Expression Of Hypertrophic Cardiomyopathy Research Articles

A Machine Learning Approach to Gene Expression in Hypertrophic Cardiomyopathy

Background/Objectives: Hypertrophic cardiomyopathy (HCM) is a common heart disorder characterized by the thickening of the heart muscle, particularly in the left ventricle, which increases the risk of cardiac complications. This study aims to analyze the expression of apoptosis-regulating genes (CASP8, CASP9, CASP3, BAX, and BCL2) in blood samples from HCM patients, to better understand their potential as biomarkers for disease progression. Methods: Quantitative real-time PCR (qPCR) was used to evaluate gene expression in blood samples from 93 HCM patients. The correlation between apoptosis-regulating genes was conducted and clinical parameters were integrated for feature importance and clustering analysis. Results: Most patients exhibited significant downregulation of CASP8, CASP9, and CASP3. In contrast, BAX expression was elevated in 71 out of 93 patients, while BCL2 was increased in 55 out of 93 patients. Correlation analysis revealed weak negative correlations between the BAX/BCL2 ratio and CASP gene expression. Conclusions: These findings suggest that reduced expression of apoptotic genes may indicate a protective cellular mechanism, which could serve as a biomarker for disease progression. Further studies are needed to investigate the potential for therapeutic modulation of these pathways to improve patient outcomes.

Abstract We011: The role of hsa-miR-9-5p in hypercontractility: insights from patients with hypertrophic cardiomyopathy

Background: Hypertrophic cardiomyopathy (HCM) is an inherited disease characterized by the thickening of the heart muscle. Mutations in contractile proteins, such as myosin binding protein C ( MYBPC3 ) and β-myosin heavy chain ( MYH7 ), account for over half of patients with familial HCM. HCM is the leading cause of sudden cardiac death among young adults and athletes, with these mutations potentially leading to hypercontractility and arrhythmias culminating in sudden cardiac death. MicroRNAs (miRNAs) are pivotal regulators of gene expression that may influence disease progression. Despite their potential significance, there is a scarcity of published data on miRNA expression in HCM. Induced pluripotent stem cells (iPSCs) have emerged as valuable tools for modeling various cardiovascular diseases, including HCM. However, the miRNA expression profiles associated with HCM remain largely unexplored within iPSC models. Investigating the differential expression of miRNAs in HCM patients offers a promising avenue to identify potential therapeutic targets for individuals affected by this condition. Methods: We performed an unbiased screen using a microarray (NanoString Technologies) that contained 798 miRNAs to identify differentially expressed miRNAs in induced pluripotent stem cell (iPSC)-CM and myocardial tissues derived from healthy donors and HCM patients with MYBPC3 and MYH7 mutations. Results: We identified 5 differentially expressed miRNAs that are significantly downregulated in both mutant MYBPC3 iPSC-CM and myocardial tissue (miR-9-5p, -4443, -367-3p, -302c-3p, and -129-2-3p) (p ≤ 0.05). In mutant MYH7 iPSC-CM and myocardial tissue, 3 miRNAs that were significantly downregulated (miR-9-5p, -151a-3p, -129-2-3p), and 1 was significantly upregulated (miR-331-5p) (p ≤ 0.05). KEGG pathway analysis of gene targets using miRTarBase and g:Profiler revealed that miR-9-5p regulates genes in the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor resistance pathway (p = 3.99x10 -9 ), which is involved in hypercontractility associated with HCM. Conclusion: This work represents the first description of miRNA expression patterns in iPSC-CMs derived from patients with HCM with additional validation from primary myocardial tissue, the current gold standard. We identified the miR-9-5p/EGFR tyrosine kinase inhibitor resistance axis as a potential therapeutic target responsible for mitigating the hypercontractile phenotype exhibited in HCM.

