Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder characterized by left ventricular hypertrophy. Sudden cardiac death (SCD) is a rare but the most catastrophic complication in patients with HCM. Implantable cardioverter-defibrillators (ICDs) are widely recognized as effective preventive measures for SCD. Individualized risk stratification and early intervention in HCM can significantly improve patient prognosis. In this study, we review the latest findings regarding pathogenesis, risk stratification, and prevention of SCD in HCM patients, highlighting the clinic practice of cardiovascular magnetic resonance imaging for SCD management.
Similar content being viewed by others
Availability of data and materials
Not applicable.
References
Semsarian C, Ingles J, Maron MS, Maron BJ (2015) New perspectives on the prevalence of hypertrophic cardiomyopathy. J Am Coll Cardiol 65(12):1249–1254. https://doi.org/10.1016/j.jacc.2015.01.019
Nishimura RA, Ommen SR, Tajik AJ (2003) Cardiology patient page. Hypertrophic cardiomyopathy: a patient perspective Circulation 108(19):e133–e135
Maron BJ, Rowin EJ, Maron MS (2018) Global burden of hypertrophic cardiomyopathy. JACC Heart Fail 6(5):376–378. https://doi.org/10.1016/j.jchf.2018.03.004
Maron BJ, Rowin EJ, Casey SA, Maron MS (2016) How hypertrophic cardiomyopathy became a contemporary treatable genetic disease with low mortality: shaped by 50 years of clinical research and practice. JAMA Cardiol 1(1). https://doi.org/10.1001/jamacardio.2015.0354
Park YM (2023) Updated risk assessments for sudden cardiac death in hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillator. Korean J Intern Med 38(1). https://doi.org/10.3904/kjim.2022.144
Maron BJ, Rowin EJ, Maron MS (2021) Evolution of risk stratification and sudden death prevention in hypertrophic cardiomyopathy: twenty years with the implantable cardioverter-defibrillator. Heart Rhythm 18(6):1012–1023. https://doi.org/10.1016/j.hrthm.2021.01.019
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P et al (2020) 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 142(25):e558–e631. https://doi.org/10.1161/CIR.0000000000000937
Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P 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):2733–2779. https://doi.org/10.1093/eurheartj/ehu284
Maron BJ, Maron MS, Maron BA, Loscalzo J (2019) Moving beyond the sarcomere to explain heterogeneity in hypertrophic cardiomyopathy: JACC review topic of the week. J Am Coll Cardiol 73(15):1978–1986. https://doi.org/10.1016/j.jacc.2019.01.061
Maron BJ, Maron MS (2013) Hypertrophic cardiomyopathy. Lancet (London, England) 381(9862):242–255. https://doi.org/10.1016/S0140-6736(12)60397-3
Seidman CE, Seidman JG (2011) Identifying sarcomere gene mutations in hypertrophic cardiomyopathy: a personal history. Circ Res 108(6):743–750. https://doi.org/10.1161/CIRCRESAHA.110.223834
Marian AJ, Braunwald E (2017) Hypertrophic cardiomyopathy genetics, Pathogenesis, clinical manifestations, diagnosis, and therapy. Circ Res 121(7):749–770. https://doi.org/10.1161/circresaha.117.311059
Prondzynski M, Mearini G, Carrier L (2019) Gene therapy strategies in the treatment of hypertrophic cardiomyopathy. Pflugers Arch 471(5):807–815. https://doi.org/10.1007/s00424-018-2173-5
Khera AV, Mason-Suares H, Brockman D, Wang M, VanDenburgh MJ, Senol-Cosar O et al (2019) Rare genetic variants associated with sudden cardiac death in adults. J Am Coll Cardiol 74(21):2623–2634. https://doi.org/10.1016/j.jacc.2019.08.1060
Shen H, Dong S-Y, Ren M-S, Wang R (2022) Ventricular arrhythmia and sudden cardiac death in hypertrophic cardiomyopathy: from bench to bedside. Frontiers In Cardiovascular Medicine 9:949294. https://doi.org/10.3389/fcvm.2022.949294
Chida A, Inai K, Sato H, Shimada E, Nishizawa T, Shimada M et al (2017) Prognostic predictive value of gene mutations in Japanese patients with hypertrophic cardiomyopathy. Heart Vessels 32(6):700–707. https://doi.org/10.1007/s00380-016-0920-0
