Day SM, Owens A, Barriales‐Villa R, Larrañaga JM, Rodríguez‐Palomares J, González‐del‐Hoyo M, Piqueras‐Flores J, Reza N, Chumakova O, Ashley EA, Parikh V, Wheeler M, Jacoby D, Pereira AC, Saberi S, Helms AS, Villacorta E, Gallego‐Delgado M, de Castro D, Domínguez F, Ripoll‐Vera T, Zorio‐Grima E, Sánchez‐Martínez JC, García‐Álvarez A, Arbelo E, Mogollón MV, Fuentes‐Cañamero ME, Grande E, Peña C, Monserrat L, Lakdawala NK. Impact of SARS-Cov-2 infection in patients with hypertrophic cardiomyopathy: results of an international multicentre registry. ESC Heart Fail 2022; 9:2189-2198. [PMID: 36255281 PMCID: PMC9288745 DOI: 10.1002/ehf2.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 01/08/2023] Open
Abstract
AIMS To describe the natural history of SARS-CoV-2 infection in patients with hypertrophic cardiomyopathy (HCM) compared with a control group and to identify predictors of adverse events. METHODS AND RESULTS Three hundred and five patients [age 56.6 ± 16.9 years old, 191 (62.6%) male patients] with HCM and SARS-Cov-2 infection were enrolled. The control group consisted of 91 131 infected individuals. Endpoints were (i) SARS-CoV-2 related mortality and (ii) severe clinical course [death or intensive care unit (ICU) admission]. New onset of atrial fibrillation, ventricular arrhythmias, shock, stroke, and cardiac arrest were also recorded. Sixty-nine (22.9%) HCM patients were hospitalized for non-ICU level care, and 21 (7.0%) required ICU care. Seventeen (5.6%) died: eight (2.6%) of respiratory failure, four (1.3%) of heart failure, two (0.7%) suddenly, and three (1.0%) due to other SARS-CoV-2-related complications. Covariates associated with mortality in the multivariable were age {odds ratio (OR) per 10 year increase 2.25 [95% confidence interval (CI): 1.12-4.51], P = 0.0229}, baseline New York Heart Association class [OR per one-unit increase 4.01 (95%CI: 1.75-9.20), P = 0.0011], presence of left ventricular outflow tract obstruction [OR 5.59 (95%CI: 1.16-26.92), P = 0.0317], and left ventricular systolic impairment [OR 7.72 (95%CI: 1.20-49.79), P = 0.0316]. Controlling for age and sex and comparing HCM patients with a community-based SARS-CoV-2 cohort, the presence of HCM was associated with a borderline significant increased risk of mortality OR 1.70 (95%CI: 0.98-2.91, P = 0.0600). CONCLUSIONS Over one-fourth of HCM patients infected with SARS-Cov-2 required hospitalization, including 6% in an ICU setting. Age and cardiac features related to HCM, including baseline functional class, left ventricular outflow tract obstruction, and systolic impairment, conveyed increased risk of mortality.
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Affiliation(s)
- Juan R. Gimeno
- Departamento de Medicina InternaUniversidad de MurciaCtra. Finca Buenavista s/n, Campus Ciencias de la Salud, El PalmarMurcia30120Spain
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
| | | | - Ana Isabel Rodríguez
- Departamento de Medicina InternaUniversidad de MurciaCtra. Finca Buenavista s/n, Campus Ciencias de la Salud, El PalmarMurcia30120Spain
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
| | - Carolyn Y. Ho
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | - Adrián Fernández
- Unidad de Cardiopatías FamiliaresFavaloro Foundation University HospitalBuenos AiresArgentina
| | - Alejandro Quiroga
- Unidad de Cardiopatías FamiliaresFavaloro Foundation University HospitalBuenos AiresArgentina
| | - Mari Angeles Espinosa
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías FamiliaresHospital General Universitario Gregorio MarañónMadridSpain
| | - Cristina Gómez‐González
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías FamiliaresHospital General Universitario Gregorio MarañónMadridSpain
| | - María Robledo
- Hospital Universitario Araba (Txagorritxu)AlavaSpain
| | | | - Sharlene M. Day
- Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Anjali Owens
- Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Roberto Barriales‐Villa
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR Cardiopatías FamiliaresComplexo Hospitalario Universitario de A CoruñaA CoruñaSpain
| | - Jose María Larrañaga
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR Cardiopatías FamiliaresComplexo Hospitalario Universitario de A CoruñaA CoruñaSpain
| | - Jose Rodríguez‐Palomares
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Department of CardiologyHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Institut de Recerca (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Maribel González‐del‐Hoyo
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Department of CardiologyHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Institut de Recerca (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Nosheen Reza
- Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | | | - Euan A. Ashley
- Center for Inherited Heart DiseaseStanford University Medical CenterStanfordCAUSA
| | - Victoria Parikh
- Center for Inherited Heart DiseaseStanford University Medical CenterStanfordCAUSA
| | - Matthew Wheeler
- Center for Inherited Heart DiseaseStanford University Medical CenterStanfordCAUSA
| | | | | | - Sara Saberi
- Department of Internal MedicineUniversity of Michigan HospitalAnn ArborMIUSA
| | - Adam S. Helms
- Department of Internal MedicineUniversity of Michigan HospitalAnn ArborMIUSA
| | - Eduardo Villacorta
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías Familiares, Servicio de CardiologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Gerencia Regional de Salud de Castilla y León (SACYL)Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
- Departamento de MedicinaUniversidad de SalamancaSalamancaSpain
| | - María Gallego‐Delgado
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías Familiares, Servicio de CardiologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Gerencia Regional de Salud de Castilla y León (SACYL)Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
- Departamento de MedicinaUniversidad de SalamancaSalamancaSpain
| | - Daniel de Castro
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR/ERN Cardiopatias FamiliaresHospital Universitario Puerta Hierro MajadahondaMadridSpain
| | - Fernando Domínguez
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR/ERN Cardiopatias FamiliaresHospital Universitario Puerta Hierro MajadahondaMadridSpain
| | - Tomás Ripoll‐Vera
- Unidad Cardiopatias FamiliaresHospital Universitario Son LlàtzerMallorcaSpain
| | - Esther Zorio‐Grima
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad Cardiopatias FamiliaresHospital Universitario y Politécnico La FeValenciaSpain
| | - José Carlos Sánchez‐Martínez
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad Cardiopatias FamiliaresHospital Universitario y Politécnico La FeValenciaSpain
| | - Ana García‐Álvarez
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Arrhythmia Section, Cardiology Department, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Elena Arbelo
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Arrhythmia Section, Cardiology Department, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS)BarcelonaSpain
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17
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Axelsson Raja A, Wakimoto H, DeLaughter DM, Reichart D, Gorham J, Conner DA, Lun M, Probst CK, Sakai N, Knipe RS, Montesi SB, Shea B, Adam LP, Leinwand LA, Wan W, Choi ES, Lindberg EL, Patone G, Noseda M, Hübner N, Seidman CE, Tager AM, Seidman JG, Ho CY. Ablation of lysophosphatidic acid receptor 1 attenuates hypertrophic cardiomyopathy in a mouse model. Proc Natl Acad Sci U S A 2022; 119:e2204174119. [PMID: 35787042 PMCID: PMC9282378 DOI: 10.1073/pnas.2204174119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2023] Open
Abstract
Myocardial fibrosis is a key pathologic feature of hypertrophic cardiomyopathy (HCM). However, the fibrotic pathways activated by HCM-causing sarcomere protein gene mutations are poorly defined. Because lysophosphatidic acid is a mediator of fibrosis in multiple organs and diseases, we tested the role of the lysophosphatidic acid pathway in HCM. Lysphosphatidic acid receptor 1 (LPAR1), a cell surface receptor, is required for lysophosphatidic acid mediation of fibrosis. We bred HCM mice carrying a pathogenic myosin heavy-chain variant (403+/-) with Lpar1-ablated mice to create mice carrying both genetic changes (403+/- LPAR1 -/-) and assessed development of cardiac hypertrophy and fibrosis. Compared with 403+/- LPAR1WT, 403+/- LPAR1 -/- mice developed significantly less hypertrophy and fibrosis. Single-nucleus RNA sequencing of left ventricular tissue demonstrated that Lpar1 was predominantly expressed by lymphatic endothelial cells (LECs) and cardiac fibroblasts. Lpar1 ablation reduced the population of LECs, confirmed by immunofluorescence staining of the LEC markers Lyve1 and Ccl21a and, by in situ hybridization, for Reln and Ccl21a. Lpar1 ablation also altered the distribution of fibroblast cell states. FB1 and FB2 fibroblasts decreased while FB0 and FB3 fibroblasts increased. Our findings indicate that Lpar1 is expressed predominantly by LECs and fibroblasts in the heart and is required for development of hypertrophy and fibrosis in an HCM mouse model. LPAR1 antagonism, including agents in clinical trials for other fibrotic diseases, may be beneficial for HCM.
