Abstract
Hypertrophic cardiomyopathy (HC) patients with extreme thickness of the left ventricular (LV) walls belong to a subgroup with a progressive clinical course and very high risk of adverse outcomes, including sudden arrhythmic cardiac death and progressive heart failure. The question of whether implantation of cardioverter defibrillator and myectomy are effective approaches for prevention of sudden cardiac death and treatment of refractory heart failure in such patients is not completely resolved. Modern achievements in treatment of HC have proven to be quite effective in many patients in reaching favorable long-term outcomes. However, can we expect the same with massive left ventricular hypertrophy? The problem of extreme LV wall thickness in HC patients is discussed in this article.
References
- Bois J.P., Geske J., Ommen S., Pellikka P. Measure of maximal left ventricular wall thickness in hypertrophic cardiomyopathy differs when comparing magnetic resonance imaging and transthoracic echocardiography. J. Am. Coll. Cardiol. 2015; 65 (10, suppl.): А983. DOI: 10.1016/S0735-1097(15)60983-4
- Briasoulis A., Mallikethi-Reddy S., Palla M., Alesh I., Afonso L. Myocardial fibrosis on cardiac magnetic resonance and cardiac outcomes in hypertrophic cardiomyopathy: A meta-analysis. Heart. 2015; 101: 1406–11. DOI: 10.1136/heartjnl-2015-307682
- Rowin E.J., Maron B.J., Romashko M., Wang W., Rastegar H., Link M.S., Maron M.S. Impact of effective management strategies on patients with the most extreme phenotypic expression of hypertrophic cardiomyopathy. Am. J. Cardiol. 2019; 124 (1): 113–21. DOI: 10.1016/j.amjcard.2019.04.002
- Maron B.J. Clinical course and management of hypertrophic cardiomyopathy. N. Engl. J. Med. 2018; 379 (7): 655–68. DOI: 10.1056/nejmra1710575
- Maron B.J., Rowin E.J., Udelson J.E., Maron M.S. Clinical spectrum and management of heart failure in hypertrophic cardiomyopathy. JACC: Heart Fail. 2018; 6 (5): 353–63. DOI: 10.1016/j.jchf.2017.09.011
- Zarudskiy A.A., Kukharchuk A.E., Kretova A.A. The study of the phenomenon of obstruction of the outflow tract of the left ventricle in real clinical practice. Sovremennye Problemy Nauki i Obrazovaniya (Modern Problems of Science and Education). 2019; 2: 137 (in Russ.). DOI 10.17513/spno.28697
- Yang H., Carasso S., Woo A., Jamorski M., Nikonova A., Wigle E.D. et al. Hypertrophy pattern and regional myocardial mechanics are related in septal and apical hypertrophic cardiomyopathy. J. Am. Soc. Echocardiogr. 2010; 23: 1081–9. DOI: 10.1016/j.echo.2010.06.006
- Bois J.P., Geske J.B., Foley T.A., Ommen S.R., Pellikka P.A. Comparison of maximal wall thickness in hypertrophic cardiomyopathy differs between magnetic resonance imaging and transthoracic echocardiography. Am. J. Cardiol. 2017; 119: 643–50. DOI: 10.1016/j.amjcard. 2016.11.010
- Maron B.J., Haas T.S., Ahluwalia A., Murphy C.J., Garberich R.F. Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry. Am. J. Med. 2016; 129 (11): 1170–7. DOI: 10.1016/j.amjmed.2016.02.031
- Maron B.J., Piccininno M., Casey S.A., Bernabó P., Spirito P. Relation of extreme left ventricular hypertrophy to age in hypertrophic cardiomyopathy. Am. J. Cardiol. 2003; 91 (5): 626–8. DOI: 10.1016/s0002-9149 (02)03326-x
- Guo X., Fan C., Tian L., Liu Y., Wang H., Zhao S. et al. The clinical features, outcomes and genetic characteristics of hypertrophic cardiomyopathy patients with severe right ventricular hypertrophy. PLoS One. 2017; 12 (3): e0174118. DOI: 10.1371/journal.pone.0174118
- Hirapur I., Kolhari V.B., Agrawal N., Rajendran R. Significant biventricular obstruction in non-syndromic hypertrophic cardiomyopathy. BMJ Case Rep. 2014; 2014: bcr2014206271. DOI: 10.1136/bcr-2014-206271
- Frank S., Braunwald E. Idiopathic hypertrophic subaortic stenosis. Clinical analysis of 126 patients with emphasis on the natural history. Circulation. 1968; 37 (5): 759–88. DOI: 10.1161/01.cir.37.5.759
- Botti G., Tagliavini S., Bonatti V., Aurier E. Isolated hypertrophic obstructive cardiomyopathy of the right ventricle. G. Ital. Cardiol. 1979; 9 (2): 170–81.