Sarcoplasmic reticulum (SR)-mitochondria tethering is lost in human heart failure

Sarcoplasmic reticulum (SR)-mitochondria (SR-mito) tethering facilitates communication between these organelles and regulates many physiological processes critical for cardiomyocyte function. Recent evidence suggests that alterations in SR-mito tethering impacts cardiac metabolism and calcium handling which contributes to cardiovascular pathologies, such as heart failure (HF). To characterize SR-mito apposition in cardiac disease we obtained electron microscopy (EM) images of individual cardiomyocytes freshly isolated from failing hearts explanted from ischemic (ICM), ischemic-dilated (ICM-DCM) and dilated cardiomyopathy (DCM) patients undergoing transplantation and nonfailing control hearts. Topographical EM analysis revealed a significant increase in the mean SR-Mito distance, as well as an increase in the minimum SR-mito distance (closest approximation of any single mitochondrion to SR) in ICM, ICM-DCM and DCM cardiomyocytes, compared to nonfailing controls. Results from the EM analysis also revealed that in DCM there was a decrease in mean mitochondrion perimeter in contact with the SR, as well as a decrease in SR in approximation with mitochondria at a distance <50-nm. In agreement, nonfailing hearts had a greater length of outer mitochondrial membrane in close contact (<20-nM) with the SR, as compared to failing cardiomyocytes. ICM and DCM cardiomyocytes displayed an overall reduction in mitochondrion perimeter and circularity, suggesting smaller and more fragmented mitochondria. Surprisingly, failing cardiomyocytes exhibited an overall increase in mitochondrial area compared to nonfailing controls. To define the molecular changes that may underlie loss of SR-mito tethering, we evaluated the expression of several proposed linkers. qPCR analysis of left ventricular samples revealed that mRNA expression of mitofusin 2 is significantly decreased in both hypertrophic cardiomyopathy (HCM) and DCM. Further, other proposed tethering components including FUNDC1, BAP31, DJ-1 and VAPB demonstrated decreased mRNA expression in HCM, DCM and ischemic HF samples, compared to nonfailing controls. IP3R1 displayed increased mRNA expression in HCM and DCM human HF samples, whereas IP3R2 and VDAC1 displayed increases in expression in HCM and ICM. These results highlight that transcriptional remodeling of the components mediating SR-mito tethering and communication may contribute to the observed structural changes in inter-organelle approximation in cardiomyocytes. These studies provide rationale for causal interrogation of the structural mechanisms regulating SR-mito communication in the context of HF progression. Fellowship in Biomedical Sciences, Lewis Katz School of Medicine. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

10 Pre-clinical studies of sotagliflozin in hypertrophic cardiomyopathy

OBJECTIVES/GOALS: Study the regulatory role of sodium glucose co-transporter 1 (SGLT1) in cardiomyocytes and the therapeutic potential of sotagliflozin in hypertrophic cardiomyopathy (HCM) by (a) quantifying SGLT1 expression in HCM and (b) examining the impact of sotagliflozin on cardiac mechanics. METHODS/STUDY POPULATION: * Use Western Blot in cardiac tissue from HCM and non-HCM patients and pre-existing RNA seq and proteomics datasets to quantify SGLT1 levels in HCM. Hypothesis: SGLT1 is upregulated in HCM * Determine how SGLT1/2 inhibition by sotagliflozin will affect cardiac mechanics using living myocardial slice (LMS) preparations. A vibratome creates 200um-thick slices from (a) failing HCM heart explants, (b) septal myectomy samples from HCM patients, and (c) nonfailing rejected donor hearts. LMS are mounted on a force transducer and work-loops are stimulated under varying pre- and after-loads. Collecting baseline and post-drug work loops allows each slice to function as its own control. Hypothesis: sotagliflozin will improve diastolic mechanics by reducing stiffness in the end-diastolic pressure-volume relationship RESULTS/ANTICIPATED RESULTS: * Preliminary results from RNA seq data indicate that SLC5A1 mRNA (encoding gene for SGLT1) is significantly decreased in HCM. No proteomics study examined thus far has detected SLC5A1, indicating that overall SGLT1 levels in cardiac tissue are quite low. We will examine SGLT1 levels in our own HCM and non-HCM tissue samples with both mass-spectrometry and Western Blot. * We analyze six slices from each heart and expect 15 donor hearts and 15 HCM hearts/myectomy samples. We visualize the work loop by plotting stress/strain. Stress/strain at mitral valve closure represents exponential end diastolic pressure-volume relationship; Stress/strain at aortic valve closure represents linear end systolic pressure volume relationship. A two-sample paired t-test will compare change in stiffness and elastance. DISCUSSION/SIGNIFICANCE: This project contributes to a growing body of research surrounding the currently unknown cardioprotective mechanism of SGLT 1/2 inhibitors, furthers the technique of using living myocardial slices to study cardiac mechanics, and supports a trial examining sotagliflozin in HCM, for which disease modifying therapy remains a prevailing unmet need.

