Myocardial morphology in hypertrophic cardiomyopathy: the current state of the problem
DOI:
https://doi.org/10.14739/2310-1210.2019.3.169215Keywords:
hypertrophic cardiomyopathy, endomyocardial fibrosisAbstract
The objective. Based on the modern sources of scientific data to analyze the morphological features of the myocardium in hypertrophic cardiomyopathy.
The paper presents a literature review on current views on the features of structural remodeling of the left ventricular myocardium in patients with hypertrophic cardiomyopathy, as well as the most common classifications of this pathology. The emphasis is made on the problem of the interrelation of myocardial disarray and fibrosis. The “small vessel disease” is an important pathogenetic link in the development of heart failure, which enhances the relation between disorder of myocardial histoarchitectonics and progressive cardiac ischemia in hypertrophic cardiomyopathy.
Conclusions. Notwithstanding the numerous research data on hypertrophic cardiomyopathy, no consensus among the authors regarding the etiology and pathogenesis of hypertrophic cardiomyopathy exists to date. Controversial data on the interrelation and sequence of disarray, myocardial hypertrophy, interstitial fibrosis, changes in the microvasculature and structural changes of the mitral valve in patients with hypertrophic cardiomyopathy hamper the search for adequate etiotropic treatment. Polymorphism of clinical and morphological manifestations of hypertrophic cardiomyopathy requires collaborative efforts to study the disease by cardiologists and pathologists.
References
Bittencourt, M. I., Cader, S. A., Araújo, D. V., & Ferreira Salles A. L. (2016). Sudden death in hypertrophic cardiomyopathy. Int. J. Cardiovasc. Sci., 29(6), 504–511. doi: 10.5935/2359-4802.20160057
Sweeting, J., Ingles, J., Timperio, A., Patterson, J., Ball, K. & Semsarian C. (2016). Physical activity in hypertrophic cardiomyopathy: prevalence of inactivity and perceived barriers. Open Heart, 3(2), e000484. doi: 10.1136/ openhrt-2016-000484
Hoey, E. T., Elassaly, M., Ganeshan, A., Watkin, R. W., & Simpson, H. (2014). The role of magnetic resonance imaging in hypertrophic cardiomyopathy. Quant. Imaging Med. Surg., 4 (5), 397–406. doi: 10.3978/j.issn.2223-4292.2014.09.04
Levine, R. A., Hagége, A. A., Judge, D.P. Padala, M., Dal-Bianco, J. P., Aikawa, E., et al. (2015). Mitral valve disease - morphology and mechanisms. Nat. Rev. Cardiol., 12(12), 689–710. doi: 10.1038/nrcardio.2015.161
Pantazis, A., Vischer, A. S., Perez-Tome, M. C. & Castelletti, S. (2015). Diagnosis and management of hypertrophic cardiomyopathy. Echo Res Pract, 2(1), 45–53. doi: 10.1530/ERP-15-0007.
Çam, F. S. & Merih, G. (2004). Hypertrophic cardiomyopathy: pathological features and molecular pathogenesis. Anadolu. Kardiyol. Derg., 4(4), 327–330.
Lee, S. P., Park, K., Kim, H. K., Kim, Y. J. & Sohn, D. W. (2013). Apically displaced papillary muscles mimicking apical hypertrophic cardiomyopathy. Eur. Heart J. Cardiovasc. Imaging, 14(2), 128–134. doi: 10.1093/ehjci/jes113
Semsarian, C., Ingles, J., Maron, M. S. & Maron, B. J. (2015). New perspectives on the prevalence of hypertrophic cardiomyopathy. Journal of the American College of Cardiology, 65(12), 1249–1254. doi: 10.1016/j.jacc.2015.01.019
Sabater-Molina, M., Pérez-Sánchez, I., Hernández del Rincón, J. P. & Gimeno, J. R. (2018). Genetics of hypertrophic cardiomyopathy: а review of current state. Clinical genetics, 93(1), 3–14. doi: 10.1111/cge.13027
Osiev, A. G., Najdenov, R. A., Kretov, E. I., Obedinskaya, N. R. & Kurbatov, V. P. (2015). Gipertroficheskaya obstruktivnaya kardiomiopatiya [Hypertrophic obstructive cardiomyopathy]. Al´manakh klinicheskoj mediciny, 38, 95–104. [in Russian].