- Kоber L., Thune J.J., Nielsen J.C., Haarbo J., Videbæ k L., Korup E. et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N. Engl. J. Med. 2016; 375: 1221–30. DOI: 10.1056/nejmoa1608029
- Rowin E., Romashko M., Maron B.J., Rastegar H., Maron M. Massive lv hypertrophy in hypertrophic cardiomyopathy is a high-risk subgroup, but is associated with favorable outcome with contemporary treatments. J. Am. Coll. Cardiol. 2018; 71 (11, Suppl.): А665. DOI: 10.1016/S0735-1097(18)31206-3
- Кардиология: национальное руководство / под ред. Е.В. Шляхто. 2-е изд., перераб. и доп. М.: ГЭОТАРМедиа; 2019. http://www.rosmedlib.ru/book/ISBN 9785970448106.html [Cardiology: national leadership / ed. E.V. Shlyakhto. Moscow: GEOTAR-Media; 2019 (in Russ.). Available at: http://www.rosmedlib.ru/book/ISBN 9785970448106.html
- Clinical recommendations of the Ministry of Health of the Russian Federation. Hypertrophic cardiomyopathy, 2016 (in Russ.). https://legalacts.ru/doc/klinicheskierekomendatsii-gipertroficheskaja-kardiomiopatija-utvminzdravom-rossii/
- Chang S.M., Lakkis N.M., Franklin J., Spencer W.H. III, Nagueh S.F. Predictors of outcome after alcohol septal ablation therapy in patients with hypertrophic obstructive cardiomyopathy. Circulation. 2004; 109 (7): 824–7. DOI: 10.1161/01.CIR.0000117089.99918.5A
- Faber L. Percutaneous septal ablation in hypertrophic obstructive cardiomyopathy: from experiment to standard of care. Adv. Med. 2014; 2014: 464851. DOI: 10.1155/2014/464851
- Rowin E.J., Maron B.J., Kiernan M.S., Casey S.A., Feldman D.S., Hryniewicz K.M. et al. Advanced heart failure with preserved systolic function in nonobstructive hypertrophic cardiomyopathy: under-recognized subset of candidates for heart transplant. Circ. Heart Fail. 2014; 7 (6): 967–75. DOI: 10.1161/CIRCHEARTFAILURE. 114.001435
- Topilsky Y., Pereira N.L., Shah D.K., Boilson B., Schirger J.A., Kushwaha S.S. et al. Left ventricular assist device therapy in patients with restrictive and hypertrophic cardiomyopathy. Circ. Heart Fail. 2011; 4 (3): 266–75. DOI: 10.1161/CIRCHEARTFAILURE. 110.959288
- Elliott P.M., Anastasakis A., Borger M.A., Borggrefe M., Cecchi F., Charron Ph. et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur. Heart J. 2014; 35 (39): 2733–79. DOI: 10.1093/eurheartj/ehu284
- Coutu M., Perrault L.P., White M., Pelletier G.B., Racine N., Poirier N.C. et al. Cardiac transplantation for hypertrophic cardiomyopathy: a valid therapeutic option. J. Heart Lung. Transplant. 2004; 23 (4): 413–7. DOI: 10.1016/S1053-2498(03)00225-0
- American Thoracic Society, American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am. J. Respir. Crit. Care Med. 2003; 167: 211–77. DOI: 10.1164/rccm.167.2.211
- Dass S., Cochlin L.E., Suttie J.J., Holloway C.J., Rider O.J., Carden L. et al. Exacerbation of cardiac energetic impairment during exercise in hypertrophic cardiomyopathy: a potential mechanism for diastolic dysfunction. Eur. Heart J. 2015; 36: 1547–54. DOI: 10.1093/eurheartj/ehv120
