Гипертрофическая кардиомиопатия у пожилых: причины, диагностика, лечение

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Гипертрофическая кардиомиопатия (ГКМП) – самая распространенная наследственная патология сердца с высокой клинической гетерогенностью. У каждого пятого больного диагноз впервые устанавливается в возрасте старше 60 лет. В обзоре обсуждаются возможные причины позднего дебюта гипертрофической кардиомиопатии, особенности диагностики и лечения этого заболевания у пожилых больных.

Об авторах

Ольга Сергеевна Чумакова

ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ

Автор, ответственный за переписку.
Email: chumakovaolga@bk.ru
ORCID iD: 0000-0003-2373-1183

к.м.н., доц. каф. терапии, кардиологии и функциональной диагностики с курсом нефрологии

Россия, Москва

Список литературы

  1. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J. 2014;35(39):2733-79. doi: 10.1093/eurheartj/ehu284
  2. Semsarian C, Ingles J, Maron MS, Maron BJ. New perspectives on the prevalence of hypertrophic cardiomyopathy. J Am Coll Cardiol. 2015;65(12):1249-54. doi: 10.1016/j.jacc.2015.01.019
  3. Marian AJ, Braunwald E. Hypertrophic Cardiomyopathy: Genetics, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy. Circ Res. 2017;121(7):749-70. doi: 10.1161/CIRCRESAHA.117.311059
  4. Maron BJ, Harris KM, Spirito P, et al. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation. 2006;114:216-25. doi: 10.1161/CIRCULATIONAHA.105.583500
  5. Hardarson T, De la Calzada CS, Curiel R, Goodwin JF. Prognosis and mortality of hypertrophic obstructive cardiomyopathy. Lancet. 1973;2(7844):1462-7. doi: 10.1016/s0140-6736(73)92730-x
  6. Charron P, Elliott PM, Gimeno JR, et al.; EORP Cardiomyopathy Registry Investigators. The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: baseline data and contemporary management of adult patients with cardiomyopathies. Eur Heart J. 2018;39(20):1784-93. doi: 10.1093/eurheartj/ehx819
  7. Maron BJ, Rowin EJ, Casey SA, et al. What Do Patients With Hypertrophic Cardiomyopathy Die from? Am J Cardiol. 2016;117(3):434-5. doi: 10.1016/j.amjcard.2015.11.013
  8. Maron BJ, Casey SA, Haas TS, et al. Hypertrophic Cardiomyopathy With Longevity to 90 Years or Older. Am J Cardiol. 2012;109(9):1341-7. doi: 10.1016/j.amjcard.2011
  9. Ho CY, Day SM, Ashley EA, et al. Genotype and Lifetime Burden of Disease in Hypertrophic Cardiomyopathy: Insights from the Sarcomeric Human Cardiomyopathy Registry (SHaRe). Circulation. 2018;138(14):1387-98. doi: 10.1161/CIRCULATIONAHA.117.033200
  10. Maron BJ, Casey SA, Maron MS. How Hypertrophic Cardiomyopathy Became a Contemporary Treatable Genetic Disease With Low Mortality. Shaped by 50 Years of Clinical Research and Practice. JAMA Cardiol. 2016;1(1):98-105. doi: 10.1001/jamacardio.2015.0354
  11. Lorenzini M, Anastasiou Z, O’Mahony C, et al. Mortality Among Referral Patients With Hypertrophic Cardiomyopathy vs the General European Population. JAMA Cardiol. 2019; p. E1-E8. doi: 10.1001/jamacardio.2019.4534
  12. Geisterfer-Lowrance AAT, Kass S, Tanigawa G, et al. A Molecular Basis for Familial Hypertrophic Cardiomyopathy: A beta Cardiac Myosin Heavy Chain Gene Missense Mutation. Cell. 1990;62:999-1006. doi: 10.1016/0092-8674(90)90274-i
  13. Maron BJ, Maron MS, Maron BA, Loscalzo J. Moving Beyond the Sarcomere to Explain Heterogeneity in Hypertrophic Cardiomyopathy: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;73(15):1978-86. doi: 10.1016/j.jacc.2019.01.061