Association of duration and intensity of exercise with phenotypic expression in hypertrophic cardiomyopathy

ObjectivesThere is limited data regarding the impact of exercise on phenotypic expression in hypertrophic cardiomyopathy (HCM). We aimed to investigate whether such an association exists in a cohort of genotype-positive HCM patients. MethodsIn this cross-sectional study of genotype-positive HCM families, we used structured questionnaires to obtain data regarding intensity and duration of exercise of participants starting at the age of 10, as well as data regarding exercise recommendations and their impact on quality of life (QOL). The association of cumulative metabolic-equivalent hours of exercise at different ages with different measures of phenotypic expression (maximal wall thickness, left atrial diameter, extent of late gadolinium enhancement) was analyzed. ResultsThe study included 109 patients from 55 families, including 43 male (39%) and 90 (83%) phenotype-positive. No association was identified between exercise duration or intensity with any of the phenotypic markers with the exception of greater cumulative exercise associated with younger age at presentation. Similar results were obtained when analysis was limited to exercise until the age of 20, until the age of 30 or only after 30.Among phenotype-positive patients, 89% recalled receiving recommendations regarding exercise restriction, 29% noted reduction in exercise level following such recommendations and 25% noted this having a significant impact on their QOL. ConclusionWe found no association between exercise intensity or duration and phenotypic expression in genotype-positive HCM patients. These findings are important for physician-patient discussions and support the recent trend towards more permissive exercise restrictions in HCM.

The levels of certain circulating microRNAs in hypertrophic cardiomyopathy are associated with echocardiographic parameters

Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease; it is characterized by left ventricular (LV) hypertrophy that cannot be explained by hemodynamic causes. It is believed that sarcomere dysfunction underlies the pathogenesis of this disease, however, only half of patients with the HCM phenotype have mutations in sarcomere-encoding genes. HCM is distinguished by both high genetic and clinical heterogeneity and therefore more studies are seeking to investigate a regulation of gene expression in HCM and how the abnormalities in this process can affect disease phenotype. One of the levels of regulation of gene expression - a post-transcriptional level - is mediated by short non-coding microRNAs that inhibit protein synthesis. To identify the correlations between levels of circulating microRNAs, previously shown to be associated with HCM, and clinical parameters of HCM patients. Correlation analysis of miR-499a-5p, miR-454 and miR-339-5p plasma levels and clinical parameters of 33 HCM patients, examined from 2019 to 2021, has been performed. Variants in HCM-associated genes were found in 49% of patients. There were no clinical differences between genotype-positive and genotype-negative patients. MiR-499a-5p level correlated with LV ejection fraction, miR-454 level - with LV diastolic function parameters and miR-339-5p level - with left atrium dimension. Levels of certain circulating microRNAs correlate with echocardiographic parameters in HCM patients.