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Affiliation(s)
- Anna Axelsson Raja
- Department of Genetics, Harvard Medical School, Boston, MA 02115
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Hiroko Wakimoto
- Department of Genetics, Harvard Medical School, Boston, MA 02115
| | | | - Daniel Reichart
- Department of Genetics, Harvard Medical School, Boston, MA 02115
| | - Joshua Gorham
- Department of Genetics, Harvard Medical School, Boston, MA 02115
| | - David A. Conner
- Department of Genetics, Harvard Medical School, Boston, MA 02115
| | - Mingyue Lun
- Department of Genetics, Harvard Medical School, Boston, MA 02115
| | - Clemens K. Probst
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Fibrosis Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Norihiko Sakai
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Fibrosis Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Division of Nephrology, Kanazawa University, Kanazawa, 920-1192 Japan
| | - Rachel S. Knipe
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Fibrosis Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Barry Shea
- Division of Pulmonary, Critical Care and Sleep Medicine, Albert Medical School of Brown University, Providence, RI 02903
| | - Leonard P. Adam
- Research and Development, Bristol-Myers Squibb Company, Princeton, NJ 08540
| | - Leslie A. Leinwand
- Biofrontiers Institute, Department of Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, CO 80302
| | - William Wan
- Biofrontiers Institute, Department of Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, CO 80302
| | - Esther Sue Choi
- Biofrontiers Institute, Department of Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, CO 80302
| | - Eric L. Lindberg
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Giannino Patone
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Michela Noseda
- National Heart and Lung Institute, British Heart Foundation Centre of Regenerative Medicine, British Heart Foundation Centre of Research Excellence, Imperial College London, London SW7 2AZ, United Kingdom
| | - Norbert Hübner
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- Charité-Universitätsmedizin, Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, 13347 Berlin, Germany
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115
- HHMI, Chevy Chase, MD 20815
| | - Andrew M. Tager
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Fibrosis Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - J. G. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115
| | - Carolyn Y. Ho
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115
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18
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Zhang M, Tam L, Wright J, Mohammadzadeh M, Han M, Chen E, Wagner M, Nemalka J, Lai H, Eghbal A, Ho CY, Lober RM, Cheshier SH, Vitanza NA, Grant GA, Prolo LM, Yeom KW, Jaju A. Radiomics Can Distinguish Pediatric Supratentorial Embryonal Tumors, High-Grade Gliomas, and Ependymomas. AJNR Am J Neuroradiol 2022; 43:603-610. [PMID: 35361575 PMCID: PMC8993189 DOI: 10.3174/ajnr.a7481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric supratentorial tumors such as embryonal tumors, high-grade gliomas, and ependymomas are difficult to distinguish by histopathology and imaging because of overlapping features. We applied machine learning to uncover MR imaging-based radiomics phenotypes that can differentiate these tumor types. MATERIALS AND METHODS Our retrospective cohort of 231 patients from 7 participating institutions had 50 embryonal tumors, 127 high-grade gliomas, and 54 ependymomas. For each tumor volume, we extracted 900 Image Biomarker Standardization Initiative-based PyRadiomics features from T2-weighted and gadolinium-enhanced T1-weighted images. A reduced feature set was obtained by sparse regression analysis and was used as input for 6 candidate classifier models. Training and test sets were randomly allocated from the total cohort in a 75:25 ratio. RESULTS The final classifier model for embryonal tumor-versus-high-grade gliomas identified 23 features with an area under the curve of 0.98; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.85, 0.91, 0.79, 0.94, and 0.89, respectively. The classifier for embryonal tumor-versus-ependymomas identified 4 features with an area under the curve of 0.82; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.93, 0.69, 0.76, 0.90, and 0.81, respectively. The classifier for high-grade gliomas-versus-ependymomas identified 35 features with an area under the curve of 0.96; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.82, 0.94, 0.82, 0.94, and 0.91, respectively. CONCLUSIONS In this multi-institutional study, we identified distinct radiomic phenotypes that distinguish pediatric supratentorial tumors, high-grade gliomas, and ependymomas with high accuracy. Incorporation of this technique in diagnostic algorithms can improve diagnosis, risk stratification, and treatment planning.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - L Tam
- Stanford University School of Medicine (L.T.), Stanford, California
| | - J Wright
- Department of Radiology (J.W.).,Department of Radiology (J.W.), Harborview Medical Center, Seattle, Washington
| | - M Mohammadzadeh
- Department of Radiology (M.M.), Tehran University of Medical Sciences, Tehran, Iran
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E Chen
- Departments of Clinical Radiology & Imaging Sciences (E.C., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - M Wagner
- Department of Diagnostic Imaging (M.W.), The Hospital for Sick Children, Ontario, Canada
| | - J Nemalka
- Division of Pediatric Neurosurgery (J.N., S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - H Lai
- Department of Radiology (H.L., A.E.), CHOC Children's Hospital of Orange County California, University of California, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), CHOC Children's Hospital of Orange County California, University of California, Irvine, California
| | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (E.C., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Dayton Children's Hospital, Dayton, Ohio; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - S H Cheshier
- Division of Pediatric Neurosurgery (J.N., S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - G A Grant
- Neurosurgery (G.A.G., L.M.P.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - L M Prolo
- Neurosurgery (G.A.G., L.M.P.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - K W Yeom
- Departments of Radiology (K.W.Y.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Norrish G, Qu C, Field E, Cervi E, Khraiche D, Klaassen S, Ojala TH, Sinagra G, Yamazawa H, Marrone C, Popoiu A, Centeno F, Schouvey S, Olivotto I, Day SM, Colan S, Rossano J, Wittekind SG, Saberi S, Russell M, Helms A, Ingles J, Semsarian C, Elliott PM, Ho CY, Omar RZ, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2022; 29:678-686. [PMID: 34718528 PMCID: PMC8967478 DOI: 10.1093/eurjpc/zwab181] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Indexed: 11/24/2022]
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort. METHODS AND RESULTS A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1-16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48-2.78]. Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52-0.97) and Uno's C-index 0.714 (95% 0.58-0.85) with a calibration slope of 1.15 (95% 0.51-1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60-0.81). CONCLUSIONS This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | | | - Sabine Klaassen
- Department of Paediatric Cardiology, Charite – Universitatsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Centre (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Centre for Molecular Medicine (MDC), Charite – Universitatsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H Ojala
- Department of Paediatric Cardiology, New Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Trieste, Italy
| | - Hirokuni Yamazawa
- Department of Paediatrics, Faculty of Medicine and Graduate school of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Anca Popoiu
- Department of Paediatrics, Children’s Hospital ‘Louis Turcanu’, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
| | | | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve Colan
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Rossano
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Russell
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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20
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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: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Kramer CM, DiMarco JP, Kolm P, Ho CY, Desai MY, Kwong RY, Dolman SF, Desvigne-Nickens P, Geller N, Kim DY, Maron MS, Appelbaum E, Jerosch-Herold M, Friedrich MG, Schulz-Menger J, Piechnik SK, Mahmod M, Jacoby D, White J, Chiribiri A, Helms A, Choudhury L, Michels M, Bradlow W, Salerno M, Dawson DK, Weinsaft JW, Berry C, Nagueh SF, Buccarelli-Ducci C, Owens A, Casadei B, Watkins H, Weintraub WS, Neubauer S. Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR. JACC Clin Electrophysiol 2021; 7:1376-1386. [PMID: 34217663 PMCID: PMC8605982 DOI: 10.1016/j.jacep.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. BACKGROUND Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. METHODS All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. RESULTS Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. CONCLUSIONS The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.
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Affiliation(s)
| | - John P DiMarco
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Paul Kolm
- MedStar Health Research Institute, Washington, DC, USA
| | - Carolyn Y Ho
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | - Nancy Geller
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | | | | | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | | | | | | | - James White
- University of Calgary, Calgary, Alberta, Canada
| | | | - Adam Helms
- University of Michigan, Anne Arbor, Michigan, USA
| | | | | | | | - Michael Salerno
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | - Colin Berry
- University of Glasgow, Glasgow, United Kingdom
| | | | | | - Anjali Owens
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Nauffal V, Marstrand P, Han L, Parikh VN, Helms AS, Ingles J, Jacoby D, Lakdawala NK, Kapur S, Michels M, Owens AT, Ashley EA, Pereira AC, Rossano JW, Saberi S, Semsarian C, Ware JS, Wittekind SG, Day S, Olivotto I, Ho CY. Worldwide differences in primary prevention implantable cardioverter defibrillator utilization and outcomes in hypertrophic cardiomyopathy. Eur Heart J 2021; 42:3932-3944. [PMID: 34491319 PMCID: PMC8497072 DOI: 10.1093/eurheartj/ehab598] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/06/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Risk stratification algorithms for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) and regional differences in clinical practice have evolved over time. We sought to compare primary prevention implantable cardioverter defibrillator (ICD) implantation rates and associated clinical outcomes in US vs. non-US tertiary HCM centres within the international Sarcomeric Human Cardiomyopathy Registry. METHODS AND RESULTS We included patients with HCM enrolled from eight US sites (n = 2650) and five non-US (n = 2660) sites and used multivariable Cox-proportional hazards models to compare outcomes between sites. Primary prevention ICD implantation rates in US sites were two-fold higher than non-US sites (hazard ratio (HR) 2.27 [1.89-2.74]), including in individuals deemed at high 5-year SCD risk (≥6%) based on the HCM risk-SCD score (HR 3.27 [1.76-6.05]). US ICD recipients also had fewer traditional SCD risk factors. Among ICD recipients, rates of appropriate ICD therapy were significantly lower in US vs. non-US sites (HR 0.52 [0.28-0.97]). No significant difference was identified in the incidence of SCD/resuscitated cardiac arrest among non-recipients of ICDs in US vs. non-US sites (HR 1.21 [0.74-1.97]). CONCLUSION Primary prevention ICDs are implanted more frequently in patients with HCM in US vs. non-US sites across the spectrum of SCD risk. There was a lower rate of appropriate ICD therapy in US sites, consistent with a lower-risk population, and no significant difference in SCD in US vs. non-US patients who did not receive an ICD. Further studies are needed to understand what drives malignant arrhythmias, optimize ICD allocation, and examine the impact of different ICD utilization strategies on long-term outcomes in HCM.
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Affiliation(s)
- Victor Nauffal
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
| | - Peter Marstrand
- Department of Cardiology, Herlev-Gentofte Hospital, University Hospital of Copenhagen, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Victoria N Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Adam S Helms
- Department of Medicine, Cardiovascular Medicine Division, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Jodie Ingles
- Department of Cardiology, Cardio Genomics Program at Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Rd, Sydney NSW 2050, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Sydney NSW 2050, Australia
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, 20 York St, New Haven, CT 06510, USA
| | - Neal K Lakdawala
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
| | - Sunil Kapur
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus, Dr. Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Anjali T Owens
- Division of Cardiovascular Medicine, Department of Medicine, Center for Inherited Cardiovascular Disease, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Alexandre C Pereira
- Department of Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, São Paulo - SP, 05403-900, Brazil
| | - Joseph W Rossano
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara Saberi
- Department of Medicine, Cardiovascular Medicine Division, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Sydney NSW 2050, Australia
- Department of Cardiology, Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia
| | - James S Ware
- Department of Medicine, National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, Du Cane Rd, London W12 0NN, UK
- Division of Cardiovascular Medicine, Department of Medicine, Royal Brompton & Harefield Hospitals, Sydney St, London SW3 6NP, UK
| | - Samuel G Wittekind
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
- The Heart Institute, Cincinnati Children’s, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Sharlene Day
- Division of Cardiovascular Medicine, Department of Medicine, Center for Inherited Cardiovascular Disease, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Firenze FI, Italy
| | - Carolyn Y Ho
- Department of Medicine, Brigham and Women’s Hospital, Cardiovascular Medicine Division, 75 Francis Street, Boston, MA 02115, USA
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23
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Ho CY, Day SM, Axelsson A, Russell MW, Zahka K, Lever HM, Pereira AC, Colan SD, Margossian R, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Bundgaard H, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Vargas JD, Soslow JH, Becker JR, Seidman CE, Lakdawala NK, Cirino AL, Burns KM, McMurray JJV, MacRae CA, Solomon SD, Orav EJ, Braunwald E. Valsartan in early-stage hypertrophic cardiomyopathy: a randomized phase 2 trial. Nat Med 2021; 27:1818-1824. [PMID: 34556856 DOI: 10.1038/s41591-021-01505-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is often caused by pathogenic variants in sarcomeric genes and characterized by left ventricular (LV) hypertrophy, myocardial fibrosis and increased risk of heart failure and arrhythmias. There are no existing therapies to modify disease progression. In this study, we conducted a multi-center, double-blind, placebo-controlled phase 2 clinical trial to assess the safety and efficacy of the angiotensin II receptor blocker valsartan in attenuating disease evolution in early HCM. In total, 178 participants with early-stage sarcomeric HCM were randomized (1:1) to receive valsartan (320 mg daily in adults; 80-160 mg daily in children) or placebo for 2 years ( NCT01912534 ). Standardized changes from baseline to year 2 in LV wall thickness, mass and volumes; left atrial volume; tissue Doppler diastolic and systolic velocities; and serum levels of high-sensitivity troponin T and N-terminal pro-B-type natriuretic protein were integrated into a single composite z-score as the primary outcome. Valsartan (n = 88) improved cardiac structure and function compared to placebo (n = 90), as reflected by an increase in the composite z-score (between-group difference +0.231, 95% confidence interval (+0.098, +0.364); P = 0.001), which met the primary endpoint of the study. Treatment was well-tolerated. These results indicate a key opportunity to attenuate disease progression in early-stage sarcomeric HCM with an accessible and safe medication.