  14. Ingles J, Burns C, Bagnall RD, et al. Nonfamilial Hypertrophic Cardiomyopathy: Prevalence, Natural History, and Clinical Implications. Circ Cardiovasc Genet. 2017;10(2):e001620. doi: 10.1161/CIRCGENETICS.116.001620
  15. Anan R, Niimura H, Takenaka T, et al. Mutations in the genes for sarcomeric proteins in Japanese patients with onset sporadic hypertrophic cardiomyopathy after age 40 years. Am J Cardiol. 2007;99(12):1750-4. doi: 10.1016/j.amjcard.2007.01.066
  16. Hirota T, Kitaoka H, Kubo T, et al. Morphologic characteristics of hypertrophic cardiomyopathy of the elderly with cardiac myosin-binding protein C gene mutations. Circ J. 2006;70(7):875-9. doi: 10.1253/circj.70.875
  17. Bos JM, Will ML, Gersh BJ, et al. Characterization of a phenotype-based genetic test prediction score for unrelated patients with hypertrophic cardiomyopathy. Mayo Clin Proc. 2014;89(6):727-37. doi: 10.1016/j.mayocp.2014.01.025
  18. Alfares AA, Kelly MA, McDermott G, et al. Results of clinical genetic testing of 2,912 probands with hypertrophic cardiomyopathy: expanded panels offer limited additional sensitivity. Genet Med. 2015;17(11):880-8. doi: 10.1038/gim.2014.205
  19. Bagnall RD, Ingles J, Dinger ME, et al. Whole Genome Sequencing Improves Outcomes of Genetic Testing in Patients With Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2018;72(4):419-29. doi: 10.1016/j.jacc.2018.04.078
  20. Van Driest SL AM, Ommen SR, Shakur R, et al. Prevalence and severity of «benign» mutations in the beta-myosin heavy chain, cardiac troponin T, and α-tropomyosin genes in hypertrophic cardiomyopathy. Circulation. 2002;106(24):3085-90. doi: 10.1161/01.cir.0000042675.59901.14
  21. Oliva-Sandoval MJ, Ruiz-Espejo F, Monserrat L, et al. Insights into genotype-phenotype correlation in hypertrophic cardiomyopathy. Findings from 18 Spanish families with a single mutation in MYBPC3. Heart. 2010;96(24):1980-4. doi: 10.1136/hrt.2010.200402
  22. Jansweijer JA, van Spaendonck-Zwarts KY, Tanck MWT, et al. Heritability in genetic heart disease: the role of genetic background. Open Heart. 2019;6(1):e000929. doi: 10.1136/openhrt-2018-000929
  23. Cerrone M, Remme CA, Tadros R, et al. Beyond the One Gene-One Disease Paradigm: Complex Genetics and Pleiotropy in Inheritable Cardiac Disorders. Circulation. 2019;140(7):595-610. doi: 10.1161/CIRCULATIONAHA.118.035954
  24. Li L, Bainbridge MN, Tan Y, et al. A Potential Oligogenic Etiology of Hypertrophic Cardiomyopathy: A Classic Single-Gene Disorder. Circ Res. 2017;120(7):1084-90. doi: 10.1161/CIRCRESAHA.116.310559
  25. Burns C, Bagnall RD, Lam L, et al. Multiple Gene Variants in Hypertrophic Cardiomyopathy in the Era of Next-Generation Sequencing. Circ Cardiovasc Genet. 2017;10(4):e001666. doi: 10.1161/CIRCGENETICS.116.001666
  26. Mouton JM, van der Merwe L, Goosen A, et al. MYBPH acts as modifier of cardiac hypertrophy in hypertrophic cardiomyopathy (HCM) patients. Hum Genet. 2016;135(5):477-83. doi: 10.1007/s00439-016-1649-7
  27. Wooten EC, Hebl VB, Wolf MJ, et al. Formin Homology 2 Domain Containing 3 (FHOD3) Variants Associated with Hypertrophic Cardiomyopathy. Circ Cardiovasc Genet. 2013;6(1):10-8. doi: 10.1161/CIRCGENETICS.112.965277
  28. Perkins MJ Van Driest SL, Ellsworth EG, et al. Gene-specific modifying effects of pro-LVH polymorphisms involving the renin-angiotensin-aldosterone system among 389 unrelated patients with hypertrophic cardiomyopathy. Eur Heart J. 2005;26:2457-62. doi: 10.1093/eurheartj/ehi438