Fraysse B, Weinberger F, Bardswell SC, Cuello F, Vignier N, Geertz B et al (2012) Increased myofilament Ca2+ sensitivity and diastolic dysfunction as early consequences of Mybpc3 mutation in heterozygous knock-in mice. J Mol Cell Cardiol 52(6):1299–1307. https://doi.org/10.1016/j.yjmcc.2012.03.009
Jacoby D, McKenna WJ (2012) Genetics of inherited cardiomyopathy. Eur Heart J 33(3):296–304. https://doi.org/10.1093/eurheartj/ehr260
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA et al (2022) 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 43(40):3997–4126. https://doi.org/10.1093/eurheartj/ehac262
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C et al (2023) 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J. https://doi.org/10.1093/eurheartj/ehad194
Finocchiaro G, Sheikh N, Leone O, Westaby J, Mazzarotto F, Pantazis A et al (2021) Arrhythmogenic potential of myocardial disarray in hypertrophic cardiomyopathy: genetic basis, functional consequences and relation to sudden cardiac death. Europace 23(7):985–995. https://doi.org/10.1093/europace/euaa348
Pelliccia F, Cecchi F, Olivotto I, Camici PG (2022) Microvascular dysfunction in hypertrophic cardiomyopathy. J Clin Med 11(21). https://doi.org/10.3390/jcm11216560
Maron BJ (2010) Contemporary insights and strategies for risk stratification and prevention of sudden death in hypertrophic cardiomyopathy. Circulation 121(3):445–456. https://doi.org/10.1161/CIRCULATIONAHA.109.878579
Coppini R, Ferrantini C, Yao L, Fan P, Del Lungo M, Stillitano F et al (2013) Late sodium current inhibition reverses electromechanical dysfunction in human hypertrophic cardiomyopathy. Circulation 127(5):575–584. https://doi.org/10.1161/CIRCULATIONAHA.112.134932
Coppini R, Ferrantini C, Del Lungo M, Stillitano F, Sartiani L, Tosi B et al (2013) Response to letter regarding article, “Late sodium current inhibition reverses electromechanical dysfunction in human hypertrophic cardiomyopathy.” Circulation 128(10):e157. https://doi.org/10.1161/CIRCULATIONAHA.113.004016
Tashiro N, Muneuchi J, Ezaki H, Kobayashi M, Yamada H, Sugitani Y et al (2022) Ventricular repolarization dispersion is a potential risk for the development of life-threatening arrhythmia in children with hypertrophic cardiomyopathy. Pediatr Cardiol 43(7):1455–1461. https://doi.org/10.1007/s00246-022-02867-3
Cheng Z, Fang T, Huang J, Guo Y, Alam M, Qian H (2021) Hypertrophic cardiomyopathy: from phenotype and pathogenesis to treatment. Frontiers In Cardiovascular Medicine 8:722340. https://doi.org/10.3389/fcvm.2021.722340
Helms AS, Alvarado FJ, Yob J, Tang VT, Pagani F, Russell MW et al (2016) Genotype-dependent and -independent calcium signaling dysregulation in human hypertrophic cardiomyopathy. Circulation 134(22):1738–1748
Okuda S, Sufu-Shimizu Y, Kato T, Fukuda M, Nishimura S, Oda T et al (2018) CaMKII-mediated phosphorylation of RyR2 plays a crucial role in aberrant Ca release as an arrhythmogenic substrate in cardiac troponin T-related familial hypertrophic cardiomyopathy. Biochem Biophys Res Commun 496(4):1250–1256. https://doi.org/10.1016/j.bbrc.2018.01.181
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO (2009) Sudden deaths in young competitive athletes. Circulation 119(8):1085–1092. https://doi.org/10.1161/circulationaha.108.804617
Finocchiaro G, Bhatia RT, Westaby J, Behr ER, Papadakis M, Sharma S et al (2023) Sudden cardiac death during exercise in young individuals with hypertrophic cardiomyopathy. JACC: Clin Electrophysiol 9(6):865–7. https://doi.org/10.1016/j.jacep.2022.12.007
Sharma S, Pelliccia A, Gati S (2020) The ‘Ten Commandments’ for the 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. https://doi.org/10.1093/eurheartj/ehaa735
Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P et al (2020) 2020 AHA/ACC Guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 142(25):e533–e557. https://doi.org/10.1161/CIR.0000000000000938
Sweeting J, Ingles J, Ball K, Semsarian C (2018) A control theory-based pilot intervention to increase physical activity in patients with hypertrophic cardiomyopathy. Am J Cardiol 122(5):866–871. https://doi.org/10.1016/j.amjcard.2018.05.023
