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{{Hypertrophic cardiomyopathy}}
{{Hypertrophic cardiomyopathy}}
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== Overview ==
== Overview ==
There is no single [[study of choice]] in the [[diagnosis]] and management of patients with HCM. Hypertrophic cardiomyopathy can be diagnosed based on clinical examination, [[imaging]], [[The electrocardiogram|ECG]], and [[genetic testing]]. In fact, a series of studies are indicated the time of diagnosing HCM among them are [[Echocardiography]] and [[The electrocardiogram|ECG]]. [[Echocardiography]] is the imaging study of choice for the diagnosis of hypertrophic cardiomyopathy. However, [[Magnetic resonance imaging|MRI]] might detect HCM sooner, and as mentioned above [[Genetic testing|genetic test]]<nowiki/>s are also helpful.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
[[File:Esc 1.png|thumb|Schematic summarizing the general approach to the diagnosis of hypertrophic cardiomyopathy: ESC 2014: Authors' reproduction of the schematic based on the European Society of Cardiology (ESC) Guidelines on the diagnosis and management of hypertrophic cardiomyopathy (European Heart Journal (2014) 35, 2733–2779 - doi 10.1093/eurheartj/ehu284) ]]
[[Image:Esc 1.png|thumb|center|600 px|Schematic summarizing the general approach to the diagnosis of hypertrophic cardiomyopathy: ESC 2014: Authors' reproduction of the schematic based on the European Society of Cardiology (ESC) Guidelines on the diagnosis and management of hypertrophic cardiomyopathy (European Heart Journal (2014) 35, 2733–2779 - doi 10.1093/eurheartj/ehu284) ]]
<br />
<br />There is no single study of choice in the diagnosis and management of patients with HCM. In fact a series of studies are indicated the time of diagnosing HCM among them are Echocardiograhy and ECG.
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of Hypertrophic cardiomyopathy.


OR


The following result of [gold standard test] is confirmatory of Hypertrophic cardiomyopathy:
'''ESC Recommended tests in patients with definite or suspected HCM'''<ref name="pmid25173338">{{cite journal| author=Authors/Task Force members. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F et al.| title=2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2014 | volume= 35 | issue= 39 | pages= 2733-79 | pmid=25173338 | doi=10.1093/eurheartj/ehu284 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25173338  }} </ref>
* [Result 1]
* [Result 2]


OR
* Standard 12-lead electrocardiography.
* Trans-thoracic 2-D and Doppler echocardiography (including assessment of left ventricular outflow tract obstruction at rest and during Valsalva manoeuvre in the sitting and semi-supine positions).
* Upright exercise testing
* 48-hour ambulatory ECG monitoring.
* Cardiac magnetic resonance imaging should be considered if local resources and expertise permit.<ref name="pmid25173338">{{cite journal| author=Authors/Task Force members. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F et al.| title=2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2014 | volume= 35 | issue= 39 | pages= 2733-79 | pmid=25173338 | doi=10.1093/eurheartj/ehu284 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25173338  }} </ref>


[Name of the investigation] must be performed when:
<br />The followings are fundamentals of diagnostic studies:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


OR
* Diagnosing  HCM
 
* To study the presence or severity of left ventricular outflow tract (LVOT) obstruction
[Name of the investigation] is the gold standard test for the diagnosis of Hypertrophic cardiomyopathy.
* Tostudy the presence or severity of mitral regurgitation
 
* To evaluate the risk of developing arrhythmia (either SVT or VT)
OR
* To examine LV function
 
=== Study of choice ===
The diagnostic study of choice for Hypertrophic cardiomyopathy is [name of the investigation].
There is no single diagnostic study of choice for the diagnosis of hypertrophic cardiomyopathy, but hypertrophic cardiomyopathy can be diagnosed based on clinical examination, imaging, ECG, and genetic testing. In fact, a series of studies are indicated the time of diagnosing HCM among them are Echocardiography and ECG. Echocardiography is the imaging study of choice for the diagnosis of hypertrophic cardiomyopathy. However, MRI might detect HCM sooner, and as mentioned above genetic tests are also helpful.
 