  29. Ortlepp JR, Vosberg HP, Reith S, et al. Genetic polymorphisms in the renin-angiotensin-aldosterone system associated with expression of left ventricular hypertrophy in hypertrophic cardiomyopathy: a study of five polymorphic genes in a family with a disease causing mutation in the myosin binding protein C gene. Heart. 2002;87:270-5. doi: 10.1136/heart.87.3.270
  30. Kolder IC, Michels M, Christiaans I, et al. The role of renin-angiotensin-aldosterone system polymorphisms in phenotypic expression of MYBPC3-related hypertrophic cardiomyopathy. Eur J Hum Genet. 2012;20(10):1071-7. doi: 10.1038/ejhg.2012.48
  31. Axelsson A, Iversen K, Vejlstrup N, et al. Efficacy and safety of the angiotensin II receptor blocker losartan for hypertrophic cardiomyopathy: the INHERIT randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2015;3(2):123-31. doi: 10.1016/S2213-8587(14)70241-4
  32. Maron MS, Chan RH, Kapur NK, et al. Effect of Spironolactone on Myocardial Fibrosis and Other Clinical Variables in Patients with Hypertrophic Cardiomyopathy. Am J Med. 2018;131(7):837-41. doi: 10.1016/j.amjmed.2018.02.025
  33. Binder J, Ommen SR, Gersh BJ, et al. Echocardiography-guided genetic testing in hypertrophic cardiomyopathy: septal morphological features predict the presence of myofilament mutations. Mayo Clin Proc. 2006;81(4):459-67. doi: 10.4065/81.4.459
  34. Kubo T, Kitaoka H, Okawa M, et al. Hypertrophic cardiomyopathy in the elderly. Geriatr Gerontol Int. 2010;10(1):9-16. doi: 10.1111/j.1447-0594.2009.00572.x
  35. Lever HM, Karam RF, Currie PJ, Healy BP. Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape. Circulation. 1989;79(3):580-9. doi: 10.1161/01.cir.79.3.580
  36. Canepa M, Malti O, David M, et al. Prevalence, Clinical Correlates and Functional Impact of Subaortic Ventricular Septal Bulge (From the Baltimore Longitudinal Study of Aging). Am J Cardiol. 2014;114(5):796-802. doi: 10.1016/j.amjcard.2014.05.068
  37. Ranasinghe I, Ayoub C, Cheruvu C, et al. Isolated hypertrophy of the basal ventricular septum: characteristics of patients with and without outflow tract obstruction. Int J Cardiol. 2014;173(3):487-93. doi: 10.1016/j.ijcard.2014.03.078
  38. Turer AT, Samad Z, Valente AM, et al. Anatomic and clinical correlates of septal morphology in hypertrophic cardiomyopathy. Eur J Echocardiogr. 2011;12(2):131-9. doi: 10.1093/ejechocard/jeq163
  39. Bos JM, Will M, Ommen S, et al. Yield of genetic testing among patients with hypertrophic cardiomyopathy diagnosed after 65 years of age. JACC. 2013;61(10):E1305. doi: 10.1016/S0735-1097(13)61305-4
  40. Hata Y, Ichimata S, Yamaguchi Y, et al. Clinicopathological and Genetic Profiles of Cases with Myocyte Disarray - Investigation for Establishing the Autopsy Diagnostic Criteria for Hypertrophic Cardiomyopathy. J Clin Med. 2019;8(4):463. doi: 10.3390/jcm8040463
  41. Maleszewski JJ. Cardiac amyloidosis: pathology, nomenclature and typing. Cardiovascular Pathology. 2015;24(6):343-50. doi: 10.1016/j.carpath.2015.07.008
  42. Maurizi N, Rella V, Fumagalli C, et al. Prevalence of cardiac amyloidosis among adult patients referred to tertiary centres with an initial diagnosis of hypertrophic cardiomyopathy. Int J Cardiol. 2019:S0167-5273(19)30935-0. doi: 10.1016/j.ijcard.2019.07.051
  43. González-López E, Gallego-Delgado M, Guzzo-Merello G, et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015;36(38):2585-94. doi: 10.1093/eurheartj/ehv338
