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Related Concept Videos

Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

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Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
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Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Cardiomyopathy I: Introduction and Classification01:25

Cardiomyopathy I: Introduction and Classification

26
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
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Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Cardiomyopathy IV: Restrictive Cardiomyopathy01:29

Cardiomyopathy IV: Restrictive Cardiomyopathy

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Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
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Related Experiment Video

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Scanning Electron Microscopy of Macerated Tissue to Visualize the Extracellular Matrix
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Microvascular Dysfunction Is Associated With Impaired Myocardial Work in Obstructive and Nonobstructive Hypertrophic

Pedro Garcia Brás1, Sílvia Aguiar Rosa1,2, Isabel Cardoso1

  • 1Department of Cardiology Santa Marta Hospital Lisbon Portugal.

Journal of the American Heart Association
|April 17, 2023
PubMed
Summary

Impaired myocardial work in hypertrophic cardiomyopathy (HCM) patients correlates with left ventricular ischemia. This finding, using 2D speckle tracking echocardiography, offers greater predictive power than global longitudinal strain for detecting hypoperfusion.

Keywords:
coronary microvascular dysfunctionhypertrophic cardiomyopathymyocardial deformationmyocardial workstrain imaging

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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomedical Engineering

Background:

  • Two-dimensional speckle tracking echocardiography (2DSTE) shows promise in assessing microvascular dysfunction, a key feature of hypertrophic cardiomyopathy (HCM).
  • Myocardial work assessment via 2DSTE may offer insights into left ventricular (LV) ischemia in HCM patients.
  • Global longitudinal strain (GLS) is a known marker, but its incremental value alongside myocardial work in HCM requires investigation.

Purpose of the Study:

  • To investigate the association between myocardial work parameters and LV ischemia in patients with HCM.
  • To determine if myocardial work provides incremental predictive value over GLS for detecting ischemia in HCM.
  • To explore the relationship between myocardial work, ischemia, and fibrosis in obstructive and non-obstructive HCM.

Main Methods:

  • Prospective study involving 75 HCM patients undergoing 2DSTE and stress perfusion cardiac magnetic resonance (CMR).
  • Analysis included stratification by HCM obstruction and significant late gadolinium enhancement (LGE ≥15% LV mass).
  • Multivariable and segmental analyses assessed correlations between myocardial work indices (global work index, global work efficiency, global constructive work) and perfusion defects.

Main Results:

  • 90.7% of patients exhibited perfusion defects; 38.7% had significant LGE.
  • Lower global work index, global work efficiency, and global constructive work significantly correlated with ischemia (P<0.001).
  • A global work index cutoff ≤1755 mmHg% showed 88% sensitivity and 71% specificity for hypoperfusion, outperforming GLS (64% sensitivity, 57% specificity).

Conclusions:

  • Impaired myocardial work is significantly associated with the extent of LV ischemia in HCM patients, as assessed by CMR.
  • This association is independent of LV hypertrophy, fibrosis (LGE), and obstructive HCM.
  • Myocardial work parameters demonstrate superior predictive power for ischemia compared to GLS in HCM.