OR
 
There is no single diagnostic study of choice for the diagnosis of Hypertrophic cardiomyopathy.
 
OR
 
There is no single diagnostic study of choice for the diagnosis of Hypertrophic cardiomyopathy, but Hypertrophic cardiomyopathy can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
Hypertrophic cardiomyopathy is primarily diagnosed based on the clinical presentation.
 
OR


Investigations:
The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy:
* Among the patients who present with clinical signs of Hypertrophic cardiomyopathy, the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of Hypertrophic cardiomyopathy, the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of Hypertrophic cardiomyopathy, the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for Hypertrophic cardiomyopathy ====
* LVH
{|
*Systolic anterior motion of the mitral valve
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
*Asymmetric thickening of the interventricular wall.
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
* Out follow obstruction, Pseudo sub-aortic stenosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
*LVOT obstruction
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
*LA enlargement (increase adverse effects of HCM including the development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume)<ref name="pmid24589281">{{cite journal| author=Maron BJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RH et al.| title=Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. | journal=Am J Cardiol | year= 2014 | volume= 113 | issue= 8 | pages= 1394-400 | pmid=24589281 | doi=10.1016/j.amjcard.2013.12.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589281  }} </ref>
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>


===== Diagnostic results =====
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for Hypertrophic cardiomyopathy:
The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy:
* [Finding 1]
* [Finding 2]


===== Sequence of Diagnostic Studies =====
* LVH
The [name of investigation] must be performed when:
*Systolic anterior motion of the mitral valve
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
*Asymmetric thickening of the interventricular wall.
* A positive [test] is detected in the patient, to confirm the diagnosis.
* Out follow obstruction, Pseudo sub-aortic stenosis
*LVOT obstruction
*LA enlargement (increase adverse effects of HCM including the development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume)<ref name="pmid24589281" />


OR
There are lots of unknown genetic abnormalities in patients with HCM. Laboratory findings consistent with the diagnosis of hypertrophic cardiomyopathy may include but not limited to mutations in the genes involved in [[Myosin|Beta-myosin heavy chain]], [[Myosin]] binding protein C, and [[Cardiac troponin|Cardiac troponin T]]. Genes involved in the [[pathogenesis]] of [[hypertrophic cardiomyopathy]] include:
*[[MYH7]]
*[[TNNT2]]
*[[TPM1|and TPM1]]. <ref>Maron BJ, Moller JH, Seidman CE et al. Impact of laboratory molecular diagnosis on contemporary diagnostic criteria for genetically transmitted cardiovascular diseases. Hypertrophic cardiomyopathy, long-QT syndrome, and Marfan syndrome. [A statement for healthcare professionals from the Councils on Clinical Cardiology, Cardiovascular Disease in the Young, and Basic Science, American Heart Association]. Circulation 1998;98:1460–71.</ref><ref>Schwartz K, Carrier L, Guicheney P, Komajda M. Molecular basis of familial cardiomyopathies. Circulation 1995;91:532–40.</ref><ref>Niimura H, Bachinski LL, Sangwatanaroj S et al. Mutations in the gene for cardiac myosin-binding protein C and late-onset familial hypertrophic cardiomyopathy. N Engl J Med 1998;338:1248–57.</ref><ref>Thierfelder L, Watkins H, MacRae C et al. Alpha-tropomyosin and cardiac troponin T mutations cause familial hypertrophic cardiomyopathy. A disease of the sarcomere. Cell 1994;77:701–12.</ref><ref>Watkins H, McKenna WJ, Thierfelder L et al. Mutations in the genes for cardiac troponin T and alpha-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med 1995;332:1058–64.</ref><ref>Charron P, Dubourg O, Desnos M et al. Clinical features and prognostic implications of familial hypertrophic cardiomyopathy related to the cardiac myosin-binding protein C gene. Circulation 1998;97: 2230–6.</ref><ref>Maron BJ, Niimura H, Casey SA et al. Development of left ventricular hypertrophy in adults in hypertrophic cardiomyopathy caused by cardiac myosin-binding protein C gene mutations. J Am Coll Cardiol 2001;38:315–21.</ref><ref>Anan R, Greve G, Thierfelder L et al. Prognostic implications of novel beta cardiac myosin heavy chain gene mutations that cause familial hypertrophic cardiomyopathy. J Clin Invest 1994;93:280–5.</ref><ref>Coviello DA, Maron BJ, Spirito P et al. Clinical features of hypertrophic cardiomyopathy caused by mutation of a “hot spot” in the alpha-tropomyosin gene. J Am Coll Cardiol 1997;29:635–40.</ref><ref>Blair E, Redwood C, Ashrafian H et al. Mutations in the gamma(2) subunit of AMP-activated protein kinase cause familial hypertrophic cardiomyopathy. Evidence for the central role of energy compromise in disease pathogenesis. Hum Mol Genet 2001;10:1215–20.</ref><ref>Erdmann J, Raible J, Maki-Abadi J et al. Spectrum of clinical phenotypes and gene variants in cardiac myosin-binding protein C mutation carriers with hypertrophic cardiomyopathy. J Am Coll Cardiol 2001;38:322–30.</ref><ref>Gruver EJ, Fatkin D, Dodds GA et al. Familial hypertrophic cardiomyopathy and atrial fibrillation caused by Arg663His beta-cardiac myosin heavy chain mutation. Am J Cardiol 1999;83:13H–8H.</ref><ref>Kimura A, Harada H, Park JE et al. Mutations in the cardiac troponin I gene associated with hypertrophic cardiomyopathy. Nat Genet 1997;16:379–82.</ref><ref>Marian AJ, Roberts R. Recent advances in the molecular genetics of hypertrophic cardiomyopathy. Circulation 1995;92:1336–47.</ref><ref>Niimura H, Patton KK, McKenna WJ et al. Sarcomere protein gene mutations in hypertrophic cardiomyopathy of the elderly. Circulation 2002;105:446–51.</ref>


