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ACC/ESC Recommendations for the Clinical Management of Hypertrophic Cardiomyopathy: A Practical Perspective

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Emerging Pathologies in Cardiology

Abstract

In November 2003 the American College of Cardiology (ACC) and the European Society of Cardiology (ESC) published in the Journal of the American College of Cardiology an expert consensus document on hypertrophic cardiomyopathy (HCM) to inform practitioners about the state of the art in managing this particular disease [1]. HCM is a genetic disease which can cause sudden cardiac death (SCD), particularly in young people (including athletes). As HCM is uncommon (1:500 in the general population) [2], many cardiologists do not see many patients with this disease, and may therefore have some difficulty in managing the cases of the patients they do see.

This document has been written by specialists with extensive experience of managing HCM. However, the statements and treatment strategies put forward by the panel are very cautious owing to the considerable difficulties involved in reaching conclusions: (1) because the disease is uncommon, the available data are relatively limited; (2) HCM has a broad disease spectrum, so individual patients may have very different risk profiles; (3) large-scale controlled and randomised study designs (as in coronary artery disease) are not available. Consequently most information derives from non-randomised and retrospective studies.

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References

  1. Maron BJ, McKenna WJ, Danielson GK et al (2003) ACC/ESC clinical expert consensus document on hypertrophic cardiomyopathy: a report of the American College of Cardiology Task Force on Clinical Experts Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol 42:687–713

    Article  Google Scholar 

  2. Maron BJ, Gardin JM, Flack JM et al (1995) Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Circulation 92:785–789

    PubMed  CAS  Google Scholar 

  3. Maron BJ, Moller JH, Seidman CE et al (1998) Impact of laboratory molecular diagnosis on contemporary diagnostic criteria for genetically transmitted cardiovascular diseases: hypertrophic cardiomyopathy, long-QT syndrome, and Marfan syndrome. Circulation 98:1460–1471

    CAS  Google Scholar 

  4. Seidman JG, Sidmn CE (2001) The genetic basis for cardiomyopathy: from mutation identification to mechanistic paradigms. Cell 104:557–567

    Article  PubMed  CAS  Google Scholar 

  5. Lechin M, Quinones MA, Omran A et al (1995) Angiotensin-I converting enzyme genotypes and left ventricular hypertrophy in patients with hypertrophic cardiomyopathy. Circulation 92:1808–1812

    PubMed  CAS  Google Scholar 

  6. Gruver EJ, Fatkin D, Dodds GA et al (1999) Familial hypertrophic cardiomyopathy and atrial fibrillation caused by Arg663His betacardiac myosin heavy chain mutation. Am J Cardiol; 83: H13–H18

    Article  Google Scholar 

  7. Arad M, Benson DW, Peez-Atayde AR et al (2002) Constitutively active AMP kinase mutations cause glycogen storage disease mimicking hypertrophic cardiomyopathy. J Clin Invest 109:357–362

    Article  PubMed  CAS  Google Scholar 

  8. Spirito P, Maron BJ (1987) Absence of progression of left ventricular hypertrophy in adults patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 9:1013–1017

    PubMed  CAS  Google Scholar 

  9. Maron BJ, Spirito P, Wesley Y et al (1986) Development and progression of left ventricular hypertrophy in children with hypertrophic cardiomyopathy. N Engl J Med 315:610–614

    Article  PubMed  CAS  Google Scholar 

  10. Niimura H, Bachinski, Sangwatanaroj S et al (1998) Mutations in the gene for cardiac myosin-binding protein C and late-onset familial hypertrophic cardiomyopathy. N Engl J Med 338:248–257

    Article  Google Scholar 

  11. Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320

    Article  PubMed  Google Scholar 

  12. Maron BJ, Casey SA, Hauser RG et al (2003) Clinical course of hypertrophic cardiomyopathy with survival to advanced age. J Am Coll Cardiol 42:882–888

    Article  PubMed  Google Scholar 

  13. McKenna W, Deanfield J, Faruqui A et al (1981) Prognosis in hypertrophic cardiomyopathy: role of age and clinical, electrocardiographic and hemodynamic features. Am J Cardiol 47:532–538

    Article  PubMed  CAS  Google Scholar 

  14. Krikler DM, Davis MJ, Rowland E et al (1980) Sudden death in hypertrophic cardiomyopathy: associated accessory pathways. Br Heart J 43:245–251

    PubMed  CAS  Google Scholar 

  15. Spirito P, Seidman CE, McKenna WJ et al (1997) The management of hypertrophic cardiomyopathy. N Engl J Med 336:775–785

    Article  PubMed  CAS  Google Scholar 

  16. Maki S, Ikeda H, Muro A et al (1998) Predictors of sudden cardiac death in hypertrophic cardiomyopathy. Am J Cardiol 82:774–778

    Article  PubMed  CAS  Google Scholar 

  17. Elliott PM, Poloniecki J, Dickie S et al (2000) Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 36:2212–2218

    Article  PubMed  CAS  Google Scholar 

  18. Maron BJ, Shirani J, Poliac LC et al (1996) Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 276:199–204

    Article  PubMed  CAS  Google Scholar 

  19. Maron BJ, Olivotto I, Spirito P et al (2000) Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation 102:858–864

    PubMed  CAS  Google Scholar 

  20. Priori S, Aliot E, Bolmstrom-Lundquist C et al (2001) Task force on sudden cardiac death of the European Society of Cardiology. Eur Heart J 22:1374–1450

    Article  PubMed  CAS  Google Scholar 

  21. Spirito P, Bellone P, Harris KM et al (2000) Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med 342:1778–1785

    Article  PubMed  CAS  Google Scholar 

  22. Elliott PM, Gimeno B Jr, Mahon NG et al (2001) Relation between severity of left ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy. Lancet 357:420–424

