Prevalence, characteristics, and natural history of apical phenotype in a large cohort of patients with hypertrophic cardiomyopathy

Rouskas, Pavlos; Zegkos, Thomas; Ntelios, Dimitrios; Gossios, Thomas D.; Parcharidou, Despοina; Papanastasiou, Christos A.; Karamitsos, Theodoros D; Vassilikos, Vassilios; Kouskouras, Kostantinos; Efthimiadis, Georgios K.

doi:10.1016/j.hjc.2023.02.004

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…At mid-term follow-up, we observed a progressive decline in LV mechanics in the ApHCM-Pure group, although a greater degree of impairment persisted in ApHCM-Mixed patients upon comparison. This adds to the characterization of ApHCM as a progressive cardiomyopathy, and, with the aforementioned discussion, suggests that ApHCM-Mixed represents a distinct subtype with more advanced ventricular dysfunction and concerns regarding observed all-cause mortality, which requires further investigation [ 7 , 8 , 11 , 12 , 13 ]. Previously identified risk factors for poor LV GLS in ApHCM include atrial fibrillation, mitral annular e’ velocity, and glomerular filtration rate, and RV hypertrophy for RV GLS [ 8 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…This phenotypic distinction is salient given the importance of the interventricular septum to bi-ventricular mechanical performance and efficiency [ 9 , 10 ]. Despite the clinical significance of ApHCM within the spectrum of cardiomyopathic disorders, there are limited data comparing ApHCM-Pure and ApHCM-Mixed [ 11 , 12 , 13 ]. A single study signaled that ApHCM-Mixed may be independently associated with a greater than 3-fold increased risk of cardiovascular morbidity, which was defined as hospitalization for syncope, congestive heart failure, nonfatal arrhythmia, stroke, or myocardial infarction [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Interventricular Septal Involvement Is Associated with More Impaired Ventricular Function and Mechanics in Apical Hypertrophic Cardiomyopathy

Mihos,

Elajami,

Misra

et al. 2024

JCDD

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Background: The interventricular septum has an important role in bi-ventricular performance. We hypothesized that septal involvement in apical hypertrophic cardiomyopathy (ApHCM-Mixed) adversely impacts ventricular structure and function when compared with isolated apical hypertrophy (ApHCM-Pure). Methods: A total of 72 patients (ApHCM-Mixed = 36, ApHCM-Pure = 36) with serial 2D and speckle-tracking echocardiographic analyses were identified. Ventricular function and mechanics were characterized by left (LV) and right (RV) ventricular global longitudinal strain (GLS), RV free wall strain, and LV myocardial work indices, and clinical events were adjudicated. Results: Clinical characteristics were similar between groups (mean age, 66 ± 15 years; 49% female; LV ejection fraction, 68 ± 11%). The ApHCM-Mixed group had larger LV mass indexes (141 ± 39 vs. 111 ± 30 g/m2, p < 0.001), worse LV (−9.6 ± 3.1 vs. −14.4 ± 3.4%, p < 0.001) and RV GLS (−14.3 ± 6.7 vs. −19.2 ± 5.2%, p = 0.001), impaired RV free wall strain (−18.5 ± 7.4 vs. −22.4 ± 6.3%, p = 0.02), and lower LV myocardial work indices including global work index (938 ± 306 vs. 1272 ± 339 mmHg%, p < 0.001), when compared with the ApHCM-Pure group. At a mean follow-up of 3.9 years, these differences all persisted. Five deaths were observed, all occurring in the ApHCM-Mixed group (14% vs. 0, p = 0.05), and with four being cardiac-related. This subgroup had a mean LV ejection fraction of 63%, LV GLS of −8.7%, an LV global work index of 875 mmHg%, and RV free wall strain of −15.9%, indicating significant subclinical bi-ventricular dysfunction. Conclusions: ApHCM-Mixed represents a distinct morphology in hypertrophic cardiomyopathy associated with more impaired ventricular function and mechanics when compared with ApHCM-Pure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interventricular Septal Involvement Is Associated with More Impaired Ventricular Function and Mechanics in Apical Hypertrophic Cardiomyopathy

