Diagnostic Usefulness of Carotid Pulse Tracing in Patients With Hypertrophic Obstructive Cardiomyopathy Due to Midventricular Obstruction

Hamada, Mareomi; Shigematsu, Yuji; Ohshima, Kiyotaka; Suzuki, Jun; Ogimoto, Akiyoshi; Ohtsuka, Tomoaki; Hara, Yuji

doi:10.1378/chest.124.4.1275

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…Thus, these results indicate that cibenzoline has a potent negative inotropic action. Systolic function estimated by fractional shortening is usually greater in patients with HCM than in normal control subjects [64]. In our experience, systolic function in patients with HCM treated with cibenzoline is close to that in normal control subjects at the chronic stage, but never decreases to a lower level than in controls.…”

Section: Systolic and Diastolic Functionssupporting

confidence: 64%

“…Two factors may be related to the decrease in LVPG. Usually, systolic function in HOCM is characterized by over-contraction [64], which is mainly due to a decrease in LV wall stress. Therefore, one factor for the reduction of LVPG may be a suppression of LV over-contraction by cibenzoline therapy, which results in decreased myocardial contractility.…”

Section: Tablementioning

confidence: 99%

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Advances in medical treatment of hypertrophic cardiomyopathy

Hamada

Ikeda

Shigematsu

2014

Journal of Cardiology

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We reviewed the natural history of patients with hypertrophic cardiomyopathy (HCM). The effect of medical treatments on natural history, left ventricular (LV) functions and LV remodeling was also evaluated. Sudden cardiac death and end-stage heart failure are the most serious complications of HCM. Age <30 years and a family history of sudden premature death are risk factors for sudden cardiac death in HCM patients. End-stage heart failure is not a specific additional phenomenon observed in patients with HCM, but is the natural course of the disease in most of those patients. After the occurrence of heart failure, the progression to cardiac death is very rapid. Young age at diagnosis, a family history of HCM, and greater wall thickness are associated with a greater likelihood of developing end-stage heart failure. Neither beta-blockers nor calcium antagonists can prevent this transition. The class Ia antiarrhythmic drugs, disopyramide and cibenzoline are useful for the reduction of LV pressure gradient. Unlike disopyramide, cibenzoline has little anticholinergic activity; therefore, this drug can be easily adapted to long-term use. In addition to the reduction in LV pressure gradient, cibenzoline can improve LV diastolic dysfunction, and induce regression of LV hypertrophy in patients with HCM. A decrease in intracellular Ca(2+) concentration through the activation of the Na(+)/Ca(2+) exchanger associated with cibenzoline therapy is likely to be closely related with the improvement in HCM-related disorders. It is possible that cibenzoline can prevent the progression from typical HCM to end-stage heart failure.

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Section: Systolic and Diastolic Functionssupporting

confidence: 64%

Section: Tablementioning

confidence: 99%

Advances in medical treatment of hypertrophic cardiomyopathy

Hamada

Ikeda

Shigematsu

2014

Journal of Cardiology

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“…Recently, however, we reported 2 specific patterns in the carotid pulse tracing of patients with MVO, 4 by which we could easily diagnose patients with MVO. In our experience, patients with MVO are not rare, and the incidence may be at least equal to that of IHSS.…”

Section: Patients With Mvo In the Clinical Setting And Selection Of Tmentioning

confidence: 99%

“…Very recently we reported that there are 2 specific patterns of carotid pulse tracing in these patients, 4 by which they may be diagnosed with ease. As to the treatment of patients with MVO, Hintringer et al reported the usefulness of permanent DDD pacing to alleviate LVPG and symptoms in an 85-year-old woman with MVO who did not respond to pharmacological therapy.…”

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confidence: 89%

Antiarrhythmic Drug Cibenzoline Attenuates Left Ventricular Pressure Gradient and Improves Transmitral Doppler Flow Pattern in Patients With Hypertrophic Obstructive Cardiomyopathy Caused by Midventricular Obstruction

Hamada

Shigematsu

Inaba

et al. 2005

Circ J

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here are 2 types of hypertrophic obstructive cardiomyopathy (HOCM): obstruction at the subaorta, called idiopathic hypertrophic subaortic stenosis (IHSS), 1 and obstruction at the mid left ventricle. 2 In contrast to the many studies of IHSS, only a few studies, other than case reports, have focused on midventricular obstruction (MVO). Two patients with MVO were reported for the first time in 1976 by Falicov et al, 2 one of whom suddenly died shortly after unsuccessful myectomy. Maron et al elucidated that the left ventricular pressure gradient (LVPG) was related to even prognosis in patients with hypertrophic cardiomyopathy (HCM). 3 Thus, attenuation of the LVPG has recently become an important strategy in the management of patients with HOCM.In the clinical setting, patients with MVO may often be overlooked. Very recently we reported that there are 2 specific patterns of carotid pulse tracing in these patients, 4 by which they may be diagnosed with ease. As to the treatment of patients with MVO, Hintringer et al reported the usefulness of permanent DDD pacing to alleviate LVPG and symptoms in an 85-year-old woman with MVO who did not respond to pharmacological therapy. 5 In patients with MVO, unlike those with IHSS, therapies involving myotomy or myectomy and alcohol septal ablation require great caution to prevent the induction or deterioration of mitral regurgitation. Both -blockers and calcium antagonists are often insufficient for attenuating LVPG. In 1982, Pollick reported the usefulness of the antiarrhythmic drug disopyramide in attenuating LVPG in IHSS. 6 Unfortunately sustained use of disopyramide is difficult owing to the thirst, dysuria and so on related to its strong anticholinergic action. We previously reported the usefulness of the antiarrhythmic drug, cibenzoline, the anticholinergic action of which is very weak, 7 to attenuate LVPG in IHSS. 8 In the present study, therefore, we examined the acute and chronic effect of cibenzoline on LVPG and left ventricular (LV) diastolic dysfunction in patients with MVO. Methods Study SubjectsTwenty-three patients with MVO participated in this study after giving written informed consent. Twenty healthy control subjects served as the comparison of the hemo-

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“…Left ventricular MVO was diagnosed when both of the following criteria were satisfied: (1) the peak instantaneous midventricular gradient was estimated to be ≥30 mmHg; and (2) midcavitary obliteration was caused by contact of marked septal hypertrophy with a hypercontractile left ventricular free wall, rather than by systolic anterior motion of the anterior leaflet of the mitral valve [9,15,24].…”

Section: Definitionsmentioning

confidence: 99%