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Affiliation(s)
- Carolyn Y Ho
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sharlene M Day
- University of Michigan, Ann Arbor, MI, USA.,Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Axelsson
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Renee Margossian
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Anne M Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Canter
- Washington University School of Medicine, St. Louis, MO, USA
| | - Richard G Bach
- Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Anjali T Owens
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lee Benson
- Toronto Hospital for Sick Children, Toronto, ON, Canada
| | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Amit R Patel
- Departments of Medicine and Radiology, University of Chicago, Chicago, IL, USA
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Philip Thrush
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jose D Vargas
- MedStar Heart and Vascular Institute, Washington, USA
| | | | - Jason R Becker
- Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Cardiology, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Christine E Seidman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Neal K Lakdawala
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allison L Cirino
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Calum A MacRae
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugene Braunwald
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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24
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de Marvao A, McGurk KA, Zheng SL, Thanaj M, Bai W, Duan J, Biffi C, Mazzarotto F, Statton B, Dawes TJW, Savioli N, Halliday BP, Xu X, Buchan RJ, Baksi AJ, Quinlan M, Tokarczuk P, Tayal U, Francis C, Whiffin N, Theotokis PI, Zhang X, Jang M, Berry A, Pantazis A, Barton PJR, Rueckert D, Prasad SK, Walsh R, Ho CY, Cook SA, Ware JS, O'Regan DP. Phenotypic Expression and Outcomes in Individuals With Rare Genetic Variants of Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2021; 78:1097-1110. [PMID: 34503678 PMCID: PMC8434420 DOI: 10.1016/j.jacc.2021.07.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is caused by rare variants in sarcomere-encoding genes, but little is known about the clinical significance of these variants in the general population. OBJECTIVES The goal of this study was to compare lifetime outcomes and cardiovascular phenotypes according to the presence of rare variants in sarcomere-encoding genes among middle-aged adults. METHODS This study analyzed whole exome sequencing and cardiac magnetic resonance imaging in UK Biobank participants stratified according to sarcomere-encoding variant status. RESULTS The prevalence of rare variants (allele frequency <0.00004) in HCM-associated sarcomere-encoding genes in 200,584 participants was 2.9% (n = 5,712; 1 in 35), and the prevalence of variants pathogenic or likely pathogenic for HCM (SARC-HCM-P/LP) was 0.25% (n = 493; 1 in 407). SARC-HCM-P/LP variants were associated with an increased risk of death or major adverse cardiac events compared with controls (hazard ratio: 1.69; 95% confidence interval [CI]: 1.38-2.07; P < 0.001), mainly due to heart failure endpoints (hazard ratio: 4.23; 95% CI: 3.07-5.83; P < 0.001). In 21,322 participants with both cardiac magnetic resonance imaging and whole exome sequencing, SARC-HCM-P/LP variants were associated with an asymmetric increase in left ventricular maximum wall thickness (10.9 ± 2.7 mm vs 9.4 ± 1.6 mm; P < 0.001), but hypertrophy (≥13 mm) was only present in 18.4% (n = 9 of 49; 95% CI: 9%-32%). SARC-HCM-P/LP variants were still associated with heart failure after adjustment for wall thickness (hazard ratio: 6.74; 95% CI: 2.43-18.7; P < 0.001). CONCLUSIONS In this population of middle-aged adults, SARC-HCM-P/LP variants have low aggregate penetrance for overt HCM but are associated with an increased risk of adverse cardiovascular outcomes and an attenuated cardiomyopathic phenotype. Although absolute event rates are low, identification of these variants may enhance risk stratification beyond familial disease.
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Affiliation(s)
- Antonio de Marvao
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Kathryn A McGurk
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sean L Zheng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Marjola Thanaj
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Wenjia Bai
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Jinming Duan
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Carlo Biffi
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Francesco Mazzarotto
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Ben Statton
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Timothy J W Dawes
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicolò Savioli
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Xiao Xu
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Rachel J Buchan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - A John Baksi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Marina Quinlan
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Paweł Tokarczuk
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Catherine Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom; Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Pantazis I Theotokis
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Xiaolei Zhang
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mikyung Jang
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Alaine Berry
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Antonis Pantazis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Paul J R Barton
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Faculty of Informatics and Medicine, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Roddy Walsh
- Department of Experimental Cardiology, Amsterdam UMC, AMC Heart Centre, Amsterdam, the Netherlands
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart A Cook
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom; National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - James S Ware
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, London, United Kingdom.
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom.
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25
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Zhang M, Wong SW, Lummus S, Han M, Radmanesh A, Ahmadian SS, Prolo LM, Lai H, Eghbal A, Oztekin O, Cheshier SH, Fisher PG, Ho CY, Vogel H, Vitanza NA, Lober RM, Grant GA, Jaju A, Yeom KW. Radiomic Phenotypes Distinguish Atypical Teratoid/Rhabdoid Tumors from Medulloblastoma. AJNR Am J Neuroradiol 2021; 42:1702-1708. [PMID: 34266866 DOI: 10.3174/ajnr.a7200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Atypical teratoid/rhabdoid tumors and medulloblastomas have similar imaging and histologic features but distinctly different outcomes. We hypothesized that they could be distinguished by MR imaging-based radiomic phenotypes. MATERIALS AND METHODS We retrospectively assembled T2-weighted and gadolinium-enhanced T1-weighted images of 48 posterior fossa atypical teratoid/rhabdoid tumors and 96 match-paired medulloblastomas from 7 institutions. Using a holdout test set, we measured the performance of 6 candidate classifier models using 6 imaging features derived by sparse regression of 900 T2WI and 900 T1WI Imaging Biomarker Standardization Initiative-based radiomics features. RESULTS From the originally extracted 1800 total Imaging Biomarker Standardization Initiative-based features, sparse regression consistently reduced the feature set to 1 from T1WI and 5 from T2WI. Among classifier models, logistic regression performed with the highest AUC of 0.86, with sensitivity, specificity, accuracy, and F1 scores of 0.80, 0.82, 0.81, and 0.85, respectively. The top 3 important Imaging Biomarker Standardization Initiative features, by decreasing order of relative contribution, included voxel intensity at the 90th percentile, inverse difference moment normalized, and kurtosis-all from T2WI. CONCLUSIONS Six quantitative signatures of image intensity, texture, and morphology distinguish atypical teratoid/rhabdoid tumors from medulloblastomas with high prediction performance across different machine learning strategies. Use of this technique for preoperative diagnosis of atypical teratoid/rhabdoid tumors could significantly inform therapeutic strategies and patient care discussions.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - S W Wong
- Department of Statistics (S.W.W.), Stanford University, Stanford, California
| | - S Lummus
- Department of Physiology and Nutrition (S.L.), University of Colorado, Colorado Springs, Colorado
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Radmanesh
- Department of Radiology (A.R.), New York University Grossman School of Medicine, New York, New York
| | - S S Ahmadian
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - L M Prolo
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - H Lai
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - O Oztekin
- Department of Neuroradiology (O.O.), Cigli Education and Research Hospital, Bakircay University, Izmir, Turkey.,Department of Neuroradiology (O.O.), Tepecik Education and Research Hospital, Health Science University, Izmir, Turkey
| | - S H Cheshier
- Division of Pediatric Neurosurgery (S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - H Vogel
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio
| | - G A Grant
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K W Yeom
- Radiology (K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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26
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Spertus JA, Fine JT, Elliott P, Ho CY, Olivotto I, Saberi S, Li W, Dolan C, Reaney M, Sehnert AJ, Jacoby D. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): health status analysis of a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2021; 397:2467-2475. [PMID: 34004177 DOI: 10.1016/s0140-6736(21)00763-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Improving symptoms is a primary treatment goal in patients with obstructive hypertrophic cardiomyopathy. Currently available pharmacological options for hypertrophic cardiomyopathy are not disease-specific and are often inadequate or poorly tolerated. We aimed to assess the effect of mavacamten, a first-in-class cardiac myosin inhibitor, on patients' health status-ie, symptoms, physical and social function, and quality of life. METHODS We did a health status analysis of EXPLORER-HCM, a phase 3, double-blind, randomised, placebo-controlled trial. The study took place at 68 clinical cardiovascular centres in 13 countries. Adult patients (≥18 years) with symptomatic obstructive hypertrophic cardiomyopathy (gradient ≥50 mm Hg and New York Heart Association class II-III) were randomly assigned (1:1) to mavacamten or placebo for 30 weeks, followed by an 8-week washout period. Both patients and staff were masked to study treatment. The primary outcome for this secondary analysis was the Kansas City Cardiomyopathy Questionnaire (KCCQ), a well validated disease-specific measure of patients' health status. It was administered at baseline and weeks 6, 12, 18, 30 (end of treatment), and 38 (end of study). Changes from baseline to week 30 in KCCQ overall summary (OS) score and all subscales were analysed using mixed model repeated measures. This study is registered with ClinicalTrials.gov, NCT03470545. FINDINGS Between May 30, 2018, and July 12, 2019, 429 adults were assessed for eligibility, of whom 251 (59%) were enrolled and randomly assigned. Of 123 patients randomly assigned to mavacamten, 92 (75%) completed the KCCQ at baseline and week 30 and of the 128 patients randomly assigned to placebo 88 (69%) completed the KCCQ at baseline and week 30. At 30 weeks, the change in KCCQ-OS score was greater with mavacamten than placebo (mean score 14·9 [SD 15·8] vs 5·4 [13·7]; difference +9·1 [95% CI 5·5-12·8]; p<0·0001), with similar benefits across all KCCQ subscales. The proportion of patients with a very large change (KCCQ-OS ≥20 points) was 36% (33 of 92) in the mavacamten group versus 15% (13 of 88) in the placebo group, with an estimated absolute difference of 21% (95% CI 8·8-33·4) and number needed to treat of five (95% CI 3-11). These gains returned to baseline after treatment was stopped. INTERPRETATION Mavacamten markedly improved the health status of patients with symptomatic obstructive hypertrophic cardiomyopathy compared with placebo, with a low number needed to treat for marked improvement. Given that the primary goals of treatment are to improve symptoms, physical and social function, and quality of life, mavacamten represents a new potential strategy for achieving these goals. FUNDING MyoKardia, a Bristol Myers Squibb company.
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Affiliation(s)
- John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri, Kansas City, MO, USA.
| | - Jennifer T Fine
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | - Perry Elliott
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Carolyn Y Ho
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Wanying Li
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | | | | | - Amy J Sehnert
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
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27
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Abstract
INTRODUCTION This is an overall review on mindfulness-based interventions (MBIs). SOURCES OF DATA We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations. AREAS OF AGREEMENT MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions. AREAS OF CONTROVERSY Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations. GROWING POINTS Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed. AREAS TIMELY FOR DEVELOPING RESEARCH More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.
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Affiliation(s)
- Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric K P Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eva C W Mak
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C Y Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
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28
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Marston NA, Han L, Olivotto I, Day SM, Ashley EA, Michels M, Pereira AC, Ingles J, Semsarian C, Jacoby D, Colan SD, Rossano JW, Wittekind SG, Ware JS, Saberi S, Helms AS, Ho CY. Clinical characteristics and outcomes in childhood-onset hypertrophic cardiomyopathy. Eur Heart J 2021; 42:1988-1996. [PMID: 33769460 PMCID: PMC8139852 DOI: 10.1093/eurheartj/ehab148] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/21/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023] Open
Abstract
AIMS Childhood-onset hypertrophic cardiomyopathy (HCM) is far less common than adult-onset disease, thus natural history is not well characterized. We aim to describe the characteristics and outcomes of childhood-onset HCM. METHODS AND RESULTS We performed an observational cohort study of 7677 HCM patients from the Sarcomeric Human Cardiomyopathy Registry (SHaRe). Hypertrophic cardiomyopathy patients were stratified by age at diagnosis [<1 year (infancy), 1-18 years (childhood), >18 years (adulthood)] and assessed for composite endpoints reflecting heart failure (HF), life-threatening ventricular arrhythmias, atrial fibrillation (AF), and an overall composite that also included stroke and death. Stratifying by age of diagnosis, 184 (2.4%) patients were diagnosed in infancy; 1128 (14.7%) in childhood; and 6365 (82.9%) in adulthood. Childhood-onset HCM patients had an ∼2%/year event rate for the overall composite endpoint, with ventricular arrhythmias representing the most common event in the 1st decade following baseline visit, but HF and AF becoming more common by the end of the 2nd decade. Sarcomeric variants were more common in childhood-onset HCM (63%) and carried a worse prognosis than non-sarcomeric disease, including a greater than two-fold increased risk of HF [HRadj 2.39 (1.36-4.20), P = 0.003] and 67% increased risk of the overall composite outcome [HRadj 1.67 (1.16-2.41), P = 0.006]. When compared with adult-onset HCM, childhood-onset was 36% more likely to develop life-threatening ventricular arrhythmias [HRadj 1.36 (1.03-1.80)] and twice as likely to require transplant or ventricular assist device [HRadj 1.99 (1.23-3.23)]. CONCLUSION Patients with childhood-onset HCM are more likely to have sarcomeric disease, carry a higher risk of life-threatening ventricular arrythmias, and have greater need for advanced HF therapies. These findings provide insight into the natural history of disease and can help inform clinical risk stratification.