The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]


=== Name of Diagnostic Criteria ===


'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''


Hypertrophic cardiomyopathy is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of Hypertrophic cardiomyopathy.
'''Sequence of Diagnostic Studies'''


OR
The diagnosis of HCM should be suspected if one of the followings exist:


There is no single diagnostic study of choice for Hypertrophic cardiomyopathy, though Hypertrophic cardiomyopathy may be diagnosed based on [name of criteria] established by [...].
* Family history of HCM
* Unexplained symptoms (ie, dyspnea, chest pain, fatigue, palpitations)
* Systolic ejection murmur
* Abnormal 12-lead electrocardiogram
* Syncope (or presyncope).  


OR


The diagnosis of Hypertrophic cardiomyopathy is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].


OR
The presence of one or more of these clinical findings should prompt further testing with imaging (echocardiography and/or cardiac MRI) to confirm the diagnosis. ''Please not that the presence of increased left ventricular (LV) wall thickening ≥15 mm anywhere in the LV wall in the absence of any other identifiable cause such as hypertension or valve disease is consistent with a diagnosis of HCM, but the other common findings such as mitral valve systolic anterior motion (SAM) or hyperdynamic LV are not obligatory for an HCM diagnosis.''


The diagnosis of Hypertrophic cardiomyopathy is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
<br />
 
OR
 
Hypertrophic cardiomyopathy may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of Hypertrophic cardiomyopathy is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of Hypertrophic cardiomyopathy is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of Hypertrophic cardiomyopathy is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of Hypertrophic cardiomyopathy.


==References==
==References==

Latest revision as of 17:37, 23 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

There is no single study of choice in the diagnosis and management of patients with HCM. Hypertrophic cardiomyopathy can be diagnosed based on clinical examination, imaging, ECG, and genetic testing. In fact, a series of studies are indicated the time of diagnosing HCM among them are Echocardiography and ECG. Echocardiography is the imaging study of choice for the diagnosis of hypertrophic cardiomyopathy. However, MRI might detect HCM sooner, and as mentioned above genetic tests are also helpful.