Vatutin, N. Т., Taradin, G. G., Maron, М. S. & Shevelek, А. N. (2016). Vnezapnaya serdechnaya smert´ u bol´nykh gipertroficheskoj kardiomiopatiej [Sudden cardiac death in patients with hypertrophic cardiomyopathy]. Kardiologiya, 56(1), 56–65. doi: 10.18565/cardio.2016.1.56-65 [in Russian].
Marian, A. J., van Rooij, E., Roberts, R. & Marian, A. J. (2016). Genetics and genomics of single-gene cardiovascular diseases: common hereditary cardiomyopathies as prototypes of single-gene disorders. J. Am. Coll. Cardiol., 68(25), 2831–2849. doi: 10.1016/j.jacc.2016.09.968
Finocchiaro, G., Haddad, F., Pavlovic, A., Magavern, E., Sinagra, G., Knowles, J. W., et al. (2014). How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience. BMJ Open, 4(6), 1–11. doi: 10.1136/bmjopen-2014-004814
Trembovetskaya, E. М. (2014). Izuchenie osobennostej deformacii stenok levogo zheludochka u bol´nykh pri gipertroficheskoj kardiomiopatii s ispol´zovaniem vektor–e´khokardiografii [Studying of peculiarities of deformity of the left ventricle walls in patients, suffering hypertrophic cardiomyopathy, using vector—echocardiography]. Klinichna khirurhiia, 10, 27–30. [in Russian].
Frolova, E´. B., Mukhametshina, G. A., Muкhitova, E. I., & Garifullina, Сh. N. (2012). Gipertroficheskaya kardiomiopatiya [Hypertrpophic cardiomyopathy]. Vestnik sovremennoj klinicheskoj mediciny, 5(4), 23–29. [in Russian]
Tang, B., Song, Y., Cui, H., Ji, K., Yu, Q., , Zhu, C., et al. (2018). Prognosis of adult obstructive hypertrophic cardiomyopathy patients with different morphological types after surgical myectomy. Eur. J. Cardiothorac. Surg., 54(2), 310–317. doi: 10.1093/ejcts/ezy037
Giesbrandt, K. J., Bolan, C. W., Shapiro, B. P., Edwards, W. D. & Mergo, P. J. (2013). Diffuse diseases of the myocardium: MRI-pathologic review of nondilated cardiomyopathies. Am. J. Roentgenol., 200 (3), 266–273. doi: 10.2214/AJR.12.9633
Maron, M. S. (2012). Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J. Cardiovasc. Magn. Reson., 14(13), 1–21. doi: 10.1186/1532-429X-14-13
Marian, A. J. & Braunwald, E. (2017). Hypertrophic cardiomyopathy: genetics, pathogenesis, clinical manifestations, diagnosis, and therapy. Circ. Res., 121(7), 749–770. doi: 10.1161/CIRCRESAHA.117.311059
Saryeva, O. P., Kamenskaya, M. V., Kulida, L. V. & Peretyat´ko, L. P. (2014). Patomorfologiya zabolevanij serdca u novorozhdennykh detej [Pathology heart disease in newborns]. Mat´ i Ditya v Kuzbasse, 2(57), 13–19. [in Russian]
Parisi, R., Mirabella, F., Secco, G. G. & Fattori, R. (2014). Multimodality imaging in apical hypertrophic cardiomyopathy. World J. Cardiol., 6(9), 916–923. doi: 10.4330/wjc.v6.i9.916
Gonzalez, W., Miles, J., Garcia, M. & Spevack, D. (2017). High prevalence of apical hypertrophic cardiomyopathy noted in non-white patients referred for clinical echocardiography. Journal of the American College of Cardiology, 69(11), 1531. doi: 10.1016/S0735-1097(17)34920-3
Gazizova, L. Yu. & Valeev, I. G. (2016). Problemy diagnostiki apikal´noj formy gipertroficheskoj kardiomiopatii [The problems of diagnosis of the apical form of hypertrophic cardiomyopathy]. Kardiologiya: novosti, mneniya, obuchenie, 1, 29–34. [in Russian].