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Affiliation(s)
- Nicholas A Marston
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,TIMI Study Group, Boston, MA, USA
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, Stanford, CA, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, The Netherlands
| | | | - Jodie Ingles
- Department of Cardiology, Royal Prince Alfred Hospital, Agnes Ginges Centre for Molecular Cardiology, at Centenary Institute, The University of Sydney, Australia
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Agnes Ginges Centre for Molecular Cardiology, at Centenary Institute, The University of Sydney, Australia
| | | | - Steven D Colan
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - James S Ware
- National Heart & Lung Institute & Royal Brompton Cardiovascular Research Centre, Imperial College London, London, England
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam S Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Carolyn Y Ho
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Affiliation(s)
- Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Andrew Wang
- Duke University School of Medicine, Durham, NC, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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30
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Harper AR, Goel A, Grace C, Thomson KL, Petersen SE, Xu X, Waring A, Ormondroyd E, Kramer CM, Ho CY, Neubauer S, Tadros R, Ware JS, Bezzina CR, Farrall M, Watkins H. Common genetic variants and modifiable risk factors underpin hypertrophic cardiomyopathy susceptibility and expressivity. Nat Genet 2021; 53:135-142. [PMID: 33495597 DOI: 10.1038/s41588-020-00764-0] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a common, serious, genetic heart disorder. Rare pathogenic variants in sarcomere genes cause HCM, but with unexplained phenotypic heterogeneity. Moreover, most patients do not carry such variants. We report a genome-wide association study of 2,780 cases and 47,486 controls that identified 12 genome-wide-significant susceptibility loci for HCM. Single-nucleotide polymorphism heritability indicated a strong polygenic influence, especially for sarcomere-negative HCM (64% of cases; h2g = 0.34 ± 0.02). A genetic risk score showed substantial influence on the odds of HCM in a validation study, halving the odds in the lowest quintile and doubling them in the highest quintile, and also influenced phenotypic severity in sarcomere variant carriers. Mendelian randomization identified diastolic blood pressure (DBP) as a key modifiable risk factor for sarcomere-negative HCM, with a one standard deviation increase in DBP increasing the HCM risk fourfold. Common variants and modifiable risk factors have important roles in HCM that we suggest will be clinically actionable.
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Affiliation(s)
- Andrew R Harper
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Anuj Goel
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Christopher Grace
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Kate L Thomson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.,Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Xiao Xu
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam Waring
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Elizabeth Ormondroyd
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | | | - Rafik Tadros
- Cardiovascular Genetics Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Martin Farrall
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK. .,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK. .,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
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31
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Eberly LA, Day SM, Ashley EA, Jacoby DL, Jefferies JL, Colan SD, Rossano JW, Semsarian C, Pereira AC, Olivotto I, Ingles J, Seidman CE, Channaoui N, Cirino AL, Han L, Ho CY, Lakdawala NK. Association of Race With Disease Expression and Clinical Outcomes Among Patients With Hypertrophic Cardiomyopathy. JAMA Cardiol 2021; 5:83-91. [PMID: 31799990 DOI: 10.1001/jamacardio.2019.4638] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Racial differences are recognized in multiple cardiovascular parameters, including left ventricular hypertrophy and heart failure, which are 2 major manifestations of hypertrophic cardiomyopathy. The association of race with disease expression and outcomes among patients with hypertrophic cardiomyopathy is not well characterized. Objective To assess the association between race, disease expression, care provision, and clinical outcomes among patients with hypertrophic cardiomyopathy. Design, Setting, and Participants This retrospective cohort study included data on black and white patients with hypertrophic cardiomyopathy from the US-based sites of the Sarcomeric Human Cardiomyopathy Registry from 1989 through 2018. Exposures Self-identified race. Main Outcomes and Measures Baseline characteristics; genetic architecture; adverse outcomes, including cardiac arrest, cardiac transplantation or left ventricular assist device implantation, implantable cardioverter-defibrillator therapy, all-cause mortality, atrial fibrillation, stroke, and New York Heart Association (NYHA) functional class III or IV heart failure; and septal reduction therapies. The overall composite outcome consists of the first occurrence of any component of the ventricular arrhythmic composite end point, cardiac transplantation, left ventricular assist device implantation, NYHA class III or IV heart failure, atrial fibrillation, stroke, or all-cause mortality. Results Of 2467 patients with hypertrophic cardiomyopathy at the time of analysis, 205 (8.3%) were black (130 male [63.4%]; mean [SD] age, 40.0 [18.6] years) and 2262 (91.7%) were white (1351 male [59.7%]; mean [SD] age, 45.5 [20.5] years). Compared with white patients, black patients were younger at the time of diagnosis (mean [SD], 36.5 [18.2] vs 41.9 [20.2] years; P < .001), had higher prevalence of NYHA class III or IV heart failure at presentation (36 of 205 [22.6%] vs 174 of 2262 [15.8%]; P = .001), had lower rates of genetic testing (111 [54.1%] vs 1404 [62.1%]; P = .03), and were less likely to have sarcomeric mutations identified by genetic testing (29 [26.1%] vs 569 [40.5%]; P = .006). Implantation of implantable cardioverter-defibrillators did not vary by race; however, invasive septal reduction was less common among black patients (30 [14.6%] vs 521 [23.0%]; P = .007). Black patients had less incident atrial fibrillation (35 [17.1%] vs 608 [26.9%]; P < .001). Black race was associated with increased development of NYHA class III or IV heart failure (hazard ratio, 1.45; 95% CI, 1.08-1.94) which persisted on multivariable Cox proportional hazards regression (hazard ratio, 1.97; 95% CI, 1.34-2.88). There were no differences in the associations of race with stroke, ventricular arrhythmias, all-cause mortality, or the overall composite outcome. Conclusions and Relevance The findings suggest that black patients with hypertrophic cardiomyopathy are diagnosed at a younger age, are less likely to carry a sarcomere mutation, have a higher burden of functionally limited heart failure, and experience inequities in care with lower use of invasive septal reduction therapy and genetic testing compared with white patients. Further study is needed to assess whether higher rates of heart failure may be associated with underlying ancestry-based disease pathways, clinical management, or structural inequities.
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Affiliation(s)
- Lauren A Eberly
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, Palo Alto, California
| | - Daniel L Jacoby
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - John Lynn Jefferies
- Heart Institute and the Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandre C Pereira
- Heart Institute (Instituto do Coração da Universidade de São Paulo), University of São Paulo Medical School, São Paulo, Brazil
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and The University of Sydney, Sydney, New South Wales, Australia
| | - Christine E Seidman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nadine Channaoui
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison L Cirino
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Larry Han
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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32
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Fumagalli C, Maurizi N, Day SM, Ashley EA, Michels M, Colan SD, Jacoby D, Marchionni N, Vincent-Tompkins J, Ho CY, Olivotto I. Association of Obesity With Adverse Long-term Outcomes in Hypertrophic Cardiomyopathy. JAMA Cardiol 2021; 5:65-72. [PMID: 31693057 DOI: 10.1001/jamacardio.2019.4268] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Patients with hypertrophic cardiomyopathy (HCM) are prone to body weight increase and obesity. Whether this predisposes these individuals to long-term adverse outcomes is still unresolved. Objective To describe the association of body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) with long-term outcomes in patients with HCM in terms of overall disease progression, heart failure symptoms, and arrhythmias. Design, Setting, and Participants In this cohort study, retrospective data were analyzed from the ongoing prospective Sarcomeric Human Cardiomyopathy Registry, an international database created by 8 high-volume HCM centers that includes more than 6000 patients who have been observed longitudinally for decades. Records from database inception up to the first quarter of 2018 were analyzed. Patients were divided into 3 groups according to BMI class (normal weight group, <25; preobesity group, 25-30; and obesity group, >30). Patients with 1 or more follow-up visits were included in the analysis. Data were analyzed from April to October 2018. Exposures Association of baseline BMI with outcome was assessed. Main Outcome and Measures Outcome was measured against overall and cardiovascular mortality, a heart failure outcome (ejection fraction less than 35%, New York Heart Association class III/IV symptoms, cardiac transplant, or assist device implantation), a ventricular arrhythmic outcome (sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter-defibrillator therapy), and an overall composite outcome (first occurrence of any component of the ventricular arrhythmic or heart failure composite end point, all-cause mortality, atrial fibrillation, or stroke). Results Of the 3282 included patients, 2019 (61.5%) were male, and the mean (SD) age at diagnosis was 47 (15) years. These patients were observed for a median (interquartile range) of 6.8 (3.3-13.3) years. There were 962 patients in the normal weight group (29.3%), 1280 patients in the preobesity group (39.0%), and 1040 patients in the obesity group (31.7%). Patients with obesity were more symptomatic (New York Heart Association class of III/IV: normal weight, 87 [9.0%]; preobesity, 138 [10.8%]; obesity, 215 [20.7%]; P < .001) and more often had obstructive physiology (normal weight, 201 [20.9%]; preobesity, 327 [25.5%]; obesity, 337 [32.4%]; P < .001). At follow-up, obesity was independently associated with the HCM-related overall composite outcome (preobesity vs normal weight: hazard ratio [HR], 1.102; 95% CI, 0.920-1.322; P = .29; obesity vs normal weight: HR, 1.634; 95% CI, 1.332-1.919; P < .001) and the heart failure composite outcome (preobesity vs normal weight: HR, 1.192; 95% CI, 0.930-1.1530; P = .20; obesity vs normal weight: HR, 1.885; 95% CI, 1.485-2.393; P < .001) irrespective of age, sex, left atrium diameter, obstruction, and genetic status. Obesity increased the likelihood of atrial fibrillation but not of life-threatening ventricular arrhythmias. Conclusions and Relevance Obesity is highly prevalent among patients with HCM and is associated with increased likelihood of obstructive physiology and adverse outcomes. Strategies aimed at preventing obesity and weight increase may play an important role in management and prevention of disease-related complications.
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Affiliation(s)
- Carlo Fumagalli
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Maurizi
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | | | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, Stanford, California
| | | | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Niccolò Marchionni
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | | | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
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33
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Ho CY, Mealiffe ME, Bach RG, Bhattacharya M, Choudhury L, Edelberg JM, Hegde SM, Jacoby D, Lakdawala NK, Lester SJ, Ma Y, Marian AJ, Nagueh SF, Owens A, Rader F, Saberi S, Sehnert AJ, Sherrid MV, Solomon SD, Wang A, Wever-Pinzon O, Wong TC, Heitner SB. Evaluation of Mavacamten in Symptomatic Patients With Nonobstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2021; 75:2649-2660. [PMID: 32466879 DOI: 10.1016/j.jacc.2020.03.064] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with nonobstructive hypertrophic cardiomyopathy (nHCM) often experience a high burden of symptoms; however, there are no proven pharmacological therapies. By altering the contractile mechanics of the cardiomyocyte, myosin inhibitors have the potential to modify pathophysiology and improve symptoms associated with HCM. OBJECTIVES MAVERICK-HCM (Mavacamten in Adults With Symptomatic Non-Obstructive Hypertrophic Cardiomyopathy) explored the safety and efficacy of mavacamten, a first-in-class reversible inhibitor of cardiac-specific myosin, in nHCM. METHODS The MAVERICK-HCM trial was a multicenter, double-blind, placebo-controlled, dose-ranging phase II study in adults with symptomatic nHCM (New York Heart Association functional class II/III), left ventricular ejection fraction (LVEF) ≥55%, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥300 pg/ml. Participants were randomized 1:1:1 to mavacamten at a pharmacokinetic-adjusted dose (targeting plasma levels of 200 or 500 ng/ml), or placebo for 16 weeks, followed by an 8-week washout. Initial dose was 5 mg daily with 1 dose titration at week 6. RESULTS Fifty-nine participants were randomized (19, 21, 19 patients to 200 ng/ml, 500 ng/ml, placebo, respectively). Their mean age was 54 years, and 58% were women. Serious adverse events occurred in 10% of participants on mavacamten and in 21% participants on placebo. Five participants on mavacamten had reversible reduction in LVEF ≤45%. NT-proBNP geometric mean decreased by 53% in the pooled mavacamten group versus 1% in the placebo group, with geometric mean differences of -435 and -6 pg/ml, respectively (p = 0.0005). Cardiac troponin I (cTnI) geometric mean decreased by 34% in the pooled mavacamten group versus a 4% increase in the placebo group, with geometric mean differences of -0.008 and 0.001 ng/ml, respectively (p = 0.009). CONCLUSIONS Mavacamten, a novel myosin inhibitor, was well tolerated in most subjects with symptomatic nHCM. Furthermore, treatment was associated with a significant reduction in NT-proBNP and cTnI, suggesting improvement in myocardial wall stress. These results set the stage for future studies of mavacamten in this patient population using clinical parameters, including LVEF, to guide dosing. (A Phase 2 Study of Mavacamten in Adults With Symptomatic Non-Obstructive Hypertrophic Cardiomyopathy [MAVERICK-HCM]; NCT03442764).
