Трудности диагностики и варианты клинического течения гипертрофической кардиомиопатии у больных пожилого возраста

Крылова Н.С., Маслова М.Ю., Потешкина Н.Г. и др. Трудности диагностики и варианты клинического течения гипертрофической кардиомиопатии у больных пожилого возраста. Consilium Medicum. 2020; 22 (10): 34–38. DOI: 10.26442/20751753.2020.10.200287

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Krylova N.S., Maslova M.Yu., Poteshkina N.G. et al. Difficulties in diagnosis and variants of the clinical course of hypertrophic cardiomyopathy in elderly patients. Consilium Medicum. 2020; 22 (10): 34–38. DOI: 10.26442/20751753.2020.10.200287

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Аннотация

Гипертрофическая кардиомиопатия (ГКМП) – генетически детерминированное заболевание c морфологической аномалией сократительных белков миокарда, проявляющееся асимметричной гипертрофией миокарда левого желудочка. В настоящее время существуют данные, что частота ГКМП в популяции может составлять до 1:200, а не 1:500, как традиционно считалось. В ранних работах по ГКМП данное заболевание всегда характеризовалось как патология молодого и среднего возраста с высоким риском внезапной сердечной смерти. В настоящее время общепризнанным является факт возможности пациентов с ГКМП доживать до пожилого и старческого возраста при доброкачественном течении заболевания. Наличие сопутствующей патологии у таких пациентов вносит свой вклад в клиническую картину болезни. В данной статье освещены проблемные вопросы диагностики ГКМП у лиц пожилого возраста с акцентом на дифференциальную диагностику ГКМП и гипертрофию левого желудочка у пациентов с артериальной гипертензией. Отдельно затронута тема дифференциальной диагностики ишемической болезни сердца при ГКМП. Описаны особенности течения ГКМП в пожилом возрасте. Представлены данные по факторам, влияющим на прогноз у пожилых пациентов с ГКМП.

Ключевые слова: гипертрофическая кардиомиопатия, пожилой возраст, дифференциальная диагностика, ишемическая болезнь сердца, артериальная гипертензия, фибрилляция предсердий, прогноз.

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Hypertrophic cardiomyopathy (HCM) is a genetically determined disease with a morphological abnormality of myocardial contractile proteins, manifested by asymmetric left ventricular myocardial hypertrophy. Currently, there is evidence that the HCM incidence rate in the population can be up to 1:200, as opposed to the traditionally quoted 1:500. In early works on HCM, this disease has been mostly perceived as a pathology of young and middle age with a high risk of sudden cardiac death. Now it is generally accepted that patients with HCM are likely to reach the old or even geriatric age subject to the benign course of the disease. Comorbidity in such patients contributes to the clinical aspect of the disease. The article deals with problem areas of HCM diagnostics in elderly patients with an emphasis on differential diagnosis of HCM and left ventricular hypertrophy as part of hypertension. It contains a discussion of differential diagnosis of ischemic heart disease in HCM. The authors also focus on the specifics of the course of HCM in old age patients and present factors affecting the prognosis for this group of patients.

Key words: hypertrophic cardiomyopathy, advanced age, differential diagnosis, ischemic heart disease, arterial hypertension, atrial fibrillation, prognosis.