Krylova, N. S., Demkina, А. Ye., Khashiyeva, F. M., Kovalevskaya, Ye. А., Poteshkina, N. G. & Vanyukov, А. Ye. (2014). Sluchaj diagnostiki аpikal´noj formy gipertroficheskoj kardiomiopatii u pacientki s klinikoj progressiruyushej stenokardii [Case of diagnosis of apical form of hypertrophic cardiomyopathy with a patient with progressive angina clinic]. Klinicist, 2, 39–44. [in Russian]. https://doi.org/10.17650/1818-8338-2014-2-39-44
Harrigan, C. J., Appelbaum, E., Maron, B. J., Buros, J. L., Gibson, C. M., Lesser, J. R., et al. (2008). Significance of papillary muscle abnormalities identified by cardiovascular magnetic resonance in hypertrophic cardiomyopathy. Am. J. Cardiol., 101(5), 668–673. doi: 10.1016/j.amjcard.2007.10.032
Kwon, D. H., Setser, R. M., Thamilarasan, M., Popovic, Z. V., Smedira, N. G., Schoenhagen, P., et al. (2008). Abnormal papillary muscle morphology is independently associated with increased left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Heart, 94(10), 1295–1301. doi: 10.1136/hrt.2007.118018
Ferreira, C., Delgado, C., Vázquez, M., Trinidad, C. & Vilar, M. (2014). Isolated papillary muscle hypertrophy: a gap in our knowledge of hypertrophic cardiomyopathy? Rev. Port. Cardiol., 33(6), 379. doi: 10.1016/j.repc. 2014.01.015
Correia, A. S., Pinho, T., Madureira, A. J., Araujo, V. & Maciel, M. J. (2013). Isolated papillary muscle hypertrophy: a variant of hypertrophic cardiomyopathy? Do not miss a hypertrophic cardiomyopathy. Eur. Heart J. Cardiovasc. Imaging, 14(3), 296. doi: 10.1093/ehjci/jes195
Boissier, F., Achkouty, G., Bruneval, P., Fabiani, J. N., Nguyen, A. T., Riant, E., et al. (2015). Rupture of mitral valve chordae in hypertrophic cardiomyopathy. Archieves of cardiovascular disease, 108(4), 244–249. doi: 10.1016/j.acvd.2015.01.003
Dzemeshkevich, S. L., Frolova, Yu. V., Kim, S. Yu., Fedorov, D. N., Zaklyazminskaya, E. V., Fedulova, S. V., et al. (2015). Anatomicheskie i morfologicheskie priznaki diffuzno-generalizovannoj formy gipertroficheskoj kardiomiopatii [Anatomic and morphological signs of a diffuse generalized hypertrophic cardiomyopathy]. Rossjskij kardiologicheskij zhurnal, 5(121), 58–63. doi: 0.15829/1560-4071-2015-05-58-63 [in Russian].
Groarke, J. D., Galazka, P. Z., Cirino, A. L., Lakdawala, N. K., Thune, J. J., Bundgaard, H., et al. (2018). Intrinsic mitral valve alterations in hypertrophic cardiomyopathy sarcomere mutation carriers. Eur. Heart J. Cardiovasc. Imaging, 19(10), 1109–1116. doi: 10.1093/ehjci/jey095
Wehman, B., Ghoreishi, M., Foster, N., Wang, L., D'Ambra, M. N., Maassel, N., et al. (2018). Transmitral septal myectomy for hypertrophic obstructive cardiomyopathy. Ann. Thorac. Surg., 105(4), 1102–1108. doi: 10.1016/j. athoracsur.2017.10.045
Silbiger, J. J. (2016). Abnormalities of the mitral apparatus in hypertrophic cardiomyopathy: echocardiographic, pathophysiologic, and surgical insights. J. Am. Soc. Echocardiogr., 29(7), 622–639. doi: 10.1016/j.echo.2016.03.003
Okorokov, А. N. (2009). Diagnostika boleznej vnutrennikh organov. Tom 8: Diagnostika boleznej serdca i sosudov [Diagnosis of diseases of internal organs. T.8 Diagnosis of heart and vascular diseases]. Moscow: Medicinskaya literatura. [in Russian].