Single-cell transcriptomics provides insights into hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a genetic heart disease that is characterized by unexplained segmental hypertrophy that is usually most pronounced in the septum. While sarcomeric gene mutations are often the genetic basis for HCM, the mechanistic origin for the heterogeneous remodeling remains largely unknown. A better understanding of the gene networks driving the cardiomyocyte (CM) hypertrophy is required to improve therapeutic strategies. Patients suffering from HCM often receive a septal myectomy surgery to relieve outflow tract obstruction due to hypertrophy. Using single-cell RNA sequencing (scRNA-seq) on septal myectomy samples from patients with HCM, we identify functional links between genes, transcription factors, and cell size relevant for HCM. The data show the utility of using scRNA-seq on the human hypertrophic heart, highlight CM heterogeneity, and provide a wealth of insights into molecular events involved in HCM that can eventually contribute to the development of enhanced therapies.

Sex Disaggregated Analysis of Risk Factors for Adverse Outcomes in Hypertrophic Cardiomyopathy

Patient sex has been associated with differences in disease penetrance and clinical expression in hypertrophic cardiomyopathy (HCM). We sought to investigate sex-disaggregated differences in risk factors for adverse outcomes in a large international HCM registry.

Abstract 11709: The Impact of Hypertension on Disease Expression in Hypertrophic Cardiomyopathy

Introduction: Pressure overload from hypertension (HTN) is an important cause of left ventricular hypertrophy (LVH) in the general population, however its impact on disease expression in hypertrophic cardiomyopathy (HCM), and differences based on the presence/absence of a sarcomeric gene variant are not well characterized. Hypothesis: HTN is associated with more prominent manifestations of HCM. Methods: Genotyped HCM patients in the Sarcomeric Human Cardiomyopathy Registry were designated SARC+ ((likely) pathogenic sarcomeric variant present) or SARC- and categorized as having HTN (≥140/90 mmHg) or normal blood pressure (nonHTN; <140/90 mmHg). Heart failure (HF; LVEF<35%, NYHA III-IV, transplant/LVAD), ventricular arrhythmias (VA; sudden death, resuscitated arrest, appropriate ICD discharge), atrial fibrillation (AF), and an overall composite (HF, VA, AF, death) were assessed by Kaplan-Meier analysis and logistic regression. Results: Of 1706 patients (62% male), 445 (26%) had HTN. Median follow up was 4.2 years. SARC+ nonHTN patients were youngest and SARC- HTN patients oldest (p<0.001; Table). Obstructive physiology was most common in SARC- HTN. SARC+ nonHTN patients had the greatest wall thickness, although absolute differences were minimal (Table). HTN was associated with HF and the overall composite outcome, but not VA or AF (Figure). On multivariable analysis, HTN predicted the HF composite (OR 1.59 [95% CI 1.07-2.26], p=0.02), especially in SARC+ patients (OR 2.34 [95% 1.33-4.11], p=0.003). Conclusions: HTN is associated with worse HF outcomes in HCM, especially among SARC+ patients, but has minimal impact on the degree of cardiac remodeling.