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Список литературы

1. Elliott PM, Anastasakis A, Borger MA et al. 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 2014; 35 (39): 2733–79. DOI: 10.1093/eurheartj/ehu284
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5. Olivotto I, Maron MS, Adabag AS. Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46 (3): 480–7.
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7. Hata Y, Ichimata S, Yamaguchi Y et al. Clinicopathological and Genetic Profiles of Cases with Myocytes Disarray – Investigation for Establishing the Autopsy Diagnostic Criteria for Hypertrophic Cardiomyopathy. J Clin Med 2019; 8 (4): 463. DOI: 10.3390/jcm8040463
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11. Razmara E, Garshasbi M. Whole-exome sequencing identifies R1279X of MYH6 gene to be associated with congenital heart disease. BMC Cardiovasc Dis 2018; 18 (1): 137. DOI: 10.1186/s12872-018-0867-4
12. Rowin EJ, Maron MS, Wells S et al. Impact of Sex on Clinical Course and Survival in the Contemporary Treatment Era for Hypertrophic Cardiomyopathy. J Am Heart Assoc 2019; 8 (21): e012041. DOI: 10.1161/JAHA.119.012041
13. Gupta T, Harikrishnan P, Kolte D et al. Outcomes of Acute Myocardial Infarction in Patients with Hypertrophic Cardiomyopathy. Am J Med 2015; 128 (8), 879–87.e1. DOI: 10.1016/j.amjmed.2015.02.025
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16. Kato TS. Discrimination of Nonobstructive Hypertrophic Cardiomyopathy From Hypertensive Left Ventricular Hypertrophy on the Basis of Strain Rate Imaging by Tissue Doppler Ultrasonography. Circulation 2004; 110 (25): 3808–14. DOI: 10.1161/01.cir.0000150334.69355.00
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18. Aslam F, Haque A, Foody J, Shirani J. The Frequency and Functional Impact of Overlapping Hypertension on Hypertrophic Cardiomyopathy: A Single-Center Experience. J Clin Hypertens 2010; 12 (4): 240–5. DOI: 10.1111/j.1751-7176.2009.00251.x2010
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[Kovalevskaia E.A., Krylova N.S., Poteshkina N.G. et al. Gipertroficheskaia kardiomiopatiia v sochetanii s ishemicheskoi bolezn'iu serdtsa: 6-letniaia istoriia nabliudeniia. Ros. kardiologicheskii zhurn. 2018; 9: 48–53. DOI: 10.15829/1560-4071-2018-9-48-53 (in Russian).]
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22. Sorajja P, Ommen SR, Nishimura RA et al. Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease. Circulation 2003; 108 (19): 2342–8. DOI: 10.1161/01.CIR.0000097110.55312.BF
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[Kaplunova V.Iu., Shakar'iants G.A., Kozhevnikova M.V. et al. Gipertroficheskaia kardiomiopatiia: formy i varianty techeniia, podkhody k farmakoterapii. Klin. med. 2017; 95 (12): 1061–9. DOI: 10.18821/0023-2149-2017-95-12-1061-1069 (in Russian).]
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[Poliakova A.A., Gudkova A.Ia., Krutikov A.N. et al. Gipertroficheskaia kardiomiopatiia v starshei vozrastnoi gruppe: vliianie faktorov kardiometabolicheskogo riska i polimorfizma gena MADD. Arterial'naia gipertenziia. 2018; 24 (1): 29–40. DOI: 10.18705/1607-419X-2018-24-1-29-40 (in Russian).]
26. Maron BJ, Rowin EJ, Casey SA et al. Risk stratification and outcome of patients with hypertrophic cardiomyopathy ≥60 years of age. Circulation 2013; 127 (5): 585–93.
27. 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.2011.12.027
28. Tsuda T, Hayashi K, Fujino N et al. Impact of Hypertrophic Cardiomyopathy on Prediction of Thromboembolism in Patients with Non-valvular Atrial Fibrillation. Heart Rhythm 2018. DOI: 10.1016/j.hrthm.2018.11.029
29. Haruki S, Minami Y, Hagiwara N. Stroke and Embolic Events in Hypertrophic Cardiomyopathy. Stroke 2016; 47 (4): 936–42. DOI: 10.1161/strokeaha.115.012130
30. Kubo T, Kitaoka H, Okawa M et al. Clinical impact of atrial fibrillation in patients with hypertrophic cardiomyopathy: results from Kochi RYOMA Study. Circ J 2009; 73: 1599–605.
31. Siontis KC, Geske JB, Ong K et al. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc 2014; 3 (3): e001002. DOI: 10.1161/JAHA.114.001002
32. Javidgonbadi D, Andersson B, Abdon NJ et al. Factors influencing long-term heart failure mortality in patients with obstructive hypertrophic cardiomyopathy in Western Sweden: probable dose-related protection from beta-blocker therapy. Open Heart 2019; 6 (1): e000963. DOI: 10.1136/openhrt-2018-000963

