2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary

Gersh, Bernard J.; Maron, Barry J.; Bonow, Robert O.; Dearani, Joseph A.; Fifer, Michael A.; Link, Mark S.; Naidu, Srihari S.; Nishimura, Rick A.; Ommen, Steve R.; Rakowski, Harry; Seidman, Christine E.; Towbin, Jeffrey A.; Udelson, James E.; Yancy, Clyde W.

doi:10.1016/j.jacc.2011.10.825

Cited by 260 publications

(100 citation statements)

References 367 publications

(365 reference statements)

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“…This finding, albeit original, was not fully unexpected given that the QT e accounts for the myocardial repolarization as well as for the intra-LV electromechanical conduction (QRS segment), the latter also known to be significantly impaired in HCM patients [42,43,44]. Nonetheless, we should acknowledge our finding as a merely descriptive one given that although NSVT is a major risk factor for SCD in these patients, its positive predictive accuracy is modest [3,5]. Moreover, even though its incidence increases with aging, it is reasonable that the presence of NSVT in young patients might reflect a greater electrical instability due to myocyte disarray, myocardial ischemia, and autonomic imbalance [45].…”

Section: Discussionmentioning

confidence: 66%

“…The diagnosis of HCM was derived from a two-dimensional echocardiographic demonstration of a hypertrophied, nondilated LV in the absence of any other cardiac or systemic disease capable of producing a similar magnitude of wall thickening [3]. Left ventricular outflow tract obstruction was considered present when the peak instantaneous outflow gradient estimated by continuous-wave Doppler was ≥30 mm Hg under basal conditions [3]. …”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, sudden cardiac death (SCD) risk stratification was performed according the established risk factors [2,3]: (1) history of HCM-related SCD in at least one first-degree relative or other relative younger than 50 years of age, (2) massive left ventricular hypertrophy [maximum wall thickness (MWT) ≥30 mm], (3) at least one run of NSVT on 24-hour Holter ECG monitoring where NSVT was defined as three or more consecutive ventricular beats at a rate ≥120 beats/min, lasting <30 s, (4) unexplained syncope judged inconsistent with a neurocardiogenic origin, and (5) hypotensive blood pressure response to an exercise test. A global variable was then obtained by adding one point for each of the SCD risk factors (SCD risk factors burden, from 0 to 5) mentioned above.…”

Section: Methodsmentioning

confidence: 99%

“…Hypertrophic cardiomyopathy (HCM), the most common inherited heart disease, is characterized by a hypertrophied nondilated left ventricle (LV) with markedly different morphologic, functional, and clinical spectra [1,2,3]. Despite its broad phenotypic expression, ventricular arrhythmias still represent a great concern in the HCM clinical course [3,4,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Despite its broad phenotypic expression, ventricular arrhythmias still represent a great concern in the HCM clinical course [3,4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

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Spatial QT Dispersion Predicts Nonsustained Ventricular Tachycardia and Correlates with Confined Systodiastolic Dysfunction in Hypertrophic Cardiomyopathy

Magrì

Piccirillo²,

Ricotta

et al. 2015

Cardiology

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Objectives: An increased dispersion of myocardial repolarization represents one of the mechanisms underlying the arrhythmic risk in hypertrophic cardiomyopathy (HCM). We investigated spatial myocardial repolarization dispersion indices in HCM patients with nonsustained ventricular tachycardia (NSVT) and, contextually, their main clinical determinants. Methods: Fifty-two well-matched HCM outpatients were categorized into two groups according to the presence or the absence of NSVT at 24-hour Holter electrocardiogram (ECG) monitoring. Each patient underwent a clinical examination, including Doppler echocardiogram integrated with tissue Doppler imaging, cardiac magnetic resonance, and 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-T_end (QT_e), Q-T_peak, T_peak-T_end (T_pT_e), J-T_peak, and J-T_end. Results: The NSVT group showed only QT_e dispersion and T_pT_e dispersion values to be significantly higher than their counterparts. NSVT occurrence was independently predicted by late gadolinium enhancement presence (p = 0.021) and QT_e Bazett dispersion (p = 0.030), the latter strongly associated with the myocardial performance index (MPI) obtained at the basal segment of the interventricular septum (p = 0.0004). Conclusion: Our data support QT_e dispersion as an easy and noninvasive tool for identifying HCM patients with NSVT propensity. The strong relationship between QT_e dispersion and MPI allows us to hypothesize an intriguing link between electrical instability and confined myocardial areas of systodiastolic dysfunction.