Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1431-1432
Author(s):  
Perry Elliott

Cardiomyopathies are a diverse group of diseases characterized by structural and functional abnormalities of the heart muscle that cannot be explained by coronary artery disease, hypertension, or valvular disease. They are grouped into specific morphological and functional phenotypes, each of which can be caused by genetic and non-genetic mechanisms.

2013 ◽  
Vol 31 (29) ◽  
pp. 3673-3680 ◽  
Author(s):  
Gregory T. Armstrong ◽  
Kevin C. Oeffinger ◽  
Yan Chen ◽  
Toana Kawashima ◽  
Yutaka Yasui ◽  
...  

Purpose To evaluate the relative contribution of modifiable cardiovascular risk factors on the development of major cardiac events in aging adult survivors of childhood cancer. Patients and Methods Among 10,724 5-year survivors (median age, 33.7 years) and 3,159 siblings in the Childhood Cancer Survivor Study, the prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity was determined, along with the incidence and severity of major cardiac events such as coronary artery disease, heart failure, valvular disease, and arrhythmia. On longitudinal follow-up, rate ratios (RRs) of subsequent cardiac events associated with cardiovascular risk factors and cardiotoxic therapy were assessed in multivariable Poisson regression models. Results Among survivors, the cumulative incidence of coronary artery disease, heart failure, valvular disease, and arrhythmia by 45 years of age was 5.3%, 4.8%, 1.5%, and 1.3%, respectively. Two or more cardiovascular risk factors were reported by 10.3% of survivors and 7.9% of siblings. The risk for each cardiac event increased with increasing number of cardiovascular risk factors (all Ptrend < .001). Hypertension significantly increased risk for coronary artery disease (RR, 6.1), heart failure (RR, 19.4), valvular disease (RR, 13.6), and arrhythmia (RR, 6.0; all P values < .01). The combined effect of chest-directed radiotherapy plus hypertension resulted in potentiation of risk for each of the major cardiac events beyond that anticipated on the basis of an additive expectation. Hypertension was independently associated with risk of cardiac death (RR, 5.6; 95% CI, 3.2 to 9.7). Conclusion Modifiable cardiovascular risk factors, particularly hypertension, potentiate therapy-associated risk for major cardiac events in this population and should be the focus of future interventional studies.


ESC CardioMed ◽  
2018 ◽  
pp. 723-725
Author(s):  
Heribert Schunkert

The elucidation of genetic mechanisms affecting the risk of atherosclerosis has largely benefited from recent technological breakthroughs in terms of high-throughput sequencing and genotyping. While a decade ago only a positive family history and mutations causing familial hypercholesterolaemia were proven to confer genetic risk of atherosclerosis, by now multiple genes have been implicated in monogenic and complex forms of accelerated atherosclerosis. At the population level, the discovery of hundreds of common variants, each affecting the risk of atherosclerosis by a small margin, may have even broader implications. A substantial finding from these studies is that the risk of atherosclerosis and its clinical manifestations, such as myocardial infarction, stroke, and peripheral arterial disease, is secondary to a much broader spectrum of underlying (genetic) mechanisms than previously thought. Indeed, the genetic variants leading to atherosclerosis go far beyond the effects of classical risk factors, such as hypertension, dyslipidaemia, diabetes mellitus, and smoking. Based on these findings, genetic risk scores are scrutinized to improve the prediction of coronary artery disease in asymptomatic individuals. Remarkably, people with a high genetic risk burden have the greatest benefit from therapeutic lowering of LDL cholesterol. Currently, the systems biology of the multiple interacting factors contributing to the risk of atherosclerosis as well as respective therapeutic implications, in part addressed by Mendelian randomization studies, is subject to intensive research. Likewise, genetic risk scores are scrutinized to improve the prediction of coronary artery disease in asymptomatic individuals. This chapter gives a brief overview on the current understanding of the genetic underpinnings of atherosclerosis.


ESC CardioMed ◽  
2018 ◽  
pp. 1437-1443
Author(s):  
Claudio Rapezzi ◽  
Massimiliano Lorenzini

Cardiomyopathies are defined as myocardial disorders in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease sufficient to explain the observed myocardial abnormality. They are grouped into specific morphological and functional phenotypes, with each phenotype subclassified into genetic and non-genetic forms (genetic in this context means single gene mutations). Hence, from a clinical perspective, this leads to a diagnostic work-up that consists of three steps: (1) phenotype definition; (2) exclusion of coronary artery disease, hypertension, valvular disease, or congenital heart disease that could explain the observed myocardial abnormalities; and (3) identification of the underlying disease cause, genetic or acquired.


Cardiomyopathy is a descriptive term that means ‘disease of the heart muscle’: ‘cardia’ refers to the heart and ‘myopathy’ literally means an abnormality of muscle. Cardiomyopathies are disorders of the myocardium that are not 2° to coronary artery disease, hypertension, congenital, valvular, or pericardial abnormalities. Cardiomyopathy is associated with myocardial dysfunction and is classified into the following four major subtypes: hypertrophic, dilated, arrhythmogenic right ventricular, and restrictive. The aim of this chapter is to outline the background, clinical presentation, diagnosis, treatment, and the role of the nurse in the management of the cardiomyopathies.


2020 ◽  
Vol 9 (11) ◽  
pp. 3385
Author(s):  
Marco Merlo ◽  
Antonio Cannatà ◽  
Gianfranco Sinagra

Dilated Cardiomyopathy (DCM) has a straightforward and apparently “simple” definition: a heart muscle disease characterized by left ventricular (LV) or biventricular dilation and systolic dysfunction in the absence of either pressure or volume overload or coronary artery disease sufficient enough to explain the dysfunction [...]


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