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1. Elliott PM, Anastasakis A, Borger MA et al. 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 2014; 35 (39): 2733–79. DOI: 10.1093/eurheartj/ehu284
2. 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. J Thorac Cardiovasc Surg 2011; 142: e153–e203.
3. 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
4. Maron BJ, Bonow RO, Cannon RO et al. Hypertrophic Cardiomyopathy. New Engl J Med 1987; 316 (14): 844–52. DOI: 10.1056/nejm198704023161405
5. Olivotto I, Maron MS, Adabag AS. Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46 (3): 480–7.
6. Canepa M, Pozios I, Vianello PF et al. Distinguishing ventricular septal bulge versus hypertrophic cardiomyopathy in the elderly. Heart 2016; 102 (14): 1087–94. DOI: 10.1136/heartjnl-2015-308764
7. Hata Y, Ichimata S, Yamaguchi Y et al. Clinicopathological and Genetic Profiles of Cases with Myocytes Disarray – Investigation for Establishing the Autopsy Diagnostic Criteria for Hypertrophic Cardiomyopathy. J Clin Med 2019; 8 (4): 463. DOI: 10.3390/jcm8040463
8. Mademont-Soler I, Mates J, Yotti R et al. Additional value of screening for minor genes and copy number variants in hypertrophic cardiomyopathy. PLoS One 2017; 12 (8): e0181465.
9. Kubo T, Kitaoka H, Okawa M et al. Hypertrophic cardiomyopathy in the elderly. Geriatr Gerontol Int 2010; 10 (1): 9–16.
10. Niimura, H. Sarcomere Protein Gene Mutations in Hypertrophic Cardiomyopathy of the Elderly. Circulation 2002; 105 (4): 446–51. DOI: 10.1161/hc0402.102990
11. Razmara E, Garshasbi M. Whole-exome sequencing identifies R1279X of MYH6 gene to be associated with congenital heart disease. BMC Cardiovasc Dis 2018; 18 (1): 137. DOI: 10.1186/s12872-018-0867-4
12. Rowin EJ, Maron MS, Wells S et al. Impact of Sex on Clinical Course and Survival in the Contemporary Treatment Era for Hypertrophic Cardiomyopathy. J Am Heart Assoc 2019; 8 (21): e012041. DOI: 10.1161/JAHA.119.012041
13. Gupta T, Harikrishnan P, Kolte D et al. Outcomes of Acute Myocardial Infarction in Patients with Hypertrophic Cardiomyopathy. Am J Med 2015; 128 (8), 879–87.e1. DOI: 10.1016/j.amjmed.2015.02.025
14. Poliakova A.A., Baranova E.I., Semernin E.N. et al. Gendernye razlichiia klinicheskogo techeniia i remodelirovaniia serdtsa pri idiopaticheskoi gipertroficheskoi kardiomiopatii v pozhilom vozraste. Ros. kardiologicheskii zhurn. 2018; 2: 13–8. DOI: 10.15829/1560-4071-2018-2-13-18 (in Russian).
15. Van Velzen HG, Schinkel AFL, Baart SJ et al. Effect of Gender and Genetic Mutations on Outcomes in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 122 (11): 1947–54. DOI: 10.1016/j.amjcard.2018.08.040
16. Kato TS. Discrimination of Nonobstructive Hypertrophic Cardiomyopathy From Hypertensive Left Ventricular Hypertrophy on the Basis of Strain Rate Imaging by Tissue Doppler Ultrasonography. Circulation 2004; 110 (25): 3808–14. DOI: 10.1161/01.cir.0000150334.69355.00
17. Karam R, Lever HM, Healy BP. Hypertensive hypertrophic cardiomyopathy or hypertrophic cardiomyopathy with hypertension? A study of 78 patients. J Am Coll Cardiol 1989; 13 (3): 580–4. DOI: 10.1016/0735-1097 (89)90596-2
18. Aslam F, Haque A, Foody J, Shirani J. The Frequency and Functional Impact of Overlapping Hypertension on Hypertrophic Cardiomyopathy: A Single-Center Experience. J Clin Hypertens 2010; 12 (4): 240–5. DOI: 10.1111/j.1751-7176.2009.00251.x2010