Genetic regulation of myocardial fibrosis in hypertrophic cardiomyopathy

Abstract Background Myocardial fibrosis is a common feature of hypertrophic cardiomyopathy (HCM) but its pathophysiology has yet to be elucidated. Purpose In this study, we used a multiplex approach to examine the genetic regulation of pathways associated with fibrosis in patients undergoing septal myectomy. Methods Myocardial tissue was collected at time of surgical intervention. Control biopsy samples were obtained from the left ventricular free wall from structurally normal hearts during autopsy following non-cardiac related death. Tissue was either snap frozen in liquid nitrogen and subsequently stored at −80 degrees or collected in RNA laterTM and frozen 24 hours later at −80 degrees. Total RNA was extracted from HCM tissue samples using the Qiagen RNeasy fibrous tissues mini kit and from control samples using mirVana isolation kit (Ambion), according to the manufacturer's protocol. Quantitative PCR (qPCR) was performed on the extracted RNA using a RT. Profiler™ Human finrosis PCR Array. Results The study cohort comprised 22 HCM samples and 5 controls. The relative regulation of genes involved in myocardial fibrosis in patients with HCM compared to controls is shown in figure 1. In patients with HCM, there was increased expression of genes involved in collagen synthesis. A significant two-fold upregulation in type III procollagen mRNA was observed relative to controls (p=0.013) with a similar trend identified for type I procollagen (1.5 fold up-regulation, p=0.081). The gene expression of MMP3 (−1.5 fold, p=0.029) and MMP8 (−1.8, p=0.002) which are involved in collaged degradation were downregulated in the HCM group. The gene expression of pro-fibrotic mediators TGF-β2 (4.8 fold, p=0.008) and CCN2 (2.9 fold, p=0.021) was also significantly elevated. Within the HCM group, there was a correlation between the fold regulation of TGF-β1 (r=0.570, p=0.006; r=0.528, p=0.012), TGF-β2 (r=0.569, p=0.006; r=0.514, p=0.014) and TGF-β3 (r=0.738, p<0.001; r=0.496, p=0.019) to gene regulation of type I and III procollagens respectively. The expression of BMP-7 which has been shown to reduce myocardial fibrosis by antagonising TGF- β mediated endothelial – mesothelial transformation of fibroblasts was also down-regulated in HCM (−3.8, p=0.015). Conclusions Genetic expression of procollagen is significantly upregulated in patients with HCM relative to controls. TGF-β and CCN2 mediated signalling appear to be key mediators in promoting collagen expression. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Heart Hospital Charitable Grant, UK Figure 1. Gene expression in HCM

Living with hypertrophic cardiomyopathy: a patient's perspective.

Hypertrophic cardiomyopathy (HCM) is a complex disease characterized by thickening of the cardiac muscle. Common symptoms include chest pain, shortness of breath, palpitations, fatigueand syncope (fainting), which are often confused for other conditions. Clinical treatment focuses on the relief of symptoms with medical therapies, which provide adequate to more variable symptomatic relief. Patients may experience more severe complications that require surgical intervention, such as implantable cardioverter-defibrillator therapy or septal myectomy. Despite the potential impact on quality of life, the humanistic burden of HCM is not well established. Here, we present four patient testimonials that highlight challenges faced by patients and clinicians in diagnosing HCM and managing symptoms. These testimonials provide valuable information on the spectrum and expression of HCM across generations. Such testimonials can better inform disease diagnosis and monitoring, maximizing quality of life and improving disease outcome.

Associations Between Female Sex, Sarcomere Variants, and Clinical Outcomes in Hypertrophic Cardiomyopathy.

The impact of sex on phenotypic expression in hypertrophic cardiomyopathy (HCM) has not been well characterized in genotyped cohorts. Retrospective cohort study from an international registry of patients receiving care at experienced HCM centers. Sex-based differences in baseline characteristics and clinical outcomes were assessed. Of 5873 patients (3788 genotyped), 2226 (37.9%) were women. At baseline, women were older (49.0±19.9 versus 42.9±18.4 years, P<0.001) and more likely to have pathogenic/likely pathogenic sarcomeric variants (HCM patients with a sarcomere mutation; 51% versus 43%, P<0.001) despite equivalent utilization of genetic testing. Age at diagnosis varied by sex and genotype despite similar distribution of causal genes. Women were 3.6 to 7.1 years older at diagnosis (P<0.02) except for patients with MYH7 variants where age at diagnosis was comparable for women and men (n=492; 34.8±19.2 versus 33.3±16.8 years, P=0.39). Over 7.7 median years of follow-up, New York Heart Association III-IV heart failure was more common in women (hazard ratio, 1.87 [CI, 1.48-2.36], P<0.001), after controlling for their higher burden of symptoms and outflow tract obstruction at baseline, reduced ejection fraction, HCM patients with a sarcomere mutation, age, and hypertension. All-cause mortality was increased in women (hazard ratio, 1.50 [CI, 1.13-1.99], P<0.01) but neither implantable cardioverter-defibrillator utilization nor ventricular arrhythmia varied by sex. In HCM, women are older at diagnosis, partly modified by genetic substrate. Regardless of genotype, women were at higher risk of mortality and developing severe heart failure symptoms. This points to a sex-effect on long-term myocardial performance in HCM, which should be investigated further.