Pelliccia A, Lemme E, Maestrini V, Di Paolo FM, Pisicchio C, Di Gioia G et al (2018) Does sport participation worsen the clinical course of hypertrophic cardiomyopathy? Circulation 137(5):531–533. https://doi.org/10.1161/circulationaha.117.031725
Lampert R, Ackerman MJ, Marino BS, Burg M, Ainsworth B, Salberg L et al (2023) Vigorous exercise in patients with hypertrophic cardiomyopathy. JAMA Cardiol 8(6). https://doi.org/10.1001/jamacardio.2023.1042
Gati S, Sharma S (2022) Exercise prescription in individuals with hypertrophic cardiomyopathy: what clinicians need to know. Heart 108(24):1930–1937. https://doi.org/10.1136/heartjnl-2021-319861
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE et al (2003) American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol 42(9):1687–713. https://doi.org/10.1016/s0735-1097(03)00941-0
Maron MS, Rowin EJ, Wessler BS, Mooney PJ, Fatima A, Patel P et al (2019) Enhanced American College of Cardiology/American Heart Association strategy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy. JAMA Cardiol 4(7):644–657. https://doi.org/10.1001/jamacardio.2019.1391
Rowin EJ, Maron BJ, Haas TS, Garberich RF, Wang W, Link MS et al (2017) Hypertrophic cardiomyopathy with left ventricular apical aneurysm: implications for risk stratification and management. J Am Coll Cardiol 69(7):761–773. https://doi.org/10.1016/j.jacc.2016.11.063
Lee DZJ, Montazeri M, Bataiosu R, Hoss S, Adler A, Nguyen ET et al (2022) Clinical characteristics and prognostic importance of left ventricular apical aneurysms in hypertrophic cardiomyopathy. JACC Cardiovasc Imaging 15(10):1696–1711. https://doi.org/10.1016/j.jcmg.2022.03.029
Debonnaire P, Katsanos S, Joyce E, OV VDB, Atsma DE, Schalij MJ et al (2015) QRS fragmentation and QTc duration relate to malignant ventricular tachyarrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 26(5):547–555. https://doi.org/10.1111/jce.12629
Dinshaw L, Munch J, Dickow J, Lezius S, Willems S, Hoffmann BA et al (2018) The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy. Clin Res Cardiol 107(2):130–137. https://doi.org/10.1007/s00392-017-1164-4
Wu G, Liu J, Wang S, Yu S, Zhang C, Wang D et al (2021) N-terminal pro-brain natriuretic peptide and sudden cardiac death in hypertrophic cardiomyopathy. Heart 107(19):1576–1583. https://doi.org/10.1136/heartjnl-2020-317701
Ramchand J, Fava AM, Chetrit M, Desai MY (2020) Advanced imaging for risk stratification of sudden death in hypertrophic cardiomyopathy. Heart 106(11):793–801. https://doi.org/10.1136/heartjnl-2019-315176
Weng Z, Yao J, Chan RH, He J, Yang X, Zhou Y et al (2016) Prognostic value of LGE-CMR in HCM: a meta-analysis. JACC Cardiovasc Imaging 9(12):1392–1402. https://doi.org/10.1016/j.jcmg.2016.02.031
Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130(6):484–495. https://doi.org/10.1161/CIRCULATIONAHA.113.007094
Li Y, Liu X, Yang F, Wang J, Xu Y, Fang T et al (2021) Prognostic value of myocardial extracellular volume fraction evaluation based on cardiac magnetic resonance T1 mapping with T1 long and short in hypertrophic cardiomyopathy. Eur Radiol 31(7):4557–4567. https://doi.org/10.1007/s00330-020-07650-7
Qin L, Min J, Chen C, Zhu L, Gu S, Zhou M et al (2021) Incremental values of T1 mapping in the prediction of sudden cardiac death risk in hypertrophic cardiomyopathy: a comparison with two guidelines. Front Cardiovasc Med 8:661673. https://doi.org/10.3389/fcvm.2021.661673
Avanesov M, Munch J, Weinrich J, Well L, Saring D, Stehning C et al (2017) Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR. Eur Radiol 27(12):5136–5145. https://doi.org/10.1007/s00330-017-4869-x
Xu Z, Wang J, Cheng W, Wan K, Li W, Pu L et al (2023) Incremental significance of myocardial oedema for prognosis in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jead065
Yang F, Wang J, Li Y, Li W, Xu Y, Wan K et al (2019) The prognostic value of biventricular long axis strain using standard cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Int J Cardiol 294:43–49. https://doi.org/10.1016/j.ijcard.2019.08.010