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Affiliation(s)
- Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | | | - Richard G Bach
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | | | - Lubna Choudhury
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | | | - Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona
| | - Yanfei Ma
- MyoKardia, Inc., Brisbane, California
| | - Ali J Marian
- Center for Cardiovascular Genetics, Institute of Molecular Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Anjali Owens
- Heart and Vascular Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, New York University School of Medicine, New York, New York
| | - Scott D Solomon
- Department of Internal Medicine, Section of Cardiovascular Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew Wang
- Duke Cardiology, Duke Health Center at Southpoint, Durham, North Carolina
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Timothy C Wong
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen B Heitner
- Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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Zhang X, Walsh R, Whiffin N, Buchan R, Midwinter W, Wilk A, Govind R, Li N, Ahmad M, Mazzarotto F, Roberts A, Theotokis PI, Mazaika E, Allouba M, de Marvao A, Pua CJ, Day SM, Ashley E, Colan SD, Michels M, Pereira AC, Jacoby D, Ho CY, Olivotto I, Gunnarsson GT, Jefferies JL, Semsarian C, Ingles J, O'Regan DP, Aguib Y, Yacoub MH, Cook SA, Barton PJR, Bottolo L, Ware JS. Disease-specific variant pathogenicity prediction significantly improves variant interpretation in inherited cardiac conditions. Genet Med 2021; 23:69-79. [PMID: 33046849 PMCID: PMC7790749 DOI: 10.1038/s41436-020-00972-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Accurate discrimination of benign and pathogenic rare variation remains a priority for clinical genome interpretation. State-of-the-art machine learning variant prioritization tools are imprecise and ignore important parameters defining gene-disease relationships, e.g., distinct consequences of gain-of-function versus loss-of-function variants. We hypothesized that incorporating disease-specific information would improve tool performance. METHODS We developed a disease-specific variant classifier, CardioBoost, that estimates the probability of pathogenicity for rare missense variants in inherited cardiomyopathies and arrhythmias. We assessed CardioBoost's ability to discriminate known pathogenic from benign variants, prioritize disease-associated variants, and stratify patient outcomes. RESULTS CardioBoost has high global discrimination accuracy (precision recall area under the curve [AUC] 0.91 for cardiomyopathies; 0.96 for arrhythmias), outperforming existing tools (4-24% improvement). CardioBoost obtains excellent accuracy (cardiomyopathies 90.2%; arrhythmias 91.9%) for variants classified with >90% confidence, and increases the proportion of variants classified with high confidence more than twofold compared with existing tools. Variants classified as disease-causing are associated with both disease status and clinical severity, including a 21% increased risk (95% confidence interval [CI] 11-29%) of severe adverse outcomes by age 60 in patients with hypertrophic cardiomyopathy. CONCLUSIONS A disease-specific variant classifier outperforms state-of-the-art genome-wide tools for rare missense variants in inherited cardiac conditions ( https://www.cardiodb.org/cardioboost/ ), highlighting broad opportunities for improved pathogenicity prediction through disease specificity.
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Affiliation(s)
- Xiaolei Zhang
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Roddy Walsh
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Rachel Buchan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - William Midwinter
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Alicja Wilk
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Risha Govind
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Nicholas Li
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Mian Ahmad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Francesco Mazzarotto
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Angharad Roberts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Pantazis I Theotokis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Erica Mazaika
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Mona Allouba
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Aswan Heart Centre, Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - Antonio de Marvao
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | | | - Sharlene M Day
- Division of Cardiovascular Medicine and Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, Rotterdam, Netherlands
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel Jacoby
- Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | | | - John L Jefferies
- The Cardiovascular Institute, University of Tennessee, Memphis, TN, USA
| | - Chris Semsarian
- Centenary Institute, The University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jodie Ingles
- Centenary Institute, The University of Sydney, Sydney, Australia
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Yasmine Aguib
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Aswan Heart Centre, Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - Magdi H Yacoub
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Aswan Heart Centre, Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - Stuart A Cook
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
- National Heart Centre, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Paul J R Barton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom
| | - Leonardo Bottolo
- Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom.
- Alan Turing Institute, London, United Kingdom.
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom.
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS, Foundation Trust London, London, United Kingdom.
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom.
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Pirruccello JP, Bick A, Chaffin M, Aragam KG, Choi SH, Lubitz SA, Ho CY, Ng K, Philippakis A, Ellinor PT, Kathiresan S, Khera AV. Titin Truncating Variants in Adults Without Known Congestive Heart Failure. J Am Coll Cardiol 2020; 75:1239-1241. [PMID: 32164899 DOI: 10.1016/j.jacc.2020.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 12/15/2022]
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Lakdawala NK, Olivotto I, Day SM, Han L, Ashley EA, Michels M, Ingles J, Semsarian C, Jacoby D, Jefferies JL, Colan SD, Pereira AC, Rossano JW, Wittekind S, Ware JS, Saberi S, Helms AS, Cirino AL, Leinwand LA, Seidman CE, Ho CY. Associations Between Female Sex, Sarcomere Variants, and Clinical Outcomes in Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2020; 14:e003062. [PMID: 33284039 DOI: 10.1161/circgen.120.003062] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The impact of sex on phenotypic expression in hypertrophic cardiomyopathy (HCM) has not been well characterized in genotyped cohorts. METHODS Retrospective cohort study from an international registry of patients receiving care at experienced HCM centers. Sex-based differences in baseline characteristics and clinical outcomes were assessed. RESULTS Of 5873 patients (3788 genotyped), 2226 (37.9%) were women. At baseline, women were older (49.0±19.9 versus 42.9±18.4 years, P<0.001) and more likely to have pathogenic/likely pathogenic sarcomeric variants (HCM patients with a sarcomere mutation; 51% versus 43%, P<0.001) despite equivalent utilization of genetic testing. Age at diagnosis varied by sex and genotype despite similar distribution of causal genes. Women were 3.6 to 7.1 years older at diagnosis (P<0.02) except for patients with MYH7 variants where age at diagnosis was comparable for women and men (n=492; 34.8±19.2 versus 33.3±16.8 years, P=0.39). Over 7.7 median years of follow-up, New York Heart Association III-IV heart failure was more common in women (hazard ratio, 1.87 [CI, 1.48-2.36], P<0.001), after controlling for their higher burden of symptoms and outflow tract obstruction at baseline, reduced ejection fraction, HCM patients with a sarcomere mutation, age, and hypertension. All-cause mortality was increased in women (hazard ratio, 1.50 [CI, 1.13-1.99], P<0.01) but neither implantable cardioverter-defibrillator utilization nor ventricular arrhythmia varied by sex. CONCLUSIONS In HCM, women are older at diagnosis, partly modified by genetic substrate. Regardless of genotype, women were at higher risk of mortality and developing severe heart failure symptoms. This points to a sex-effect on long-term myocardial performance in HCM, which should be investigated further.
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Affiliation(s)
- Neal K Lakdawala
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
| | - Iacopo Olivotto
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
| | - Larry Han
- Harvard University, Biostatistics, Boston, MA (L.H.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands (M.M.)
| | - Jodie Ingles
- Department of Cardiology, Royal Prince Alfred Hospital, Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, NSW, Australia (J.I., C.S.)
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, NSW, Australia (J.I., C.S.)
| | | | | | - Steven D Colan
- Boston Children's Hospital (S.D.C.), Harvard Medical School, MA
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | | | - Sam Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, OH (S.W.)
| | - James S Ware
- National Heart & Lung Institute, Royal Brompton Cardiovascular Research Centre, Imperial College London, United Kingdom (J.S.W.)
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.S., A.S.H.)
| | - Adam S Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.S., A.S.H.)
| | - Allison L Cirino
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
| | - Leslie A Leinwand
- MCDB & BioFrontiers Institute, University of Colorado, Boulder (L.A.L.)
| | - Christine E Seidman
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA.,Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Carolyn Y Ho
- Brigham and Women's Hospital (N.K.L., A.L.C., C.E.S., C.Y.H.), Harvard Medical School, MA
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Affiliation(s)
- Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
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Ahluwalia M, Ho CY. Cardiovascular genetics: the role of genetic testing in diagnosis and management of patients with hypertrophic cardiomyopathy. Heart 2020; 107:183-189. [PMID: 33172912 DOI: 10.1136/heartjnl-2020-316798] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 01/17/2023] Open
Abstract
Genetic testing in hypertrophic cardiomyopathy (HCM) is a valuable tool to manage patients and their families. Genetic testing can help inform diagnosis and differentiate HCM from other disorders that also result in increased left ventricular wall thickness, thereby directly impacting treatment. Moreover, genetic testing can definitively identify at-risk relatives and focus family management. Pathogenic variants in sarcomere and sarcomere-related genes have been implicated in causing HCM, and targeted gene panel testing is recommended for patients once a clinical diagnosis has been established. If a pathogenic or likely pathogenic variant is identified in a patient with HCM, predictive genetic testing is recommended for their at-risk relatives to determine who is at risk and to guide longitudinal screening and risk stratification. However, there are important challenges and considerations to implementing genetic testing in clinical practice. Genetic testing results can have psychological and other implications for patients and their families, emphasising the importance of genetic counselling before and after genetic testing. Determining the clinical relevance of genetic testing results is also complex and requires expertise in understanding of human genetic variation and clinical manifestations of the disease. In this review, we discuss the genetics of HCM and how to integrate genetic testing in clinical practice.
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Affiliation(s)
- Monica Ahluwalia
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Olivotto I, Oreziak A, Barriales-Villa R, Abraham TP, Masri A, Garcia-Pavia P, Saberi S, Lakdawala NK, Wheeler MT, Owens A, Kubanek M, Wojakowski W, Jensen MK, Gimeno-Blanes J, Afshar K, Myers J, Hegde SM, Solomon SD, Sehnert AJ, Zhang D, Li W, Bhattacharya M, Edelberg JM, Waldman CB, Lester SJ, Wang A, Ho CY, Jacoby D. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2020; 396:759-769. [PMID: 32871100 DOI: 10.1016/s0140-6736(20)31792-x] [Citation(s) in RCA: 428] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiac muscle hypercontractility is a key pathophysiological abnormality in hypertrophic cardiomyopathy, and a major determinant of dynamic left ventricular outflow tract (LVOT) obstruction. Available pharmacological options for hypertrophic cardiomyopathy are inadequate or poorly tolerated and are not disease-specific. We aimed to assess the efficacy and safety of mavacamten, a first-in-class cardiac myosin inhibitor, in symptomatic obstructive hypertrophic cardiomyopathy. METHODS In this phase 3, randomised, double-blind, placebo-controlled trial (EXPLORER-HCM) in 68 clinical cardiovascular centres in 13 countries, patients with hypertrophic cardiomyopathy with an LVOT gradient of 50 mm Hg or greater and New York Heart Association (NYHA) class II-III symptoms were assigned (1:1) to receive mavacamten (starting at 5 mg) or placebo for 30 weeks. Visits for assessment of patient status occurred every 2-4 weeks. Serial evaluations included echocardiogram, electrocardiogram, and blood collection for laboratory tests and mavacamten plasma concentration. The primary endpoint was a 1·5 mL/kg per min or greater increase in peak oxygen consumption (pVO2) and at least one NYHA class reduction or a 3·0 mL/kg per min or greater pVO2 increase without NYHA class worsening. Secondary endpoints assessed changes in post-exercise LVOT gradient, pVO2, NYHA class, Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS), and Hypertrophic Cardiomyopathy Symptom Questionnaire Shortness-of-Breath subscore (HCMSQ-SoB). This study is registered with ClinicalTrials.gov, NCT03470545. FINDINGS Between May 30, 2018, and July 12, 2019, 429 adults were assessed for eligibility, of whom 251 (59%) were enrolled and randomly assigned to mavacamten (n=123 [49%]) or placebo (n=128 [51%]). 45 (37%) of 123 patients on mavacamten versus 22 (17%) of 128 on placebo met the primary endpoint (difference +19·4%, 95% CI 8·7 to 30·1; p=0·0005). Patients on mavacamten had greater reductions than those on placebo in post-exercise LVOT gradient (-36 mm Hg, 95% CI -43·2 to -28·1; p<0·0001), greater increase in pVO2 (+1·4 mL/kg per min, 0·6 to 2·1; p=0·0006), and improved symptom scores (KCCQ-CSS +9·1, 5·5 to 12·7; HCMSQ-SoB -1·8, -2·4 to -1·2; p<0·0001). 34% more patients in the mavacamten group improved by at least one NYHA class (80 of 123 patients in the mavacamten group vs 40 of 128 patients in the placebo group; 95% CI 22·2 to 45·4; p<0·0001). Safety and tolerability were similar to placebo. Treatment-emergent adverse events were generally mild. One patient died by sudden death in the placebo group. INTERPRETATION Treatment with mavacamten improved exercise capacity, LVOT obstruction, NYHA functional class, and health status in patients with obstructive hypertrophic cardiomyopathy. The results of this pivotal trial highlight the benefits of disease-specific treatment for this condition. FUNDING MyoKardia.