Pejčinović, V. P., Peršić, V., Boban, M., et al. (2017). Hypertrophic and noncompacted cardiomyopathy of left ventricle: different manifestations of the same disease. Cardiologia Croatica, 12(4), 135. doi: 10.15836/ccar2017.135
Mattos, B. P. (2002). Genetic bases of hypertrophic cardiomyopathy. Arq. Bras. Cardiol, 78, 332–340. doi: 10.1590/S0066-782X2002000300009
Bokeriya, L. А., Berseneva, М. I. & Маlenkov D. А. (2010). Aritmogennye oslozhneniya gipertroficheskoj kardiomiopatii [Arrhythmogenic complications of hypertrophic cardiomyopathy]. Annaly aritmologii, 3, 62–69. [in Russian].
Varma, K. P. & Neema, P. K. (2014). Hypertrophic cardiomyopathy: Part 1 ‑ introduction, pathology and pathophysiology. Annals of Cardiac Anaesthesia, 17(2), 118–124. doi: 10.4103/0971-9784.129841
Elliott, P. M., Anastasakis, A., Borger, M. A., Borggrefe, M., Cecchi, F., Charron, P., et al. (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), 2733–2779. doi: 10.1093/eurheartj/ehu284
Taub, G. S., Balla, E. A., Gorovenko, I. I. & Shakhnyuk, N. E. (2016). Gipertroficheskaya kardiomiopatiya i trudnosti eye diagnostiki v lechebnoj praktike [Hypertrophic cardiomyopathy and difficulties of its diagnosis in treatment practice]. Zhurnal grodnenskogo gosudarstvennogo meditsinskogo universiteta - Journal of the Grodno State Medical University, 4, 117 -120. [in Russian].
Osovskaya, N. Yu. (2012). Kardiomiopatii: osnovnye principy klassifikacii i diagnostiki [Cardiomyopathy: the basic principles of classification and diagnosis]. Zdoro’ya Ukrayiny. Tematychnyi nomer, 52–54. [in Russian].
Varnava, A. M., Elliott, P. M., Sharma, S., McKenna, W. J. & Davies, M. J. (2000). Hypertrophic cardiomyopathy: the interrelation of disarray, fibrosis and small vessel disease. Heart, 84(5), 476–482. doi: 10.1136/heart.84.5.476
Kosovski, L. & Fernandes, S. (2015). Sudden cardiac death a modern pathology approach to hypertrophic cardiomyopathy. Arch. Pathol. Lab. Med., 139(3), 413–416. doi: 10.5858/arpa.2013-0489-RS
Varnava, A. M., Elliott, P. M., Mahon, N., Davies, M. J. & McKenna, W. J. (2001). Relation between myocyte disarray and outcome in hypertrophic cardiomyopathy. Am. J. Cardiol., 88(3), 275–279. doi: 10.1016/S0002-9149(01)01640-X
Almaas, V. M. & Amlie, J. P. (2010). Histopathological changes and clinical implications in patients with hypertrophic cardiomyopathy. European Cardiology, 6(2), 88–91. doi: 10.15420/ecr.2010.6.2.88
Masuda, H., Yamauchi, M., Yoshida, M., Takahashi, M., Nanjo, H., Asari, Y., & Sugita, A. (2005). Side‐to‐side linking of myocardial cells in hypertrophic cardiomyopathy: whole heart microscopic observation with tangential sections. Pathology International, 55(11), 677–687. doi: 10.1111/j.1440-1827.2005.01894.x
Cunningham, K. S., Veinot, J. P. & Butany, J. (2006). An approach to endomyocardial biopsy interpretation. J. Clin. Pathol., 59 (2), 121–129. doi: 10.1136/jcp.2005.026443
Muthiah, R. (2016). Apical right ventricular hypertrophic cardiomyopathy – a case report. Case reports in clinical medicine, 5, 57–60. doi: 10.4236/crcm.2016.52010
Maron, B. J., Sato, N., Robert, W. C., Edwards, J. E. & Chandra, R. S. (1979). Quantitative analysis of cardiac muscle cell disorganization in the ventricular septum. Comparison of fetuses and infants with and without congenital heart disease and patients with hypertrophic cardiomyopathy. Circulation, 60(3), 685–696.
Naidu, S. (2015). Hypertrophic cardiomyopathy. Springer: Verlag London.