Yang F, Wang L, Wang J, Pu L, Xu Y, Li W et al (2021) Prognostic value of fast semi-automated left atrial long-axis strain analysis in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 23(1):36. https://doi.org/10.1186/s12968-021-00735-2
Wang J, Li Y, Yang F, Bravo L, Wan K, Xu Y et al (2021) Fractal analysis: prognostic value of left ventricular trabecular complexity cardiovascular MRI in participants with hypertrophic cardiomyopathy. Radiology 298(1):71–79. https://doi.org/10.1148/radiol.2020202261
Fahmy AS, Neisius U, Chan RH, Rowin EJ, Manning WJ, Maron MS et al (2020) Three-dimensional deep convolutional neural networks for automated myocardial scar quantification in hypertrophic cardiomyopathy: a multicenter multivendor study. Radiology 294(1):52–60. https://doi.org/10.1148/radiol.2019190737
Wang J, Bravo L, Zhang J, Liu W, Wan K, Sun J et al (2021) Radiomics analysis derived from LGE-MRI predict sudden cardiac death in participants with hypertrophic cardiomyopathy. Front Cardiovasc Med 8:766287. https://doi.org/10.3389/fcvm.2021.766287
Zegkos T, Tziomalos G, Parcharidou D, Ntelios D, Papanastasiou CA, Karagiannidis E et al (2022) Validation of the new American College of Cardiology/American Heart Association Guidelines for the risk stratification of sudden cardiac death in a large Mediterranean cohort with hypertrophic cardiomyopathy. Hellenic J Cardiol 63:15–21. https://doi.org/10.1016/j.hjc.2021.06.005
Wang J, Zhang Z, Li Y, Xu Y, Wan K, Chen Y (2019) Variable and limited predictive value of the European Society of Cardiology hypertrophic cardiomyopathy sudden-death risk model: a meta-analysis. Can J Cardiol 35(12):1791–1799. https://doi.org/10.1016/j.cjca.2019.05.004
Taha M, Dahat P, Toriola S, Satnarine T, Zohara Z, Adelekun A et al (2023) Metoprolol or verapamil in the management of patients with hypertrophic cardiomyopathy: a systematic review. Cureus. https://doi.org/10.7759/cureus.43197
Pollick C (1982) Muscular subaortic stenosis. N Engl J Med 307(16):997–999. https://doi.org/10.1056/nejm198210143071607
Adelman AG, Shah PM, Gramiak R, Wigle ED (1970) Long-term propranolol therapy in muscular subaortic stenosis. Heart 32(6):804–811. https://doi.org/10.1136/hrt.32.6.804
Hegde SM, Lester SJ, Solomon SD, Michels M, Elliott PM, Nagueh SF et al (2021) Effect of mavacamten on echocardiographic features in symptomatic patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 78(25):2518–2532. https://doi.org/10.1016/j.jacc.2021.09.1381
Maron BJ, Shen WK, Link MS, Epstein AE, Almquist AK, Daubert JP et al (2000) Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med 342(6):365–373. https://doi.org/10.1056/nejm200002103420601
Shun-Shin MJ, Zheng SL, Cole GD, Howard JP, Whinnett ZI, Francis DP (2017) Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials. Eur Heart J 38(22):1738–1746. https://doi.org/10.1093/eurheartj/ehx028
Elliott P (2021) Sudden cardiac death in hypertrophic cardiomyopathy: time to change the narrative. Eur Heart J 42(38):3945–3947. https://doi.org/10.1093/eurheartj/ehab608
Funding
This work was supported by grants from the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (Grant Number: 2023HXFH041), the Natural Science Foundation of Sichuan Province (Grant Number: 23NSFSC4589), and the National Natural Science Foundation of China (Grant Number: 82202248).
Author information
Authors and Affiliations
Contributions
LP, JL, WQ, JZ, HC, ZT, YH, JW, and YC contributed to the conception/design of the work, acquisition of data, interpretation of the data, and writing/revising the manuscript. All authors read and approved the final manuscript and take responsibility for all aspects of the reliability of the data presented and their discussed interpretation.
Corresponding authors
Ethics declarations
Ethical approval
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Pu, L., Li, J., Qi, W. et al. Current perspectives of sudden cardiac death management in hypertrophic cardiomyopathy. Heart Fail Rev 29, 395–404 (2024). https://doi.org/10.1007/s10741-023-10355-w
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10741-023-10355-w