  44. Spada M, Pagliardini S, Yasuda M, et al. High incidence of later-onset fabry disease revealed by newborn screening. Am J Hum Genet. 2006;79(1):31-40. doi: 10.1086/504601
  45. Monserrat L, Gimeno-Blanes JR, Marin F, et al. Prevalence of fabry disease in a cohort of 508 unrelated patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2007;50(25):2399-403. doi: 10.1016/j.jacc.2007.06.062
  46. Sachdev B, Takenaka T, Teraguchi H, et al. Prevalence of Anderson-Fabry disease in male patients with late onset hypertrophic cardiomyopathy. Circulation. 2002;105:1407-11. doi: 10.1161/01.cir.0000012626.81324.38
  47. Ammirati E, Contri R, Coppini R, et al. Pharmacological treatment of hypertrophic cardiomyopathy: current practice and novel perspectives. Eur J Heart Fail. 2016;18(9):1106-18. doi: 10.1002/ejhf.541
  48. Leong KMW, Chow JJ, Ng FS, et al. Comparison of the Prognostic Usefulness of the European Society of Cardiology and American Heart Association/American College of Cardiology Foundation Risk Stratification Systems for Patients With Hypertrophic Cardiomyopathy. Am J Cardiol. 2018;121(3):349-55. doi: 10.1016/j.amjcard.2017.10.027
  49. Ушкалова Е.А. Зырянов С.К., Затолочина К.Э. и др. Применение антиаритмических средств у пожилых пациентов. Препараты I и II класса по классификации Вогана-Вильямса. Рациональная Фармакотерапия в Кардиологии. 2016;12(4):471-8 [Ushkalova EA, Zyryanov SK, Zatolochina KE, et al. Antiarrhythmic drugs use in elderly patients. Vaughan Williams class I and II drugs. Rational Pharmacotherapy in Cardiology. 2016;12(4):471-8 (In Russ.)]. doi: 10.20996/1819-6446-2016-12-4-471-478
  50. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(24):e783-831. doi: 10.1161/CIR.0b013e318223e2bd
  51. Liebregts M, Steggerda RC, Vriesendorp PA, et al. Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy. JACC Cardiovasc Interv. 2016;9(5):463-9. doi: 10.1016/j.jcin.2015.11.036
  52. Kimmelstiel C, Zisa DC, Kuttab JS, et al. Guideline-Based Referral for Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy Is Associated With Excellent Clinical Outcomes. Circ Cardiovasc Interv. 2019;12(7):e007673. doi: 10.1161/CIRCINTERVENTIONS.118.007673
  53. Maron BJ, Rowin EJ, Casey SA, et al. Risk Strati cation and Outcome of Patients With Hypertrophic Cardiomyopathy ≥60 Years of Age. Circulation. 2013;127(5):585-93. doi: 10.1161/CIRCULATIONAHA.112.136085
  54. Guttmann OP, Rahman MS, O’Mahony C, et al. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart. 2014;100(6):465-72. doi: 10.1136/heartjnl-2013-304276
  55. Guttmann OP, Pavlou M, O’Mahony C, et al.; Hypertrophic Cardiomyopathy Outcomes Investigators. Predictors of atrial fibrillation in hypertrophic cardiomyopathy. Heart. 2017;103(9):672-8. doi: 10.1136/heartjnl-2016-309672
  56. Rowin EJ, Hausvater A, Link MS, et al. Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Circulation. 2017;136(25):2420-36. doi: 10.1161/CIRCULATIONAHA.117.029267
  57. Garg L, Gupta M, Sabzwari SRA, et al. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management. Heart Fail Rev. 2019;24(2):189-97. doi: 10.1007/s10741-018-9752-6

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2. Рис. 1. Сигмовидная МЖП у больной 94 лет.

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3. Рис. 2. ЭКГ больной 94 лет без нарушений реполяризации и патологических зубцов Q, характерных для ГКМП.

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