Shliakhto, E. V., Bokeriia, L. A., Rybakova, M. G., Semernin, E. N., Selivanova, G. V., Vlasova, T. D., et al. (2007). Kletochnye aspekty patogeneza gipertroficheskoj kardiomiopatii: rol' poliploidii kardiomiocitov i aktivaciiv miokarda yadernogo antigena proliferiruyushchej kletki [Cell aspects of pathogenesis of hypertrophic cardiomyopathy: the role of cardiomyocyte polyploidy and activation of the proliferating cell nuclear antigen in myocardium]. Tsitologiya, 49(10), 817–823. [in Russian].
Gudkova, A. Ya., Rybakova, M. G., Bockeria, L. A. & Shlyakhto, E. V. (2012). Gipertroficheskaya kardiomiopatiya. Kliniko-morfologicheskie sopostavleniya [Hypertrophic cardiomyopathy. Clinical and morphological comparisons]. Arkhiv patologii, 4, 8–11. [in Russian].
Fidzianska, A., Bilinska, Z. T. & Walczak, E. (2010). Autophagy in transition from hypertrophic cardiomyopathy to heart failure. J. Electron. Microsc. (Tokyo), 59(2), 181–183. doi: 10.1093/jmicro/dfp048
Kimura, H., Eguchi, S., Sasaki, J., Kuba, K., Nakanishi, H., Takasuga, Sh. et al. (2017). Vps34 regulates myofibril proteostasis to prevent hypertrophic cardiomyopathy. Journal of clinical investigation insight, 2(1), 2–17. doi: 10.1172/jci.insight.89462
Bogaert, J., Dymarkowski, S., Taylor, A. M. & Muthurangu, V. (2012). Clinical cardiac MRI. Springer: Verlag Berlin Heidelberg.
Pinali, C., Bennett, H. J., Davenport, J. B., Caldwell, J. L., Starborg, T., Trafford, A. W., & Kitmitto, A. (2015). Three-dimensional structure of the intercalated disc reveals plicate domain and gap junction remodeling in heart failure. Biophys. J., 108(3), 498–507. doi: 10.1016/j.bpj.2014.12.001
Heusch, G., Libby, P., Gersh, B., Yellon, D., Böhm, M., Lopaschuk, G., & Opie, L. (2014). Lancet seminar: cardiovascular remodelling in coronary artery disease and heart failure. Lancet, 383(9932), 1933–1943. doi: 10.1016/S0140-6736(14)60107-0
Ho, C. Y., López, B., Coelho-Filho, O. R. , Lakdawala, N. K., Cirino, A. L., Jarolim, P. et al. (2010). Myocardial fibrosis as an early manifestation of hypertrophic cardiomyopathy. N. Engl. J. Med., 363(6), 552–563. doi: 10.1056/NEJMoa1002659
Shirani, J., William, R. P., Roberts, C. & Maron, B. J. (2000). Morphology and significance of the left ventricular collagen network in young patients with hypertrophic cardiomyopathy and sudden cardiac death. Journal of American College of cardiology, 35(1), 36–44. doi: 10.1016/S0735-1097(99)00492-1
Savchenko, M. I., Kovalev, Yu. R. & Kuchinskiy, A. P. (2013). Gipertroficheskaya kardiomiopatiya: fibroz ili gipertrofiya [Hypertrophic cardiomyopathy: fibrosis or hypertrophy]. Arterial'naya gipertenziya, 19(2), 148–155. [in Russian].
Harvey, P. A. & Leinwand, L. A. (2011). The cell biology of disease: cellular mechanisms of cardiomyopathy. J. Cell. Biol., 194(3), 355–365. doi: 10.1083/jcb.201101100
Contaldi, C. (2016). Assessment of myocardial fibrosis in hypertrophic cardiomyopathy by cardiac magnetic resonance: modalities and clinical applications. International cardiovascular forum journal, 8, 3–9. doi: 10.17987/icfj.v8i0.253
Noureldin, R. A., Liu, S., Nacif, M. S., Judge, D. P., Halushka, M. K., Abraham, T. P., et al. (2012). The diagnosis of hypertrophic cardiomyopathy by cardiovascular magnetic resonance. J. Cardiovasc. Magn. Reson., 14, 17. doi: 10.1186/1532-429X-14-17
Moravski, G., Ofek, E., Rakowski, H., Butany, J., Williams, L., Ralph-Edwards, A. et al. (2013). Myocardial fibrosis in hypertrophic cardiomyopathy. JACC: Cardiovascular imaging, 6(5), 587–596. doi: 10.1016/j.jcmg.2012.09.018
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)