Abstract 13296: Risk Loci of Hypertrophic Cardiomyopathy Identified via the UK Biobank

Introduction: Hypertrophic cardiomyopathy (HCM) is the most commonly inherited cardiac disease affecting 1:500 to 1:200 individuals worldwide. HCM has a heterogeneous genetic profile and phenotypic expression. More than 1400 known pathogenic variants have been identified in 11 sarcomere genes. In about 40% of HCM patients, the genetic cause may not be identified. The same mutation may lead to different phenotypes and severity in different individuals. Identification of novel HCM genes and modifiers will expand our understanding of the signaling pathways that are responsible for phenotypic expression of HCM. Methods: The UK Biobank comprises clinical and genetic data for greater than 500,000 individuals. We used OASIS, an information system for analyzing, searching, and visualizing associations between phenotype and genotype data to analyze this data. We compared control individuals to HCM individuals identified by ICD-10 code (I42.1 and I42.2) in a 20-to-1 fashion. Related individuals and those with confounding diagnoses were excluded. Results: The analysis was performed with Plink’s GLM option, and we identified 84 variants with a minor allele frequency of 0.5% or greater in 65 genes associated with HCM with a p &lt; 1x10 -6 , including 4 with p &lt; 5x10 -8 . The identified genes encode lncRNAs, miRNAs, and membrane proteins. Variants with high significance were identified in the genes encoding putative ciliary components DNAL4 (dynein axonemal light chain 4; p = 2.9x10 -8 ), MYO1D (unconventional myosin 1D; p = 3.1x10 -8 ), ITFAP (intraflagellar transport associated protein; p = 9.5x10 -8 ), CABCOCO1 (ciliary associated calcium biding coiled-coil 1; p = 3.7x 10 -7 ), EVL (Enah-Vasp-like; p = 4.4x 10 -7 ) and IFT122 (intraflagellar transport 122; p = 8.0 x10 -7 ). Conclusion: While none of these have previously associated with HCM, our findings suggest ciliary structure and function may play a role in disease manifestation. Our method is unique by pooling individuals in a large population set to identify potential causative or contributing mutations. Bioinformatic tools, such as OASIS, allow for the identification of previously unrecognized variants that may play a role in the development of HCM. This approach has identified numerous novel genes as possible risk loci.

Newer risk assessment strategies in hypertrophic cardiomyopathy.

The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed. Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particularly concerning in pediatric patients' where weight gain and linear growth is likely to lead to more significant hemodynamic changes in shorter periods of time. Some studies have even shown that risk factors concerning in adults may actually be protective in pediatric patients. Additionally, large gaps still remain between genotype and phenotype expression in HCM. A better understanding of the relationship between cause, phenotype, and outcomes is needed to truly be able to determine risk for SCD in childhood HCM. Larger studies, including newer technologies and quantitative models, similar to the European HCM Risk-SCD model, which allows for a quantitative risk diagnosis, are needed as well.

P664Effect of lifelong physical activity on phenotype expression in hypertrophic cardiomyopathy

P664Effect of lifelong physical activity on phenotype expression in hypertrophic cardiomyopathy

Does RV fibrosis have an effect on mortality in patients hypertrophic cardiomyopathy? An LV vs. RV national death index (NDI) study

Background Introduction CMR has become the leading technique to define the clinical impact of hypertrophic cardiomyopathy (HCM) providing complete coverage of both ventricles with high spatial resolution. Gadolinium delayed-enhancement (DHE) accurately identifies regions of myocardial fibrosis. Via CMR, innumerable studies have established that LVH is the predominant phenotypic expression of HCM. It is well known that myocardial fibrosis can occur in patients with HCM and is independently linked to a poorer prognosis than those without fibrosis by CMR.

