Kim K, et al. J Lipid Atheroscler. 2021 Sep;10(3):291-302. https://doi.org/10.12997/jla.2021.10.3.291

Background: Although nonsustained ventricular tachycardia (NSVT) is a risk factor for sudden cardiac death in hypertrophic‐cardiomyopathy (HCM), the impact of premature ventricular contraction (PVC) burden, in the absence of NSVT, is not well‐known.Hypothesis: PVC burden may be associated with myocardial fibrosis and genetic mutations in patients with HCM.Methods: Of the 212 patients prospectively enrolled to the HCM registry of genetics, 84 were evaluated with both cardiac magnetic resonance, 24‐hour Holter monitoring and genetic analysis. Among them, 71 patients have not been diagnosed with NSVT.Results: Patients with NSVT (n = 13) had a higher late gadolinium enhancement (LGE) amount, extracellular volume fraction (ECV), and prevalence of sarcomere mutations compared with patients without NSVT. Among patients without NSVT, those with LGE (n = 46) had a higher total PVC (109 ± 332 vs 7 ± 13, P = .003) and PVC burden (0.114 ± 0.225 vs 0.008 ± 0.014%, P = .003) during 24‐hour Holter monitoring compared with others. The %LGE and global ECV were correlated with PVC burden (r = 0.377, P = .001; r = 0.401, P = .001). The optimal cutoff value for PVC number for LGE was 45 (37.0% and 100% sensitivity and specificity, respectively) with 0.733 of the area under the receiver operating characteristic‐curve (P < .001). Thick filament gene mutation was more prevalent in the higher PVC burden group (41.2% vs 16.7%, P = .048).Conclusion: Total PVC burden is significantly related to increase in myocardial fibrosis in HCM patients without NSVT.

Chung H, et al. Int J Heart Fail. 2022 Jan;4:e7. https://doi.org/10.36628/ijhf.2022.0006

Korean Circulation Journal 대한심장학회지 순환기 Chung H, et al. Korean Circ J. 2021 Jun;51:e92. https://doi.org/10.4070/kcj.2021.0197

Prasugrel (Efient, Eli Lilly) is an oral inhibitor of platelet activation and aggregation. Prasugrel, coadministered with acetylsalicylic acid, has marketing authorisation for the prevention of atherothrombotic events in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance on the use of prasugrel for patients undergoing PCI was published in October 2009.1 Prasugrel, in combination with aspirin, is recommended as an option for patients when: The following sections present evidence on use of prasugrel and an overview of the independent advisory Appraisal Committee's considerations in developing its guidance for NICE. The importance of expert and stakeholder involvement in the development of NICE guidance is also explained. Prasugrel was considered under the NICE single technology appraisal process.2 In this process, the manufacturer provides an evidence submission, which comprises a report (structured according to a template set by NICE) and economic model. The structured report sets out the evidence base for the drug, and the economic model assesses its cost-effectiveness compared to current standard practice – in this case the use of clopidogrel. The manufacturer's submission, therefore, forms the core evidence source for the Appraisal Committee's considerations. In addition, an academic group, the Evidence Review Group (in this case, the Liverpool Reviews and Implementation Group, University of Liverpool) is commissioned to critique the manufacturer's submission, and produce a report of its findings.3 The Evidence Review Group may also undertake exploratory analyses using the submitted materials and report these to the Appraisal Committee. The Appraisal Committee developed recommendations for the use of prasugrel in two stages. First, it met to consider the available evidence and the …

Ventricular hypertrophy is associated with diastolic dysfunction, resulting in increased left atrial (LA) pressure, enlargement, fibrosis, and decreased LA function. Hypertrophic cardiomyopathy (HCM) is characterized by myocyte disarray, myocardial fibrosis, and hypertrophy. Notably, a thickened and noncompliant LV results in the impairment of diastolic function. These conditions promote LA remodeling and enlargement, which contribute to developing and maintaining atrial fibrillation (AF). AF is an atrial arrhythmia that occurs frequently in HCM, and evaluating the morphology and physiology of the atrium and ventricle is important for treatment and prognosis determination in HCM patients with AF. In addition, it provides a clue that can predict the possibility of new AF, even in patients not previously diagnosed with AF. Cardiac magnetic resonance (CMR), which can overcome the limitations of transthoracic echocardiography (TTE), has been widely used traditionally and even enables tissue characterization; moreover, it has emerged as an essential imaging modality for patients with HCM. Here, we review the role of multimodal imaging in patients with HCM and AF.