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Affiliation(s)
- Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; University of Florence, Florence, Italy.
| | - Artur Oreziak
- 1st Department of Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain; Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain; Servizo Galego de Saúde, A Coruña, Spain; Universidade da Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red, Madrid, Spain
| | - Theodore P Abraham
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Ahmad Masri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Pablo Garcia-Pavia
- Centro de Investigación Biomédica en Red, Madrid, Spain; Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew T Wheeler
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anjali Owens
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Milos Kubanek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Morten K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Juan Gimeno-Blanes
- Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Kia Afshar
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA; Stanford University, Palo Alto, CA, USA
| | - Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Andrew Wang
- Duke University School of Medicine, Durham, NC, USA
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
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Canepa M, Fumagalli C, Tini G, Vincent-Tompkins J, Day SM, Ashley EA, Mazzarotto F, Ware JS, Michels M, Jacoby D, Ho CY, Olivotto I. Temporal Trend of Age at Diagnosis in Hypertrophic Cardiomyopathy: An Analysis of the International Sarcomeric Human Cardiomyopathy Registry. Circ Heart Fail 2020; 13:e007230. [PMID: 32894986 PMCID: PMC7497482 DOI: 10.1161/circheartfailure.120.007230] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Over the last 50 years, the epidemiology of hypertrophic cardiomyopathy (HCM) has changed because of increased awareness and availability of advanced diagnostic tools. We aim to describe the temporal trends in age, sex, and clinical characteristics at HCM diagnosis over >4 decades. Methods: We retrospectively analyzed records from the ongoing multinational Sarcomeric Human Cardiomyopathy Registry. Overall, 7286 patients with HCM diagnosed at an age ≥18 years between 1961 and 2019 were included in the analysis and divided into 3 eras of diagnosis (<2000, 2000–2010, >2010). Results: Age at diagnosis increased markedly over time (40±14 versus 47±15 versus 51±16 years, P<0.001), both in US and non-US sites, with a stable male-to-female ratio of about 3:2. Frequency of familial HCM declined over time (38.8% versus 34.3% versus 32.7%, P<0.001), as well as heart failure symptoms at presentation (New York Heart Association III/IV: 18.1% versus 15.8% versus 12.6%, P<0.001). Left ventricular hypertrophy became less marked over time (maximum wall thickness: 20±6 versus 18±5 versus 17±5 mm, P<0.001), while prevalence of obstructive HCM was greater in recent cohorts (peak gradient >30 mm Hg: 31.9% versus 39.3% versus 39.0%, P=0.001). Consistent with decreasing phenotypic severity, yield of pathogenic/likely pathogenic variants at genetic testing decreased over time (57.7% versus 45.6% versus 38.4%, P<0.001). Conclusions: Evolving HCM populations include progressively greater representation of older patients with sporadic disease, mild phenotypes, and genotype-negative status. Such trend suggests a prominent role of imaging over genetic testing in promoting HCM diagnoses and urges efforts to understand genotype-negative disease eluding the classic monogenic paradigm.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Italy (M.C., G.T.)
| | - Carlo Fumagalli
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (C.F., F.M., I.O.)
| | - Giacomo Tini
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Italy (M.C., G.T.)
| | | | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Francesco Mazzarotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (C.F., F.M., I.O.).,National Heart and Lung Institute and National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, United Kingdom (F.M., J.S.W.)
| | - James S Ware
- National Heart and Lung Institute and National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, United Kingdom (F.M., J.S.W.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | | | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (C.F., F.M., I.O.)
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Helms AS, Thompson AD, Glazier AA, Hafeez N, Kabani S, Rodriguez J, Yob JM, Woolcock H, Mazzarotto F, Lakdawala NK, Wittekind SG, Pereira AC, Jacoby DL, Colan SD, Ashley EA, Saberi S, Ware JS, Ingles J, Semsarian C, Michels M, Olivotto I, Ho CY, Day SM. Spatial and Functional Distribution of MYBPC3 Pathogenic Variants and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2020; 13:396-405. [PMID: 32841044 PMCID: PMC7676622 DOI: 10.1161/circgen.120.002929] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Pathogenic variants in MYBPC3, encoding cardiac MyBP-C (myosin binding protein C), are the most common cause of familial hypertrophic cardiomyopathy. A large number of unique MYBPC3 variants and relatively small genotyped hypertrophic cardiomyopathy cohorts have precluded detailed genotype-phenotype correlations.
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Affiliation(s)
- Adam S Helms
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Andrea D Thompson
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Amelia A Glazier
- Molecular & Integrative Physiology (A.A.G.), University of Michigan, Ann Arbor
| | - Neha Hafeez
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Samat Kabani
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Juliani Rodriguez
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Jaime M Yob
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Helen Woolcock
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Francesco Mazzarotto
- Department of Experimental & Clinical Medicine, University of Florence, Italy (F.M., I.O.).,National Heart & Lung Institute & Royal Brompton Cardiovascular Research Center, Imperial College London, United Kingdom (F.M., J.S.W.)
| | - Neal K Lakdawala
- Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (N.K.L., C.Y.H.)
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH (S.G.W.)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paolo Medical School, Brazil (A.C.P.)
| | - Daniel L Jacoby
- Cardiovascular Medicine, Yale University, New Haven, CT (D.L.J.)
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, MA (S.D.C.)
| | - Euan A Ashley
- Center for Inherited Heart Disease, Stanford University, CA (E.A.A.)
| | - Sara Saberi
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia (J.I., C.S.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia (J.I., C.S.)
| | - Michelle Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.M.)
| | - Iacopo Olivotto
- Department of Experimental & Clinical Medicine, University of Florence, Italy (F.M., I.O.).,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.)
| | - Carolyn Y Ho
- Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (N.K.L., C.Y.H.)
| | - Sharlene M Day
- Cardiovascular Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
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Quon JL, Bala W, Chen LC, Wright J, Kim LH, Han M, Shpanskaya K, Lee EH, Tong E, Iv M, Seekins J, Lungren MP, Braun KRM, Poussaint TY, Laughlin S, Taylor MD, Lober RM, Vogel H, Fisher PG, Grant GA, Ramaswamy V, Vitanza NA, Ho CY, Edwards MSB, Cheshier SH, Yeom KW. Deep Learning for Pediatric Posterior Fossa Tumor Detection and Classification: A Multi-Institutional Study. AJNR Am J Neuroradiol 2020; 41:1718-1725. [PMID: 32816765 PMCID: PMC7583118 DOI: 10.3174/ajnr.a6704] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Posterior fossa tumors are the most common pediatric brain tumors. MR imaging is key to tumor detection, diagnosis, and therapy guidance. We sought to develop an MR imaging-based deep learning model for posterior fossa tumor detection and tumor pathology classification. MATERIALS AND METHODS The study cohort comprised 617 children (median age, 92 months; 56% males) from 5 pediatric institutions with posterior fossa tumors: diffuse midline glioma of the pons (n = 122), medulloblastoma (n = 272), pilocytic astrocytoma (n = 135), and ependymoma (n = 88). There were 199 controls. Tumor histology served as ground truth except for diffuse midline glioma of the pons, which was primarily diagnosed by MR imaging. A modified ResNeXt-50-32x4d architecture served as the backbone for a multitask classifier model, using T2-weighted MRIs as input to detect the presence of tumor and predict tumor class. Deep learning model performance was compared against that of 4 radiologists. RESULTS Model tumor detection accuracy exceeded an AUROC of 0.99 and was similar to that of 4 radiologists. Model tumor classification accuracy was 92% with an F1 score of 0.80. The model was most accurate at predicting diffuse midline glioma of the pons, followed by pilocytic astrocytoma and medulloblastoma. Ependymoma prediction was the least accurate. Tumor type classification accuracy and F1 score were higher than those of 2 of the 4 radiologists. CONCLUSIONS We present a multi-institutional deep learning model for pediatric posterior fossa tumor detection and classification with the potential to augment and improve the accuracy of radiologic diagnosis.
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Affiliation(s)
- J L Quon
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - W Bala
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | | | - J Wright
- Department of Radiology (J.W.), Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - L H Kim
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - M Han
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - K Shpanskaya
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - E H Lee
- Electrical Engineering (E.H.L.)
| | | | | | - J Seekins
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - M P Lungren
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - K R M Braun
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - T Y Poussaint
- Departments of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - S Laughlin
- Departments of diagnostic Imaging (S.L.)
| | | | - R M Lober
- Department of Neurosurgery (R.M.L.), Dayton Children's Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - H Vogel
- and Pathology (H.V.), Stanford University, Stanford, California
| | - P G Fisher
- Division of Child Neurology (P.G.F.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - G A Grant
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - V Ramaswamy
- and Haematology/Oncology (V.R.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle Washington.,Fred Hutchinson Cancer Research Center (N.A.V.), Seattle, Washington
| | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - M S B Edwards
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - S H Cheshier
- Departments of Neurosurgery (S.H.C.), University of Utah School of Medicine, Salt Lake City, Utah
| | - K W Yeom
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
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Miron A, Lafreniere-Roula M, Steve Fan CP, Armstrong KR, Dragulescu A, Papaz T, Manlhiot C, Kaufman B, Butts RJ, Gardin L, Stephenson EA, Howard TS, Aziz PF, Balaji S, Ladouceur VB, Benson LN, Colan SD, Godown J, Henderson HT, Ingles J, Jeewa A, Jefferies JL, Lal AK, Mathew J, Jean-St-Michel E, Michels M, Nakano SJ, Olivotto I, Parent JJ, Pereira AC, Semsarian C, Whitehill RD, Wittekind SG, Russell MW, Conway J, Richmond ME, Villa C, Weintraub RG, Rossano JW, Kantor PF, Ho CY, Mital S. A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy. Circulation 2020; 142:217-229. [PMID: 32418493 PMCID: PMC7365676 DOI: 10.1161/circulationaha.120.047235] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death (SCD) in children and young adults. Our objective was to develop and validate a SCD risk prediction model in pediatric hypertrophic cardiomyopathy to guide SCD prevention strategies. METHODS In an international multicenter observational cohort study, phenotype-positive patients with isolated hypertrophic cardiomyopathy <18 years of age at diagnosis were eligible. The primary outcome variable was the time from diagnosis to a composite of SCD events at 5-year follow-up: SCD, resuscitated sudden cardiac arrest, and aborted SCD, that is, appropriate shock following primary prevention implantable cardioverter defibrillators. Competing risk models with cause-specific hazard regression were used to identify and quantify clinical and genetic factors associated with SCD. The cause-specific regression model was implemented using boosting, and tuned with 10 repeated 4-fold cross-validations. The final model was fitted using all data with the tuned hyperparameter value that maximizes the c-statistic, and its performance was characterized by using the c-statistic for competing risk models. The final model was validated in an independent external cohort (SHaRe [Sarcomeric Human Cardiomyopathy Registry], n=285). RESULTS Overall, 572 patients met eligibility criteria with 2855 patient-years of follow-up. The 5-year cumulative proportion of SCD events was 9.1% (14 SCD, 25 resuscitated sudden cardiac arrests, and 14 aborted SCD). Risk predictors included age at diagnosis, documented nonsustained ventricular tachycardia, unexplained syncope, septal diameter z-score, left ventricular posterior wall diameter z score, left atrial diameter z score, peak left ventricular outflow tract gradient, and presence of a pathogenic variant. Unlike in adults, left ventricular outflow tract gradient had an inverse association, and family history of SCD had no association with SCD. Clinical and clinical/genetic models were developed to predict 5-year freedom from SCD. Both models adequately discriminated between patients with and without SCD events with a c-statistic of 0.75 and 0.76, respectively, and demonstrated good agreement between predicted and observed events in the primary and validation cohorts (validation c-statistic 0.71 and 0.72, respectively). CONCLUSION Our study provides a validated SCD risk prediction model with >70% prediction accuracy and incorporates risk factors that are unique to pediatric hypertrophic cardiomyopathy. An individualized risk prediction model has the potential to improve the application of clinical practice guidelines and shared decision making for implantable cardioverter defibrillator insertion. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT0403679.