Diagnostic Study of Choice

Schematic summarizing the general approach to the diagnosis of hypertrophic cardiomyopathy: ESC 2014: Authors' reproduction of the schematic based on the European Society of Cardiology (ESC) Guidelines on the diagnosis and management of hypertrophic cardiomyopathy (European Heart Journal (2014) 35, 2733–2779 - doi 10.1093/eurheartj/ehu284)


There is no single study of choice in the diagnosis and management of patients with HCM. In fact a series of studies are indicated the time of diagnosing HCM among them are Echocardiograhy and ECG.


ESC Recommended tests in patients with definite or suspected HCM[1]

  • Standard 12-lead electrocardiography.
  • Trans-thoracic 2-D and Doppler echocardiography (including assessment of left ventricular outflow tract obstruction at rest and during Valsalva manoeuvre in the sitting and semi-supine positions).
  • Upright exercise testing
  • 48-hour ambulatory ECG monitoring.
  • Cardiac magnetic resonance imaging should be considered if local resources and expertise permit.[1]


The followings are fundamentals of diagnostic studies:

  • Diagnosing HCM
  • To study the presence or severity of left ventricular outflow tract (LVOT) obstruction
  • Tostudy the presence or severity of mitral regurgitation
  • To evaluate the risk of developing arrhythmia (either SVT or VT)
  • To examine LV function

Study of choice

There is no single diagnostic study of choice for the diagnosis of hypertrophic cardiomyopathy, but hypertrophic cardiomyopathy can be diagnosed based on clinical examination, imaging, ECG, and genetic testing. In fact, a series of studies are indicated the time of diagnosing HCM among them are Echocardiography and ECG. Echocardiography is the imaging study of choice for the diagnosis of hypertrophic cardiomyopathy. However, MRI might detect HCM sooner, and as mentioned above genetic tests are also helpful.

The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy:

  • LVH
  • Systolic anterior motion of the mitral valve
  • Asymmetric thickening of the interventricular wall.
  • Out follow obstruction, Pseudo sub-aortic stenosis
  • LVOT obstruction
  • LA enlargement (increase adverse effects of HCM including the development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume)[2]
Diagnostic results

The following result of Echocardiography/MRI is confirmatory of hypertrophic cardiomyopathy:

  • LVH
  • Systolic anterior motion of the mitral valve
  • Asymmetric thickening of the interventricular wall.
  • Out follow obstruction, Pseudo sub-aortic stenosis
  • LVOT obstruction
  • LA enlargement (increase adverse effects of HCM including the development of AF)(>48 mm transverse dimension or ≥118 mL chamber volume)[2]

There are lots of unknown genetic abnormalities in patients with HCM. Laboratory findings consistent with the diagnosis of hypertrophic cardiomyopathy may include but not limited to mutations in the genes involved in Beta-myosin heavy chain, Myosin binding protein C, and Cardiac troponin T. Genes involved in the pathogenesis of hypertrophic cardiomyopathy include:



Sequence of Diagnostic Studies

The diagnosis of HCM should be suspected if one of the followings exist:

  • Family history of HCM
  • Unexplained symptoms (ie, dyspnea, chest pain, fatigue, palpitations)
  • Systolic ejection murmur
  • Abnormal 12-lead electrocardiogram
  • Syncope (or presyncope).


The presence of one or more of these clinical findings should prompt further testing with imaging (echocardiography and/or cardiac MRI) to confirm the diagnosis. Please not that the presence of increased left ventricular (LV) wall thickening ≥15 mm anywhere in the LV wall in the absence of any other identifiable cause such as hypertension or valve disease is consistent with a diagnosis of HCM, but the other common findings such as mitral valve systolic anterior motion (SAM) or hyperdynamic LV are not obligatory for an HCM diagnosis.


