Syncope in hypertrophic cardiomyopathy (part I): An updated systematic review and meta-analysis

Mascia, Giuseppe; Crotti, Lia; Groppelli, Antonella; Canepa, M; Merlo, Andrea Carlo; Benenati, Stefano; Paolo, Di Donna; Roberta, Della Bona; Soranna, Davide; Antonella, Zambon; Porto, Italo; Olivotto, Iacopo; Parati, Gianfranco; Brignole, Michele; Cecchi, Francesca

doi:10.1016/j.ijcard.2022.03.028

Cited by 25 publications

(21 citation statements)

References 80 publications

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“…In patients with left ventricular hypertrophy, the careful assessment of symptoms and medical history is mandatory to assess the pre-test probability of CA, before costly diagnostic procedures with limited availability such as cardiac magnetic resonance imaging and bone scintigraphy are initiated. Although carpal tunnel syndrome, lumbar stenosis or biceps tendon rupture are typical features of CA, syncope may point towards hypertrophic cardiomyopathy as an underlying condition [ 26 , 27 , 28 ]. In experienced hands, speckle-tracking echocardiography can offer additional diagnostic benefit, and typical features (an apical sparing pattern or radial basoapical gradient, and a high EF global longitudinal strain ratio) yielded high diagnostic accuracy for the presence of CA [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

et al. 2022

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We aimed to ascertain the real-world diagnostic accuracy of bone scintigraphy in combination with free light chain (FLC) assessment for transthyretin (ATTR) cardiac amyloidosis (CA) using the histopathological diagnosis derived from endomyocardial biopsy (EMB) as a reference standard. We retrospectively analyzed 102 patients (22% women) with suspected CA from seven Austrian amyloidosis referral centers. The inclusion criteria comprised the available results of bone scintigraphy, FLC assessment, and EMB with histopathological analysis. ATTR and AL were diagnosed in 60 and 21 patients (59%, 21%), respectively, and concomitant AL and ATTR was identified in one patient. The specificity and positive predictive value (PPV) of Perugini score ≥ 2 for ATTR CA were 95% and 96%. AL was diagnosed in three out of 31 patients (10%) who had evidence of monoclonal proteins and a Perugini score ≥ 2. When excluding all patients with detectable monoclonal proteins (n = 62) from analyses, the PPV of Perugini score ≥ 2 for ATTR CA was 100% and the NPV of Perugini score < 2 for ATTR CA was 79%. Conclusively, ATTR CA can be diagnosed non-invasively in the case of a Perugini score ≥ 2 and an unremarkable FLC assessment. However, tissue biopsy is mandatory in suspected CA in any other constellation of non-invasive diagnostic work-up.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

et al. 2022

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“…Our present study is limited by its observational design, the size of the patient population and the single-center design. Our study population is comprised of structural heart disease patients, however, we did not discriminate between those with higher risk of SCD, such as patients with hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy ( 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in one-year recurrence and all-cause mortality following catheter ablation of ventricular tachycardia in structural heart disease

Komlósi²,

Vámosi³

et al. 2022

Front. Cardiovasc. Med.

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AimsWe aimed to establish sex-specific predictors for 1-year VT recurrence and 1-year all-cause mortality in patients with structural heart disease undergoing catheter ablation.MethodsWe analyzed data of 299 patients recorded in our structured registry. These included medical history, echocardiography parameters, laboratory results, VT properties, procedural data.ResultsOut of the 299 patients, 34 (11%) were female. No significant difference was found between women and men in terms of VT recurrence (p = 0.74) or mortality (p = 0.07). In females, severe mitral regurgitation (MR), tricuspid regurgitation (TR), presentation with incessant VT, and preprocedural electrical storm (ES) were associated with increased risk of VT recurrence. Diabetes, implanted CRT, VT with hemodynamic instability, ES and advanced MR were the risk factors of mortality in women. ACEi/ARB use predicted a favorable outcome in both endpoints among females. In men, independent predictors of VT recurrence were the composite parameter of ES and multiple ICD therapies, presentation with incessant VT, severe MR, while independent predictors of mortality were age, LVEF, creatinine and previously implanted CRT.ConclusionAccording to our investigation, there are pronounced sex differences in predictors of recurrence and mortality following VT ablation.

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“…The common symptoms of patients with HCM are chest pain, dyspnea, palpitations, and syncope (19)(20)(21), and these symptoms overlap with those in patients with CAD. The symptoms of patients with ApHCM, a specific type of HCM, are similar to those of HCM and need to be differentiated from CAD.…”

Section: Discussionmentioning

confidence: 99%

Twenty-four hour variability of inverted T-waves in patients with apical hypertrophic cardiomyopathy

Yang

Tao

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with apical hypertrophic cardiomyopathy (ApHCM) have marked inverted T-waves that vary over several years. Inverted T-waves in ApHCM are unstable, but it is unclear whether this change is due to coronary artery disease (CAD) or if it is a characteristic of ApHCM itself. We aimed to study the characteristics of inverted T-waves in patients with ApHCM over the course of 24 h to improve the diagnostic indices of ApHCM.MethodsWe examined 83 patients with ApHCM and 89 patients with CAD (who served as the control group). All patients underwent a 24-h dynamic electrocardiogram (ECG). We analyzed the average depth of inverted T-waves per minute and sorted them from shallow to deep; the sorted ECG segments at the 10th, 50th, and 90th positions of the T-wave were subsequently analyzed.ResultsThe amplitudes of inverted T-waves in ApHCM corresponding to the 10th, 50th, and 90th percentiles were −5.13 ± 4.11, −8.10 ± 4.55, and −10.9 ± 5.04 mm, respectively. Changes in the degree of inverted T-waves were greater in ApHCM than in CAD. T-wave amplitudes in ApHCM were strongly associated with heart rate and circadian rhythm and only weakly associated with CAD and posture. Maximum T-wave amplitudes in the CAD group were <10 mm, while 68% of patients with ApHCM had maximum T-wave amplitudes >10 mm, and all patients with ApHCM aged <50 years had maximum T-wave amplitudes >10 mm.ConclusionNotable variations in the T-waves of patients with ApHCM were observed over 24 h. ECG examinations during states of inactivity (comparable to sleep) improved the sensitivity of the diagnosis of ApHCM. Inverted T-wave amplitudes correlated with heart rate and circadian rhythm, where T-wave changes in ApHCM may be due to the normalization of abnormal T-waves effect. Identifying T-wave amplitudes >10 mm can effectively improve the diagnostic rate of ApHCM, especially in patients aged <50 years. The short-term change in T-waves in patients with ApHCM could serve as a novel index that will help in the diagnosis of ApHCM.

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Syncope in hypertrophic cardiomyopathy (part I): An updated systematic review and meta-analysis

Cited by 25 publications

References 80 publications

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

Sex differences in one-year recurrence and all-cause mortality following catheter ablation of ventricular tachycardia in structural heart disease

Twenty-four hour variability of inverted T-waves in patients with apical hypertrophic cardiomyopathy

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