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Affiliation(s)
- Anastasia Miron
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada (M.L.-R., C.-P, S.F.)
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada (M.L.-R., C.-P, S.F.)
| | - Katey R. Armstrong
- Division of Pediatric Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, Canada (K.R.A.)
| | - Andreea Dragulescu
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tanya Papaz
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Johns Hopkins Medical Center, Baltimore, MD (C.M.)
| | - Beth Kaufman
- Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA (B.K.)
| | - Ryan J. Butts
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s Medical Center of Dallas, TX (R.J.B.)
| | - Letizia Gardin
- Department of Cardiology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada (L.G.)
| | - Elizabeth A. Stephenson
- Department of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Ontario, Canada (E.A.S., S.M.)
| | - Taylor S. Howard
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital (T.S.H.)
| | - Pete F. Aziz
- Center for Pediatric and Congenital Heart Disease, Pediatric Electrophysiology and Pacing, Cleveland Clinic Children’s Hospital, OH (P.F.A.)
| | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, OHSU Doernbecher Children’s Hospital, Portland (S.B.)
| | - Virginie Beauséjour Ladouceur
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lee N. Benson
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, MA (S.D.C.)
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Monroe Carrell Jr Children’s Hospital at Vanderbilt, Nashville, TN (J.G.)
| | | | - Jodie Ingles
- Agnes Ginges Center for Molecular Cardiology at Centenary Institute, The University of Sydney, New South Wales, Australia (J.I., C.S.)
| | - Aamir Jeewa
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - John L. Jefferies
- Division of Adult Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis (J.L.J.)
| | - Ashwin K. Lal
- Division of Pediatric Cardiology, University of Utah Primary Children’s Hospital, Salt Lake City (A.K.L.)
| | - Jacob Mathew
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia (J.M., R.G.W.)
| | - Emilie Jean-St-Michel
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, South Holland, Netherlands (M.M.)
| | - Stephanie J. Nakano
- Department of Pediatrics, Division of Cardiology, Children’s Hospital Colorado, Aurora (S.J.N.)
| | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O.)
| | - John J. Parent
- Department of Pediatrics, Riley Children’s Hospital, Indianapolis, IN (J.J.P.)
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | - Christopher Semsarian
- Agnes Ginges Center for Molecular Cardiology at Centenary Institute, The University of Sydney, New South Wales, Australia (J.I., C.S.)
| | | | | | - Mark W. Russell
- Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI (M.W.R.)
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada (J.C.)
| | - Marc E. Richmond
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/Morgan Stanley Children’s Hospital, New York, NY (M.E.R.)
| | - Chet Villa
- The Heart Institute, Cincinnati Children’s Hospital, OH (S.G.W., C.V.)
| | - Robert G. Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia (J.M., R.G.W.)
- Murdoch Children’s Research Institute, University of Melbourne, Victoria, Australia (R.G.W.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, PA (J.W.R.)
| | - Paul F. Kantor
- Division of Cardiology, Children’s Hospital of Los Angeles, CA (P.F.K.)
| | - Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (C.Y.H.)
| | - Seema Mital
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Ontario, Canada (E.A.S., S.M.)
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Ho CY, Olivotto I, Jacoby D, Lester SJ, Roe M, Wang A, Waldman CB, Zhang D, Sehnert AJ, Heitner SB. Study Design and Rationale of EXPLORER-HCM: Evaluation of Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy. Circ Heart Fail 2020; 13:e006853. [PMID: 32498620 DOI: 10.1161/circheartfailure.120.006853] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by unexplained left ventricular (LV) hypertrophy associated with dynamic LV outflow tract obstruction. Current medical therapies are nonspecific and have limited efficacy in relieving symptoms. Mavacamten is a first-in-class targeted inhibitor of cardiac myosin, which has been shown to reduce LV outflow tract obstruction, improve exercise capacity, and relieve symptoms of oHCM in the PIONEER-HCM phase 2 study. METHODS EXPLORER-HCM is a multicenter, phase 3, randomized, double-blind, placebo-controlled trial to investigate the efficacy and safety of mavacamten in treating symptomatic oHCM. Eligible adults with oHCM and New York Heart Association Functional Class II or III are randomized 1:1 to receive once-daily, oral mavacamten, or matching placebo for 30 weeks. The primary composite functional end point is clinical response at week 30 compared to baseline defined as either (1) an increase in peak oxygen consumption ≥1.5 mL/kg/min and reduction of at least one New York Heart Association class; or (2) an improvement of ≥3.0 mL/kg/min in peak oxygen consumption with no worsening of New York Heart Association class. Secondary end points include change in postexercise LV outflow tract gradient, New York Heart Association class, peak oxygen consumption, and patient-reported outcomes assessed by the Kansas City Cardiomyopathy Questionnaire and a novel HCM-specific instrument. Exploratory end points aim to characterize the effect of mavacamten on multiple aspects of oHCM pathophysiology. CONCLUSIONS EXPLORER-HCM is a phase 3 trial in oHCM testing a first-in-class, targeted strategy of myosin inhibition to improve symptom burden and exercise capacity through reducing LV outflow tract obstruction. Results of this trial will provide evidence to support the first disease-specific treatment for HCM. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03470545.
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Affiliation(s)
- Carolyn Y Ho
- Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | | | | | | | - Matthew Roe
- Duke Clinical Research Institute, Durham, NC (M.R.)
| | - Andrew Wang
- Duke University School of Medicine, Durham, NC (A.W.)
| | | | | | | | - Stephen B Heitner
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland (S.B.H.)
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45
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Neubauer S, Kolm P, Ho CY, Kwong RY, Desai MY, Dolman SF, Appelbaum E, Desvigne-Nickens P, DiMarco JP, Friedrich MG, Geller N, Harper AR, Jarolim P, Jerosch-Herold M, Kim DY, Maron MS, Schulz-Menger J, Piechnik SK, Thomson K, Zhang C, Watkins H, Weintraub WS, Kramer CM. Distinct Subgroups in Hypertrophic Cardiomyopathy in the NHLBI HCM Registry. J Am Coll Cardiol 2020; 74:2333-2345. [PMID: 31699273 DOI: 10.1016/j.jacc.2019.08.1057] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The HCMR (Hypertrophic Cardiomyopathy Registry) is a National Heart, Lung, and Blood Institute-funded, prospective registry of 2,755 patients with hypertrophic cardiomyopathy (HCM) recruited from 44 sites in 6 countries. OBJECTIVES The authors sought to improve risk prediction in HCM by incorporating cardiac magnetic resonance (CMR), genetic, and biomarker data. METHODS Demographic and echocardiographic data were collected. Patients underwent CMR including cine imaging, late gadolinium enhancement imaging (LGE) (replacement fibrosis), and T1 mapping for measurement of extracellular volume as a measure of interstitial fibrosis. Blood was drawn for the biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (cTnT), and genetic analysis. RESULTS A total of 2,755 patients were studied. Mean age was 49 ± 11 years, 71% were male, and 17% non-white. Mean ESC (European Society of Cardiology) risk score was 2.48 ± 0.56. Eighteen percent had a resting left ventricular outflow tract (LVOT) gradient ≥30 mm Hg. Thirty-six percent had a sarcomere mutation identified, and 50% had any LGE. Sarcomere mutation-positive patients were more likely to have reverse septal curvature morphology, LGE, and no significant resting LVOT obstruction. Those that were sarcomere mutation negative were more likely to have isolated basal septal hypertrophy, less LGE, and more LVOT obstruction. Interstitial fibrosis was present in segments both with and without LGE. Serum NT-proBNP and cTnT levels correlated with increasing LGE and extracellular volume in a graded fashion. CONCLUSIONS The HCMR population has characteristics of low-risk HCM. Ninety-three percent had no or only mild functional limitation. Baseline data separated patients broadly into 2 categories. One group was sarcomere mutation positive and more likely had reverse septal curvature morphology, more fibrosis, but less resting obstruction, whereas the other was sarcomere mutation negative and more likely had isolated basal septal hypertrophy with obstruction, but less fibrosis. Further follow-up will allow better understanding of these subgroups and development of an improved risk prediction model incorporating all these markers.
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Affiliation(s)
- Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC
| | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Milind Y Desai
- Cardiovascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Evan Appelbaum
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - John P DiMarco
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Andrew R Harper
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Petr Jarolim
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Jerosch-Herold
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin S Maron
- Division of Cardiology, Tufts New England Medical Center, Boston, Massachusetts
| | - Jeanette Schulz-Menger
- Cardiology Department, Charite' Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kate Thomson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Cheng Zhang
- MedStar Heart and Vascular Institute, Washington, DC
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
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Nijenkamp LLAM, Bollen IAE, Niessen HWM, dos Remedios CG, Michels M, Poggesi C, Ho CY, Kuster DWD, van der Velden J. Sex-specific cardiac remodeling in early and advanced stages of hypertrophic cardiomyopathy. PLoS One 2020; 15:e0232427. [PMID: 32369506 PMCID: PMC7199944 DOI: 10.1371/journal.pone.0232427] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/14/2020] [Indexed: 01/28/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequent genetic cardiac disease with a prevalence of 1:500 to 1:200. While most patients show obstructive HCM and a relatively stable clinical phenotype (stage II), a small group of patients progresses to end-stage HCM (stage IV) within a relatively brief period. Previous research has shown sex-differences in stage II HCM with more diastolic dysfunction in female than in male patients. Moreover, female patients more often show progression to heart failure. Here we investigated if differences in functional and structural properties of the heart may underlie sex-differences in disease progression from stage II to stage IV HCM. Cardiac tissue from stage II and IV patients was obtained during myectomy (n = 54) and heart transplantation (n = 10), respectively. Isometric force was measured in membrane-permeabilized cardiomyocytes to define active and passive myofilament force development. Titin isoform composition was assessed using gel electrophoresis, and the amount of fibrosis and capillary density were determined with histology. In accordance with disease stage-dependent adverse cardiac remodeling end-stage patients showed a thinner interventricular septal wall and larger left ventricular and atrial diameters compared to stage II patients. Cardiomyocyte contractile properties and fibrosis were comparable between stage II and IV, while capillary density was significantly lower in stage IV compared to stage II. Women showed more adverse cellular remodeling compared to men at stage II, evident from more compliant titin, more fibrosis and lower capillary density. However, the disease stage-dependent reduction in capillary density was largest in men. In conclusion, the more severe cellular remodeling in female compared to male stage II patients suggests a more advanced disease stage at the time of myectomy in women. Changes in cardiomyocyte contractile properties do not explain the progression of stage II to stage IV, while reduced capillary density may underlie disease progression to end-stage heart failure.