- Masri A., Pierson L.M., Smedira N.G., Agarwal S., Lytle B.W., Naji P. et al. Predictors of longterm outcomes in patients with hypertrophic cardiomyopathy undergoing cardiopulmonary stress testing and echocardiography. Am. Heart J. 2015; 169: 684–92. DOI: 10.1016/j.ahj.2015.02.006
- Coats C.J., Rantell K., Bartnik A., Patel A., Mist B., McKenna W.J., Elliott P.M. Cardiopulmonary exercise testing and prognosis in hypertrophic cardiomyopathy. Circ. Heart Fail. 2015; 8: 1022–31. DOI: 10.1161/CIRCHEARTFAILURE.114.002248
- Finocchiaro G., Haddad F., Knowles J.W., Caleshu C., Pavlovic A., Homburger J. et al. Cardiopulmonary responses and prognosis in hypertrophic cardiomyopathy: a potential role for comprehensive noninvasive hemodynamic assessment. JACC Heart Fail. 2015; 3: 408–18. DOI: 10.1016/j.jchf.2014.11.011
- Magrì D., Re F., Limongelli G., Agostoni P., Zachara E., Correale M. et al. Heart failure progression in hypertrophic cardiomyopathy: possible insights from cardiopulmonary exercise testing. Circ. J. 2016; 80: 2204–11. DOI: 10.1253/circj.CJ-16-0432 31. Magrì D., Limongelli G., Re F., Agostoni P., Zachara E., Correale M. et al. Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy. Heart. 2016; 102: 602–9. DOI: 10.1136/heartjnl2015-308453 32. Torres M.F., Herez-Villa F. Heart transplantation in patients with hypertrophic cardiomyopathy. Glob. Cardiol. Sci. Pract. 2018; 3: 32. DOI: 10.21542/gcsp.2018.32 33. Biagini E., Spirito P., Leone O., Picchio F.M., Coccolo F., Ragni L. et al. Heart transplantation in hypertrophic cardiomyopathy. Am. J. Cardiol. 2008; 101 (3): 387–92. DOI: 10.1016/j.amjcard.2007.09.085
- Huang X.S., Chen L.W., Pan Y.C., Lin F., Wang Q.M., Huang Z.Y. et al. Outcome post orthotopic heart transplantation for patients with end-stage hypertrophic cardiomyopathy. Zhonghua Xin Xue Guan Bing Za Zhi. 2011; 39 (2): 114–7.
- Lee M.S., Zimmer R., Kobashigawa J. Long-term outcomes of orthotopic heart transplantation for hypertrophic cardiomyopathy. Transplant. Proc. 2014; 46 (5): 1502–5. DOI: 10.1016/j.transproceed. 2013.12.052 36. Maron M.S., Finley J.J., Bos J.M., Hauser T.H., Manning W.J., Haas T.S. et al. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation. 2008; 118 (15): 1541–9. DOI: 10.1161/CIRCULATIONAHA. 108.781401
- Coutu M., Perrault L.P., White M., Pelletier G.B., Racine N., Poirier N.C. et al. Cardiac transplantation for hypertrophic cardiomyopathy: a valid therapeutic option. J. Heart Lung Transplant. 2004; 23 (4): 413–7. DOI: 10.1016/S1053-2498(03)00225-0
- Kato T.S., Takayama H., Yoshizawa S., Marboe C., Schulze P.C., Farr M. et al. Cardiac transplantation in patients with hypertrophic cardiomyopathy. Am. J. Cardiol. 2012; 110 (4): 568–74. DOI: 10.1016/j.amjcard.2012.04.030
- Pasqualucci D., Fornaro A., Castelli G., Rossi A., Arretini A., Chiriatti C. et al. Clinical spectrum, therapeutic options, and outcome of advanced heart failure in hypertrophic cardiomyopathy. Circ. Heart Fail. 2015; 8 (6): 1014–21. DOI: 10.1161/CIRCHEARTFAILURE. 114.001843
About the authors
- Leo A. Bockeria, Academician of RAS and RAMS, President, ORCID
- Marina I. Berseneva, Cand. Med. Sc., Head of Department, ORCID
- Alina A. Khugaeva, Junior Researcher, ORCID