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Microvascular Dysfunction in Hypertrophic Cardiomyopathy

Francesco Pelliccia1, Franco Cecchi2, Iacopo Olivotto3

  • 1Department of Cardiovascular Sciences, Sapienza University, 00166 Rome, Italy.

Journal of Clinical Medicine
|November 11, 2022
PubMed

Insights

Myocardial ischemia, driven by coronary microvascular dysfunction (CMD), is key in hypertrophic cardiomyopathy (HCM). Early non-invasive assessment of CMD is crucial for managing heart failure and sudden cardiac death risk in HCM patients.

Area of Science:

  • Cardiology
  • Cardiovascular Pathophysiology

Background:

  • Myocardial ischemia is a significant feature of hypertrophic cardiomyopathy (HCM), influencing heart failure (HF) and sudden cardiac death (SCD).
  • Coronary microvascular dysfunction (CMD), without epicardial coronary artery disease, is the primary cause of ischemia in HCM.
  • Assessing microcirculation non-invasively is challenging but vital for understanding HCM pathophysiology.

Purpose of the Study:

  • To highlight the importance of assessing myocardial ischemia and CMD in hypertrophic cardiomyopathy.
  • To emphasize the role of non-invasive multimodality imaging in evaluating microvascular dysfunction.
  • To underscore the necessity of early CMD diagnosis for risk stratification and patient management in HCM.

Main Methods:

  • Utilizing a multimodality approach for detailed assessment of microvascular dysfunction and ischemia.
  • Employing non-invasive diagnostic tools including transthoracic Doppler echocardiography, positron emission tomography, and cardiac magnetic resonance.
  • Integrating diagnostic work-up for myocardial ischemia into the routine management of HCM patients.

Main Results:

  • Non-invasive assessment of CMD using advanced imaging techniques is feasible and recommended for all HCM patients.
  • Myocardial ischemia contributes to cardiac fibrosis, left ventricular remodeling, heart failure, and arrhythmias in HCM.
  • Comprehensive evaluation of ischemia aids in the risk stratification for sudden cardiac death in HCM.

Conclusions:

  • Non-invasive assessment of coronary microvascular dysfunction should be a standard part of HCM evaluation.
  • Early diagnosis and management of myocardial ischemia are critical for improving outcomes in HCM patients.
  • Addressing CMD is a key challenge for improving the prognosis of hypertrophic cardiomyopathy.

Keywords:
hypertrophic cardiomyopathymicrocirculationmyocardial ischemia

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