19. Takeda A, Takeda N. Different pathophysiolody of cardiac hyperthrophy in hypertension and hypertrophic cardiomyopathy. J Mol Cell Cardiol 1997; 29 (11): 2961–5.
20. Kovalevskaia E.A., Krylova N.S., Poteshkina N.G. et al. Gipertroficheskaia kardiomiopatiia v sochetanii s ishemicheskoi bolezn'iu serdtsa: 6-letniaia istoriia nabliudeniia. Ros. kardiologicheskii zhurn. 2018; 9: 48–53. DOI: 10.15829/1560-4071-2018-9-48-53 (in Russian).
21. Shin DG, Son J-W, Park JY et al. Impact of coronary artery anatomy on clinical course and prognosis in apical hypertrophic cardiomyopathy: analysis of coronary angiography and computed tomography. Korean Circ J 2015; 45 (1): 38–43. DOI: 10.4070/kcj.2015.45.1.38
22. Sorajja P, Ommen SR, Nishimura RA et al. Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease. Circulation 2003; 108 (19): 2342–8. DOI: 10.1161/01.CIR.0000097110.55312.BF
23. Sado DM, Iqbal J. Hypertrophic cardiomyopathy in older patients. Clin Med (Lond) 2010; 10 (2): 196–8. DOI: 10.7861/clinmedicine.10-2-196
24. Kaplunova V.Iu., Shakar'iants G.A., Kozhevnikova M.V. et al. Gipertroficheskaia kardiomiopatiia: formy i varianty techeniia, podkhody k farmakoterapii. Klin. med. 2017; 95 (12): 1061–9. DOI: 10.18821/0023-2149-2017-95-12-1061-1069 (in Russian).
25. Poliakova A.A., Gudkova A.Ia., Krutikov A.N. et al. Gipertroficheskaia kardiomiopatiia v starshei vozrastnoi gruppe: vliianie faktorov kardiometabolicheskogo riska i polimorfizma gena MADD. Arterial'naia gipertenziia. 2018; 24 (1): 29–40. DOI: 10.18705/1607-419X-2018-24-1-29-40 (in Russian).
26. Maron BJ, Rowin EJ, Casey SA et al. Risk stratification and outcome of patients with hypertrophic cardiomyopathy ≥60 years of age. Circulation 2013; 127 (5): 585–93.
27. 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.2011.12.027
28. Tsuda T, Hayashi K, Fujino N et al. Impact of Hypertrophic Cardiomyopathy on Prediction of Thromboembolism in Patients with Non-valvular Atrial Fibrillation. Heart Rhythm 2018. DOI: 10.1016/j.hrthm.2018.11.029
29. Haruki S, Minami Y, Hagiwara N. Stroke and Embolic Events in Hypertrophic Cardiomyopathy. Stroke 2016; 47 (4): 936–42. DOI: 10.1161/strokeaha.115.012130
30. Kubo T, Kitaoka H, Okawa M et al. Clinical impact of atrial fibrillation in patients with hypertrophic cardiomyopathy: results from Kochi RYOMA Study. Circ J 2009; 73: 1599–605.
31. Siontis KC, Geske JB, Ong K et al. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc 2014; 3 (3): e001002. DOI: 10.1161/JAHA.114.001002
32. Javidgonbadi D, Andersson B, Abdon NJ et al. Factors influencing long-term heart failure mortality in patients with obstructive hypertrophic cardiomyopathy in Western Sweden: probable dose-related protection from beta-blocker therapy. Open Heart 2019; 6 (1): e000963. DOI: 10.1136/openhrt-2018-000963

Авторы

Н.С. Крылова*1,2, М.Ю. Маслова1, Н.Г. Потешкина1,2, Е.А. Ковалевская2, Г.Б. Селиванова1

1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница №52» Департамента здравоохранения г. Москвы, Москва, Россия
*krylova_n@list.ru

________________________________________________

Natalia S. Krylova*1,2, Maria Yu. Maslova1, Natalia G. Poteshkina1,2, Elena A. Kovalevskaya2, Galina B. Selivanova1

1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 City Clinical Hospital №52, Moscow, Russia
*krylova_n@list.ru

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