Mihos,

Elajami,

Misra

et al. 2024

JCDD

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Relationship between obesity and hypertrophic or dilated cardiomyopathy: The role of sex

Antonopoulos,

Panagiotopoulos,

Terentes‐Printzios

et al. 2024

Clinical Obesity

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SummaryEvidence suggests an association between obesity and the risk for cardiomyopathy development; however, robust evidence is still lacking. In this study we sought to explore the relationship of obesity with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) and possible interactions with sex using large‐scale epidemiological real‐world data. We analysed data from the Nationwide Inpatient Sample of US hospitalisations for the years 2015–2019. There were a total of 46 934 admissions with diagnosis of HCM and 170 924 with DCM. There was a significant interaction between cardiomyopathies' diagnosis with sex and age subgroups; the rates of both DCM and HCM increased with age (p < .001 for both); DCM diagnosis was significantly higher in males compared with females (0.85% vs. 0.35%, p < .001). After adjustment for age, sex, race and presence of arterial hypertension there was a significant stepwise positive association between obesity and the population rates of both cardiomyopathy subtypes. For hospitalised patients with a body mass index (BMI) ≥30 kg/m2 there was an odds ratio (OR) of 1.68 (95% CI: 1.55–1.81, p < .001) for HCM and OR = 1.82 (95% CI: 1.79–1.84, p < .001) for DCM. More importantly, the positive relationship between a cardiomyopathy diagnosis (HCM or DCM) with increasing BMI was driven by the male sex (p < .001 for both) and it was non‐significant in females. The findings from this nationwide observational analysis support a sexual dimorphism in the relationship between obesity and HCM or DCM, which should be further investigated.

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A Case of New-Onset Atrial Tachyarrhythmias With Apical Hypertrophic Cardiomyopathy and Bronchiectasis in a Very Elderly Patient: A Therapeutic Dilemma

Kurisu,

Fujiwara

2024

Cureus

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Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease that is genetically transmitted as an autosomal dominant trait. Even apical HCM (ApHCM) induces atrial fibrillation (AF) based on underlying left ventricle (LV) diastolic dysfunction, where anticoagulation therapy is recommended. However, anticoagulation for AF in patients at high risk of bleeding is a double-edged sword. A 98-year-old woman living in a nursing home presented to our hospital with sudden-onset dyspnea and palpitation persisting for two hours. The patient had a history of apical HCM and bronchiectasis. An electrocardiogram showed a regular tachycardia with a heart rate of 130 bpm, suggesting atrial flutter with 2:1 atrioventricular conduction. Intravenous verapamil (5 mg) resulted in the conversion into AF, and subsequent cibenzoline (70 mg) failed to restore sinus rhythm. Given the impossibility of continuous anticoagulation, electrical cardioversion was planned. Electrical cardioversion was successful in converting AF into sinus rhythm. Given the very high risk of hemoptysis, anticoagulation was avoided. This case gives an insight into how to manage a practical therapeutic problem, which is the coexistence of AF and bronchiectasis. A variety of individual factors should be considered for clinical decision-making and management of patients with concomitant HCM and AF.

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Prevalence, characteristics, and natural history of apical phenotype in a large cohort of patients with hypertrophic cardiomyopathy

Cited by 3 publications

References 45 publications

Interventricular Septal Involvement Is Associated with More Impaired Ventricular Function and Mechanics in Apical Hypertrophic Cardiomyopathy

Interventricular Septal Involvement Is Associated with More Impaired Ventricular Function and Mechanics in Apical Hypertrophic Cardiomyopathy

Relationship between obesity and hypertrophic or dilated cardiomyopathy: The role of sex

A Case of New-Onset Atrial Tachyarrhythmias With Apical Hypertrophic Cardiomyopathy and Bronchiectasis in a Very Elderly Patient: A Therapeutic Dilemma

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