Gender differences in the clinical features of hypertrophic cardiomyopathy caused by cardiac myosin-binding protein C gene mutations

BackgroundAlthough gender may be one of the important factors modifying phenotypic expression in hypertrophic cardiomyopathy (HCM), there has been little information on it. Methods and resultsWe investigated gender differences in the clinical features of HCM caused by cardiac myosin-binding protein C gene (MYBPC3) mutations. Sixty-one subjects (28 families) carrying MYBPC3 mutations were studied. Of the 61 subjects with MYBPC3 mutations, 50 patients including 23 female patients were phenotype-positive by echocardiography. Disease penetrance in subjects aged ≤40 years old was 92% in males and 67% in females. Females showed delayed onset of left ventricular hypertrophy compared with males in subjects who were genotype-positive. Female patients were more symptomatic at diagnosis than were males (mean New York Heart Association class: 1.7±0.8 versus 1.2±0.4, p=0.012). From a longitudinal point of view by age, no significant gender difference in cardiovascular deaths or cardiovascular events was found. During the follow-up period after diagnosis of HCM (13±8 years), female patients who were phenotype-positive had significantly more frequent heart failure events than did phenotypically affected male patients (p=0.028). ConclusionsAlthough females with MYBPC3 mutations showed later onset of the disease, female patients were more symptomatic at diagnosis and had more frequent heart failure events once they had developed hypertrophy.

Phenotypic expression in hypertrophic cardiomyopathy and late gadolinium enhancement on cardiac magnetic resonance

Introduction and AimThe prognostic value of late gadolinium enhancement (LGE) for risk stratification of hypertrophic cardiomyopathy (HCM) patients is the subject of disagreement. We set out to examine the association between clinical and morphological variables, risk factors for sudden cardiac death and LGE in HCM patients. MethodsFrom a population of 78 patients with HCM, we studied 53 who underwent cardiac magnetic resonance. They were divided into two groups according to the presence or absence of LGE. Ventricular arrhythmias and morbidity and mortality during follow-up were analyzed. ResultsPatients with LGE were younger at the time of diagnosis (p=0.046) and more often had a family history of sudden death (p=0.008) and known coronary artery disease (p=0.086). On echocardiography they had greater maximum wall thickness (p=0.007) and left atrial area (p=0.037) and volume (p=0.035), and more often presented a restrictive pattern of diastolic dysfunction (p=0.011) with a higher E/E′ ratio (p=0.003) and left ventricular systolic dysfunction (p=0.038). Cardiac magnetic resonance supported the association between LGE and previous echocardiographic findings: greater left atrial area (p=0.029) and maximum wall thickness (p<0.001) and lower left ventricular ejection fraction (p=0.056). Patients with LGE more often had an implantable cardioverter-defibrillator (ICD) (p=0.015). At follow-up, no differences were found in the frequency of ventricular arrhythmias, appropriate ICD therapies or mortality. ConclusionsThe presence of LGE emerges as a risk marker, associated with the classical predictors of sudden cardiac death in this population. However, larger studies are required to confirm its independent association with clinical events.

FREQUENCY OF METABOLIC GENE MUTATIONS IN PATIENTS REFERRED FOR HYPERTROPHIC CARDIOMYOPATHY GENETIC TESTING

Hypertrophic cardiomyopathy (HCM) is a sudden death predisposing disease often caused by sarcomeric gene mutations. Several metabolic storage diseases can also mimic the phenotypic expression of HCM. We sought to determine the spectrum and prevalence of sarcomeric and metabolic gene mutations in

Is there concordance between LV fibrosis and RV fibrosis in patients with hypertrophic cardiomyopathy; should there be?

Background CMR has become the leading modality to define the clinical impact of hypertrophic cardiomyopathy (HCM) providing complete coverage of both ventricles with high spatial resolution. Late gadolinium enhancement (LGE) accurately identifies regions of myocardial fibrosis. Via CMR, innumerable studies have established that LVH and LGE are the predominant phenotypic expressions of HCM. It is well known that myocardial fibrosis can occur in patients with HCM and is independently linked to a poorer prognosis than those without fibrosis by CMR.