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The International Journal of Cardiovascular Imaging

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Open Access 26-06-2023 | Sudden Cardiac Death | Review Paper

Mechanisms and prognostic impact of myocardial ischaemia in hypertrophic cardiomyopathy

Authors: James A. Coleman, Zakariye Ashkir, Betty Raman, Alfonso Bueno-Orovio

Published in: The International Journal of Cardiovascular Imaging | Issue 10/2023

Abstract

Despite the progress made in risk stratification, sudden cardiac death and heart failure remain dreaded complications for hypertrophic cardiomyopathy (HCM) patients. Myocardial ischaemia is widely acknowledged as a contributor to cardiovascular events, but the assessment of ischaemia is not yet included in HCM clinical guidelines. This review aims to evaluate the HCM-specific pro-ischaemic mechanisms and the potential prognostic value of imaging for myocardial ischaemia in HCM. A literature review was performed using PubMed to identify studies with non-invasive imaging of ischaemia (cardiovascular magnetic resonance, echocardiography, and nuclear imaging) in HCM, prioritising studies published after the last major review in 2009. Other studies, including invasive ischaemia assessment and post-mortem histology, were also considered for mechanistic or prognostic relevance. Pro-ischaemic mechanisms in HCM reviewed included the effects of sarcomeric mutations, microvascular remodelling, hypertrophy, extravascular compressive forces and left ventricular outflow tract obstruction. The relationship between ischaemia and fibrosis was re-appraised by considering segment-wise analyses in multimodal imaging studies. The prognostic significance of myocardial ischaemia in HCM was evaluated using longitudinal studies with composite endpoints, and reports of ischaemia-arrhythmia associations were further considered. The high prevalence of ischaemia in HCM is explained by several micro- and macrostructural pathological features, alongside mutation-associated energetic impairment. Ischaemia on imaging identifies a subgroup of HCM patients at higher risk of adverse cardiovascular outcomes. Ischaemic HCM phenotypes are a high-risk subgroup associated with more advanced left ventricular remodelling, but further studies are required to evaluate the independent prognostic value of non-invasive imaging for ischaemia.

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Title: Mechanisms and prognostic impact of myocardial ischaemia in hypertrophic cardiomyopathy
Authors: James A. Coleman
Zakariye Ashkir
Betty Raman
Alfonso Bueno-Orovio
Publication date: 26-06-2023
Publisher: Springer Netherlands
Keywords: Sudden Cardiac Death
Cardiomyopathy
Published in: The International Journal of Cardiovascular Imaging / Issue 10/2023
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-023-02894-y

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Mechanisms and prognostic impact of myocardial ischaemia in hypertrophic cardiomyopathy

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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