    Article  PubMed  CAS  Google Scholar 

  23. Adabag AS, Casey SA, Maron BJ (2002) Sudden death in hypertrophic cardiomyopathy: patterns and prognostic significance of tachyarrhythmias on ambulatory Holter ECG. Circulation 106:710

    Google Scholar 

  24. Monserrat L, Elliott PM, Gimeno JR et al (2003) Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden risk in young patients. J Am Coll Cardiol 42:873–879

    Article  PubMed  Google Scholar 

  25. Cecchi F, Olivotto I, Montereggi A et al (1995) Hypertrophic cardiomyopathy in Tuscany: clinical course and outcome in an unselected regional population. J Am Coll Cardiol 26:1529–1536

    Article  PubMed  CAS  Google Scholar 

  26. Olivotto I, Cecchi F, Case SA et al (2001) Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation 104:2517–2524

    PubMed  CAS  Google Scholar 

  27. Stafford WJ, Trohman RG, Bilskr M et al (1996) Cardiac arrest in adolescent with atrial fibrillation and hypertrophic cardiomyopathy. J Am Coll Cardiol 7:701–704

    Article  Google Scholar 

  28. Davies MJ, McKenna WJ (1995) Hypertrophic cardiomyopathy, pathology and pathogenesis. Histopathology 26:493–500

    PubMed  CAS  Google Scholar 

  29. Choudhoury L, Marholdt H, Wagner A et al (2002) Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 40:2156–2164

    Article  Google Scholar 

  30. Yetman AT, McCrindle BW, MacDonald C et al (1998) Myocardial bridging in children with hypertrophic cardiomyopathy — a risk factor for sudden death. N Engl J Med 339:1201–1209

    Article  PubMed  CAS  Google Scholar 

  31. Maron MS, Olivotto I, Betocchi S et al (2003) Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 348:295–303

    Article  PubMed  Google Scholar 

  32. Ackerman MJ, VanDriest SL, Ommen SR et al (2002) Prevalence and age-dependence of malignant mutations in the beta-myosin heavy chain and troponin T genes in hypertrophic cardiomyopathy: a comprehensive outpatient perspective. J Am Coll Cardiol 39:2042–2048

    Article  PubMed  CAS  Google Scholar 

  33. Fananapazir L, Chang AC, Epstein SE (1992) Prognostic determinants in hypertrophic cardiomyopathy. Perspective evaluation of a therapeutic strategy based on clinical, Holter, hemodynamic, and electrophysiologic findings. Circulation 86:730–740

    PubMed  CAS  Google Scholar 

  34. Wigle E, Rakowski H, Kimball BP et al (1995) Hypertrophic cardiomyopathy. Clinical spectrum and treatment. Circulation 92:1680–1692

    PubMed  CAS  Google Scholar 

  35. Sherid MV, Pearle G, Gunsburg DZ (1998) Mechanism of benefit of negative inotropes in obstructive hypertrophic cardiomyopathy. Circulation 97:41–47

    Google Scholar 

  36. McKenna WJ, Oakley CM, Krikler DM et al (1985) Improved survival with amiodarone in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Br Heart J 53:412–416

    PubMed  CAS  Google Scholar 

  37. Cecchi F, Olivotto I, Montereggi et al (1998) Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population. Heart 79:331–336

    PubMed  CAS  Google Scholar 

  38. Maron BJ, Merrill WH, Freier PA et al (1978) Long-term clinical course and asymptomatic status of patients after operation for hypertrophic subaortic stenosis. Circulation 57:1205–1213

    PubMed  CAS  Google Scholar 

  39. Merrill WH, Friesinger GC, Graham TP J et al (2000) Long-lasting improvement after septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 69:1732–1735

    Article  PubMed  CAS  Google Scholar 

  40. Theodoro DA, Danielson GK, Feldt RH et al (1996) Hypertrophic obstructive cardiomyopathy in pediatric patients: results of surgical treatment. J Thorac Cardiovasc Surg 112:1589–1597

    Article  PubMed  CAS  Google Scholar 

  41. Quin JX, Shiota T, Lever HM et al (2001) Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery. J Am Coll Cardiol 38:1994–2000

    Article  Google Scholar 

  42. Maron BJ, Nishimura RA, McKenna WJ et al (1999) Assessment of permanent dualchamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, cross-over study (M-PATHY). Circulation 99:2927–2933

    PubMed  CAS  Google Scholar 

  43. Nishimura RA, Trusty JM, Hayes DL et al (1997) Dual-chamber pacing for hypertrophic cardiomyopathy: a randomized, double-blind, cross-over trial. J Am Coll Cardiol 29:435–441

    Article  PubMed  CAS  Google Scholar 

  44. Maron BJ, Shen W-K, Link MS et al (2000) Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cadiomyopathy. N Engl J Med 342:365–373

    Article  PubMed  CAS  Google Scholar 

  45. Gregoratos G, Abrams J, Epstein AE et al (2002) ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices. Circulation 106:2145–2161

    Article  PubMed  Google Scholar 

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© 2005 Springer-Verlag Italia

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Delise, P. et al. (2005). ACC/ESC Recommendations for the Clinical Management of Hypertrophic Cardiomyopathy: A Practical Perspective. In: Gulizia, M.M. (eds) Emerging Pathologies in Cardiology. Springer, Milano . https://doi.org/10.1007/88-470-0341-5_33

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  • DOI: https://doi.org/10.1007/88-470-0341-5_33

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0311-8

  • Online ISBN: 978-88-470-0341-5

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