References

  1. ↑ 1.0 1.1 Authors/Task Force members. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F; et al. (2014). "2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)". Eur Heart J. 35 (39): 2733–79. doi:10.1093/eurheartj/ehu284. PMID 25173338.
  2. ↑ 2.0 2.1 Maron BJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RH; et al. (2014). "Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance". Am J Cardiol. 113 (8): 1394–400. doi:10.1016/j.amjcard.2013.12.045. PMID 24589281.
  3. ↑ Maron BJ, Moller JH, Seidman CE et al. Impact of laboratory molecular diagnosis on contemporary diagnostic criteria for genetically transmitted cardiovascular diseases. Hypertrophic cardiomyopathy, long-QT syndrome, and Marfan syndrome. [A statement for healthcare professionals from the Councils on Clinical Cardiology, Cardiovascular Disease in the Young, and Basic Science, American Heart Association]. Circulation 1998;98:1460–71.
  4. ↑ Schwartz K, Carrier L, Guicheney P, Komajda M. Molecular basis of familial cardiomyopathies. Circulation 1995;91:532–40.
  5. ↑ Niimura H, Bachinski LL, Sangwatanaroj S et al. Mutations in the gene for cardiac myosin-binding protein C and late-onset familial hypertrophic cardiomyopathy. N Engl J Med 1998;338:1248–57.
  6. ↑ Thierfelder L, Watkins H, MacRae C et al. Alpha-tropomyosin and cardiac troponin T mutations cause familial hypertrophic cardiomyopathy. A disease of the sarcomere. Cell 1994;77:701–12.
  7. ↑ Watkins H, McKenna WJ, Thierfelder L et al. Mutations in the genes for cardiac troponin T and alpha-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med 1995;332:1058–64.
  8. ↑ Charron P, Dubourg O, Desnos M et al. Clinical features and prognostic implications of familial hypertrophic cardiomyopathy related to the cardiac myosin-binding protein C gene. Circulation 1998;97: 2230–6.
  9. ↑ Maron BJ, Niimura H, Casey SA et al. Development of left ventricular hypertrophy in adults in hypertrophic cardiomyopathy caused by cardiac myosin-binding protein C gene mutations. J Am Coll Cardiol 2001;38:315–21.
  10. ↑ Anan R, Greve G, Thierfelder L et al. Prognostic implications of novel beta cardiac myosin heavy chain gene mutations that cause familial hypertrophic cardiomyopathy. J Clin Invest 1994;93:280–5.
  11. ↑ Coviello DA, Maron BJ, Spirito P et al. Clinical features of hypertrophic cardiomyopathy caused by mutation of a “hot spot” in the alpha-tropomyosin gene. J Am Coll Cardiol 1997;29:635–40.
  12. ↑ Blair E, Redwood C, Ashrafian H et al. Mutations in the gamma(2) subunit of AMP-activated protein kinase cause familial hypertrophic cardiomyopathy. Evidence for the central role of energy compromise in disease pathogenesis. Hum Mol Genet 2001;10:1215–20.
  13. ↑ Erdmann J, Raible J, Maki-Abadi J et al. Spectrum of clinical phenotypes and gene variants in cardiac myosin-binding protein C mutation carriers with hypertrophic cardiomyopathy. J Am Coll Cardiol 2001;38:322–30.
  14. ↑ Gruver EJ, Fatkin D, Dodds GA et al. Familial hypertrophic cardiomyopathy and atrial fibrillation caused by Arg663His beta-cardiac myosin heavy chain mutation. Am J Cardiol 1999;83:13H–8H.
  15. ↑ Kimura A, Harada H, Park JE et al. Mutations in the cardiac troponin I gene associated with hypertrophic cardiomyopathy. Nat Genet 1997;16:379–82.
  16. ↑ Marian AJ, Roberts R. Recent advances in the molecular genetics of hypertrophic cardiomyopathy. Circulation 1995;92:1336–47.
  17. ↑ Niimura H, Patton KK, McKenna WJ et al. Sarcomere protein gene mutations in hypertrophic cardiomyopathy of the elderly. Circulation 2002;105:446–51.

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