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Affiliation(s)
- Louise L. A. M. Nijenkamp
- Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- * E-mail:
| | - Ilse A. E. Bollen
- Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Hans W. M. Niessen
- Pathology and Cardiac Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Michelle Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Corrado Poggesi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Carolyn Y. Ho
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Diederik W. D. Kuster
- Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Jolanda van der Velden
- Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
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Adalsteinsdottir B, Burke M, Maron BJ, Danielsen R, Lopez B, Diez J, Jarolim P, Seidman J, Seidman CE, Ho CY, Gunnarsson GT. Hypertrophic cardiomyopathy in myosin-binding protein C ( MYBPC3) Icelandic founder mutation carriers. Open Heart 2020; 7:e001220. [PMID: 32341788 PMCID: PMC7174027 DOI: 10.1136/openhrt-2019-001220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 01/21/2023] Open
Abstract
Objective The myosin-binding protein C (MYBPC3) c.927-2A>G founder mutation accounts for >90% of sarcomeric hypertrophic cardiomyopathy (HCM) in Iceland. This cross-sectional observational study explored the penetrance and phenotypic burden among carriers of this single, prevalent founder mutation. Methods We studied 60 probands with HCM caused by MYBPC3 c.927-2A>G and 225 first-degree relatives. All participants underwent comprehensive clinical evaluation and relatives were genotyped. Results Genetic and clinical evaluation of relatives identified 49 genotype-positive (G+) relatives with left ventricular hypertrophy (G+/LVH+), 59 G+without LVH (G+/LVH-) and 117 genotype-negative relatives (unaffected). Compared with HCM probands, G+/LVH+ relatives were older at HCM diagnosis, had less LVH, a less prevalent diastolic dysfunction, fewer ECG abnormalities, lower serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I levels, and fewer symptoms. The penetrance of HCM was influenced by age and sex; specifically, LVH was present in 39% of G+males but only 9% of G+females under age 40 years (p=0.015), versus 86% and 83%, respectively, after age 60 (p=0.89). G+/LVH- subjects had normal wall thicknesses, diastolic function and NT-proBNP levels, but subtle changes in LV geometry and more ECG abnormalities than their unaffected relatives. Conclusions Phenotypic expression of the Icelandic MYBPC3 founder mutation varies by age, sex and proband status. Men are more likely to have LVH at a younger age, and disease manifestations were more prominent in probands than in relatives identified via family screening. G+/LVH- individuals had subtle clinical differences from unaffected relatives well into adulthood, indicating subclinical phenotypic expression of the pathogenic mutation.
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Affiliation(s)
- Berglind Adalsteinsdottir
- Department of Medicine, University of Iceland, Reykjavik, Iceland.,Division of Cardiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Michael Burke
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA.,Cardiology Division, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ragnar Danielsen
- Division of Cardiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Begoña Lopez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Navarra, Spain.,Carlos III Health Institute, Madrid, Spain
| | - Javier Diez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Navarra, Spain.,Carlos III Health Institute, Madrid, Spain
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Howard Hughes Medical Institute, Boston, Massachusetts, USA
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gunnar Th Gunnarsson
- Department of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Akureyri Hospital, Akureyri, Iceland
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Marstrand P, Han L, Day SM, Olivotto I, Ashley EA, Michels M, Pereira AC, Wittekind SG, Helms A, Saberi S, Jacoby D, Ware JS, Colan SD, Semsarian C, Ingles J, Lakdawala NK, Ho CY. Hypertrophic Cardiomyopathy With Left Ventricular Systolic Dysfunction: Insights From the SHaRe Registry. Circulation 2020; 141:1371-1383. [PMID: 32228044 PMCID: PMC7182243 DOI: 10.1161/circulationaha.119.044366] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. The term “end stage” has been used to describe hypertrophic cardiomyopathy (HCM) with left ventricular systolic dysfunction (LVSD), defined as occurring when left ventricular ejection fraction is <50%. The prognosis of HCM-LVSD has reportedly been poor, but because of its relative rarity, the natural history remains incompletely characterized.
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Affiliation(s)
- Peter Marstrand
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.M., N.K.L., C.Y.H.).,Department of Cardiology, Herlev-Gentofte Hospital, University Hospital of Copenhagen, Denmark (P.M.)
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (L.H.)
| | - Sharlene M Day
- Department of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (A.C.P.)
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, OH (S.G.W.)
| | - Adam Helms
- Department of Internal Medicine, University of Michigan, Ann Arbor (A.H., S.S.)
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor (A.H., S.S.)
| | | | - James S Ware
- National Heart and Lung Institute and Royal Brompton Cardiovascular Research Centre, Imperial College London, United Kingdom (J.S.W.)
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, MA (S.D.C.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S., J.I.)
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S., J.I.)
| | - Neal K Lakdawala
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.M., N.K.L., C.Y.H.)
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.M., N.K.L., C.Y.H.)
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Toepfer CN, Garfinkel AC, Venturini G, Wakimoto H, Repetti G, Alamo L, Sharma A, Agarwal R, Ewoldt JF, Cloonan P, Letendre J, Lun M, Olivotto I, Colan S, Ashley E, Jacoby D, Michels M, Redwood CS, Watkins HC, Day SM, Staples JF, Padrón R, Chopra A, Ho CY, Chen CS, Pereira AC, Seidman JG, Seidman CE. Myosin Sequestration Regulates Sarcomere Function, Cardiomyocyte Energetics, and Metabolism, Informing the Pathogenesis of Hypertrophic Cardiomyopathy. Circulation 2020; 141:828-842. [PMID: 31983222 PMCID: PMC7077965 DOI: 10.1161/circulationaha.119.042339] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is caused by pathogenic variants in sarcomere protein genes that evoke hypercontractility, poor relaxation, and increased energy consumption by the heart and increased patient risks for arrhythmias and heart failure. Recent studies show that pathogenic missense variants in myosin, the molecular motor of the sarcomere, are clustered in residues that participate in dynamic conformational states of sarcomere proteins. We hypothesized that these conformations are essential to adapt contractile output for energy conservation and that pathophysiology of HCM results from destabilization of these conformations. METHODS We assayed myosin ATP binding to define the proportion of myosins in the super relaxed state (SRX) conformation or the disordered relaxed state (DRX) conformation in healthy rodent and human hearts, at baseline and in response to reduced hemodynamic demands of hibernation or pathogenic HCM variants. To determine the relationships between myosin conformations, sarcomere function, and cell biology, we assessed contractility, relaxation, and cardiomyocyte morphology and metabolism, with and without an allosteric modulator of myosin ATPase activity. We then tested whether the positions of myosin variants of unknown clinical significance that were identified in patients with HCM, predicted functional consequences and associations with heart failure and arrhythmias. RESULTS Myosins undergo physiological shifts between the SRX conformation that maximizes energy conservation and the DRX conformation that enables cross-bridge formation with greater ATP consumption. Systemic hemodynamic requirements, pharmacological modulators of myosin, and pathogenic myosin missense mutations influenced the proportions of these conformations. Hibernation increased the proportion of myosins in the SRX conformation, whereas pathogenic variants destabilized these and increased the proportion of myosins in the DRX conformation, which enhanced cardiomyocyte contractility, but impaired relaxation and evoked hypertrophic remodeling with increased energetic stress. Using structural locations to stratify variants of unknown clinical significance, we showed that the variants that destabilized myosin conformations were associated with higher rates of heart failure and arrhythmias in patients with HCM. CONCLUSIONS Myosin conformations establish work-energy equipoise that is essential for life-long cellular homeostasis and heart function. Destabilization of myosin energy-conserving states promotes contractile abnormalities, morphological and metabolic remodeling, and adverse clinical outcomes in patients with HCM. Therapeutic restabilization corrects cellular contractile and metabolic phenotypes and may limit these adverse clinical outcomes in patients with HCM.
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Affiliation(s)
- Christopher N. Toepfer
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
- Cardiovascular Medicine, Radcliffe Department of Medicine (C.N.T., C.S.R., H.C.W.), University of Oxford, UK
- Wellcome Centre for Human Genetics (C.N.T., H.C.W.), University of Oxford, UK
| | - Amanda C. Garfinkel
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
| | - Gabriela Venturini
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor)-University of São Paulo Medical School, Brazil (G.V., A.C.P.)
| | - Hiroko Wakimoto
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
| | - Giuliana Repetti
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
| | - Lorenzo Alamo
- Centro de Biología Estructural, Instituto Venezolano de Investigaciones Cientifìcas (IVIC), Caracas (L.A., R.P.)
| | - Arun Sharma
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
| | - Radhika Agarwal
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
| | - Jourdan F. Ewoldt
- Department of Biomedical Engineering, Boston University, MA (J.F.E., P.C., J.L., A.C., C.S.C.)
| | - Paige Cloonan
- Department of Biomedical Engineering, Boston University, MA (J.F.E., P.C., J.L., A.C., C.S.C.)
| | - Justin Letendre
- Department of Biomedical Engineering, Boston University, MA (J.F.E., P.C., J.L., A.C., C.S.C.)
| | - Mingyue Lun
- Department of Medicine, Division of Genetics (M.L.), Brigham and Women’s Hospital, Boston, MA
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (I.O.)
| | - Steve Colan
- Department of Cardiology, Boston Children’s Hospital, MA (S.C.)
| | - Euan Ashley
- Center for Inherited Cardiovascular Disease, Stanford University, CA (E.A.)
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Diseases, Yale School of Medicine, New Haven, CT (D.J.)
| | - Michelle Michels
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands (M.M.)
| | - Charles S. Redwood
- Cardiovascular Medicine, Radcliffe Department of Medicine (C.N.T., C.S.R., H.C.W.), University of Oxford, UK
| | - Hugh C. Watkins
- Cardiovascular Medicine, Radcliffe Department of Medicine (C.N.T., C.S.R., H.C.W.), University of Oxford, UK
- Wellcome Centre for Human Genetics (C.N.T., H.C.W.), University of Oxford, UK
| | - Sharlene M. Day
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D.)
| | - James F. Staples
- Department of Biology, University of Western Ontario, London, Canada (J.F.S.)
| | - Raúl Padrón
- Centro de Biología Estructural, Instituto Venezolano de Investigaciones Cientifìcas (IVIC), Caracas (L.A., R.P.)
- Division of Cell Biology and Imaging, Department of Radiology, University of Massachusetts Medical School, Worcester (R.P.)
| | - Anant Chopra
- Department of Biomedical Engineering, Boston University, MA (J.F.E., P.C., J.L., A.C., C.S.C.)
| | - Carolyn Y. Ho
- Cardiovascular Division (C.Y.H., C.E.S.), Brigham and Women’s Hospital, Boston, MA
| | - Christopher S. Chen
- Department of Biomedical Engineering, Boston University, MA (J.F.E., P.C., J.L., A.C., C.S.C.)
| | - Alexandre C. Pereira
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor)-University of São Paulo Medical School, Brazil (G.V., A.C.P.)
| | - Jonathan G. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA (C.N.T., A.C.G., G.V., H.W., G.R., A.S., R.A., A.C.P., J.G.S., C.E.S.)
- Cardiovascular Division (C.Y.H., C.E.S.), Brigham and Women’s Hospital, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
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Ho CY, Day SM, Ashley EA, Michels M, Pereira AC, Jacoby D, Lakdawala NK, Ware JS, Helms AS, Colan SD, Seidman CE, Olivotto I. Response by Ho et al to Letter Regarding Article, "Genotype and Lifetime Burden of Disease in Hypertrophic Cardiomyopathy: Insights From the Sarcomeric Human Cardiomyopathy Registry (SHaRe)". Circulation 2019; 139:1559-1560. [PMID: 30883221 DOI: 10.1161/circulationaha.118.039069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.Y.H., N.K.L., C.E.S.)
| | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D., A.S.H.)
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, The Netherlands (M.M.)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | | | - Neal K Lakdawala
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.Y.H., N.K.L., C.E.S.)
| | - James S Ware
- National Heart & Lung Institute & NIHR Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, England (J.S.W.)
| | - Adam S Helms
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D., A.S.H.)
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, MA (S.D.C.)
| | - Christine E Seidman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.Y.H., N.K.L., C.E.S.).,Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (I.O.)
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