Commentary on the enigma of small vessel disease in hypertrophic cardiomyopathy: is invasive assessment of microvascular resistance a novel independent predictor of prognosis?

Achim, Alexandru; Savaria, Badal U; Buja, L. M.

doi:10.1016/j.carpath.2022.107448

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Subendocardial ischaemia is an especially important cause of chronic angina and acute coronary syndrome without obstructive coronary artery in patients with HCM. Small vessel disease has been suggested to contribute to myocardial ischaemia and coronary microvascular dysfunction in the HCM population 43 . Mechanisms that are unique to HCM include (i) increased left ventricular wall thickness and (ii) increased left ventricular intracavitary pressures due to outflow or mid‐cavitary obstruction 44 .…”

Section: Discussionmentioning

confidence: 99%

“…Small vessel disease has been suggested to contribute to myocardial ischaemia and coronary microvascular dysfunction in the HCM population. 43 Mechanisms that are unique to HCM include (i) increased left ventricular wall thickness and (ii) increased left ventricular intracavitary pressures due to outflow or mid-cavitary obstruction. 44 Indeed, acute coronary syndrome without obstructive coronary artery is not an uncommon initial presentation (prevalence 9-14%) in patients with HCM.…”

Section: Potential Mechanismsmentioning

confidence: 99%

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Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

et al. 2023

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Aims Prior studies have suggested causal relationships between obesity and acute cardiovascular events. It has been also known that the risk of acute cardiovascular events is reduced by bariatric surgery. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy (HCM). In this context, we aimed to investigate whether bariatric surgery is associated with a reduced risk of cardiovascular‐related acute care use in patients with HCM. Methods and results In this population‐based study, the bariatric surgery group consisted of patients with HCM who underwent bariatric surgery from January 2004 to December 2014. The control group included those who have obesity and HCM and received non‐bariatric elective intra‐abdominal surgery during the same period. The outcome was cardiovascular‐related acute care use (i.e. emergency department (ED) visits or unplanned hospitalizations for cardiovascular disease) during a 1‐year post‐surgery period. We used the SPARCS database, a population‐based ED and inpatient database in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6‐month post‐surgery periods. We adjusted for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2 years before the index surgery, and the Elixhauser co‐morbidity measures. We also performed propensity score (PS)‐matching and inverse probability treatment weighting analyses using these variables. The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 in the control group. The risk was not significantly different in the 1–6 months post‐surgery period. By contrast, in the 7–12 months post‐surgery period, the risk of cardiovascular‐related acute care use was significantly lower in the bariatric surgery group (adjusted odds ratio 0.23; 95% CI 0.068–0.71; P = 0.01) compared with the control group. In the PS‐matched cohort, there were no significant differences in the baseline characteristics. The PS‐matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7–12 months post‐surgery period. The inverse probability treatment weighting analysis replicated the findings. Conclusions Bariatric surgery was associated with a lower risk of cardiovascular‐related acute care use in the 7–12 months post‐surgery period in this population‐based study.

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Section: Discussionmentioning

confidence: 99%

Section: Potential Mechanismsmentioning

confidence: 99%

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

et al. 2023

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“…Myocardial fibrosis (LGE) is progressive in some patients with HCM, with impaired energetics and perfusion abnormalities postulated as possible mechanistic drivers of the fibrotic process [72]. The typical perfusion abnormality in HCM is small vessel ischemia (coronary microvascular dysfunction), which in time leads to fibrosis, although some postulate that the remodelling of the microcirculation at the arteriolar and capillary levels might also occur secondary to the fibrosis [73,74]. Moreover, there is growing evidence for the activation of fibrotic pathways occurring early in the course of the disease before hypertrophic remodelling and microvascular dysfunction and ischemia occur [75].…”

Section: Lge As Risk Stratificationmentioning

confidence: 99%

Advances in Multi-Modality Imaging in Hypertrophic Cardiomyopathy

Goldie,

Lee,

Coats

et al. 2024

JCM

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Hypertrophic cardiomyopathy (HCM) is characterized by abnormal growth of the myocardium with myofilament disarray and myocardial hyper-contractility, leading to left ventricular hypertrophy and fibrosis. Where culprit genes are identified, they typically relate to cardiomyocyte sarcomere structure and function. Multi-modality imaging plays a crucial role in the diagnosis, monitoring, and risk stratification of HCM, as well as in screening those at risk. Following the recent publication of the first European Society of Cardiology (ESC) cardiomyopathy guidelines, we build on previous reviews and explore the roles of electrocardiography, echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging. We examine each modality’s strengths along with their limitations in turn, and discuss how they can be used in isolation, or in combination, to facilitate a personalized approach to patient care, as well as providing key information and robust safety and efficacy evidence within new areas of research.

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“…It should not be forgotten that treatment in HCM is not limited to septal reduction and that the prognosis and clinical course is also influenced by malignant arrhythmias and myocardial ischaemia (small vessel disease changes). 45 , 46 General treatment includes lifestyle modification (limit dehydration, decreased alcohol intake and decreased caffeine consumption. ), pharmacological (symptomatic and pathogenetic), electrophysiological ablation, invasive septal reduction therapy and implantable devices (dual chamber pacing, ICDs).…”

Section: ‘To Ablate or Operate’mentioning

confidence: 99%

Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

et al. 2023

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Percutaneous and surgical therapies for septal reduction for hypertrophic cardiomyopathy have been going head‐to‐head for the past 20 years with similar outcomes and mortality rates, although contemporary myectomy seems to materialize its superiority. However, on closer analysis, the external validity of studies advocating myectomy does not translate to all centres. The aim of this review was to examine the most recent data on septal reduction therapy and to attempt to phenotype the appropriate patient for each of the two treatments. The key to similar low mortality rates between ventricular septal myectomy and alcohol septal ablation appears to be proper patient selection performed in high volume clinical environments. Furthermore, we analyse the role of mavacampten (the recently approved cardiac myosin inhibitor) in replacing or complementing the two septal reduction therapies.

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Commentary on the enigma of small vessel disease in hypertrophic cardiomyopathy: is invasive assessment of microvascular resistance a novel independent predictor of prognosis?

Cited by 7 publications

References 21 publications

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

Effects of bariatric surgery on cardiovascular‐related acute care use in patients with hypertrophic cardiomyopathy

Advances in Multi-Modality Imaging in Hypertrophic Cardiomyopathy

Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

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