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Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Systematic Review Article

Hypertrophic Cardiomyopathy in Saudi Arabia: A Systematic Review of the Epidemiological, Clinical, and Imaging Features

Author(s): Bodour S. Rajab*

Volume 19, Issue 2, 2023

Published on: 22 December, 2022

Article ID: e250822208003 Pages: 10

DOI: 10.2174/1573403X18666220825153725

Price: $65

Abstract

Background: A systematic review was performed to deliver a critical view of clinical and research practice on hypertrophic cardiomyopathy (HCM) in Saudi Arabia. Scopus, PubMed, and Google Scholar databases were searched for original articles reporting clinical and/or imaging findings among HCM patients in Saudi Arabia. Of 559 records identified, 3 studies and 1 abstract were included, involving 169 patients.

Methods: The mean age ranged between 40and 56 years, up to 93.3% were males. A family history of HCM was reported in one study (5%), and sudden cardiac death was investigated in two studies (9% and 13%). Dyspnea was the most frequent symptom (60-68.7%) reported, followed by chest pain (12.5%-73.3%).

Results: Regarding complications, atrial fibrillation was reported among 0-25% of the patients, mitral regurgitations among 13.3-50%, and ventricular tachycardia among 5-12.5%. Imaging parameters were inadequately documented and suggested a high prevalence of left atrial enlargement, SVI + RV5 > 35 mm, blocks, and asymmetric septal hypertrophy.

Conclusion: The ejection fraction was reported by two studies with a mean±SD of 68±13% and 77.2±8.07%. The researchers stress the paucity, low quality, and disparity in time of original studies about HCM in Saudi Arabia and recommend conducting national multicenter studies, with appropriate design, notably using screening-based recruitment methods.

Keywords: Hypertrophic, cardiomyopathy, Saudi Arabia, Systematic review, epidemiological, imaging features.

Graphical Abstract

[1]
Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70(1): 1-25.
[http://dx.doi.org/10.1016/j.jacc.2017.04.052] [PMID: 28527533]
[2]
Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1659-724.
[http://dx.doi.org/10.1016/S0140-6736(16)31679-8] [PMID: 27733284]
[3]
Joseph P, Leong D, McKee M, et al. Reducing the global burden of cardiovascular disease, part 1: The epidemiology and risk factors. Circ Res 2017; 121(6): 677-94.
[http://dx.doi.org/10.1161/CIRCRESAHA.117.308903] [PMID: 28860318]
[4]
Sepanlou SG, Parsaeian M, Krohn KJ, et al. Disability Adjusted Life Years (DALYs) for 315 diseases and injuries and Healthy Life Expectancy (HALE) in Iran and its neighboring countries, 1990-2015: Findings from global burden of disease study 2015. Arch Iran Med 2017; 20(7): 403-18.
[PMID: 28745902]
[5]
Roth GA, Johnson CO, Abate KH, Abd AF, Ahmed M. The burden of cardiovascular diseases among US States, 1990-2016. JAMA Cardiol 2018; 3: 375-89.
[http://dx.doi.org/10.1001/jamacardio.2018.0385]
[6]
Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies. Circulation 2006; 113(14): 1807-16.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.106.174287] [PMID: 16567565]
[7]
Brieler J, Breeden MA, Tucker J. Cardiomyopathy: An overview. Am Fam Physician 2017; 96(10): 640-6.
[PMID: 29431384]
[8]
Dokainish H, Teo K, Zhu J, et al. Heart failure in Africa, Asia, the Middle East and South America: The inter-CHF study. Int J Cardiol 2016; 204: 133-41.
[http://dx.doi.org/10.1016/j.ijcard.2015.11.183] [PMID: 26657608]
[9]
Elasfar A, Alhabeeb W, Elasfar S. Heart failure in the Middle East Arab Countries: Current and future perspectives. J Saudi Heart Assoc 2020; 32(2): 236-41.
[http://dx.doi.org/10.37616/2212-5043.1040] [PMID: 33154923]
[10]
Towbin JA. Inherited cardiomyopathies. Circ J 2014; 78(10): 2347-56.
[http://dx.doi.org/10.1253/circj.CJ-14-0893] [PMID: 25186923]
[11]
Geske JB, Ommen SR, Gersh BJ. Hypertrophic cardiomyopathy. JACC Heart Fail 2018; 6(5): 364-75.
[http://dx.doi.org/10.1016/j.jchf.2018.02.010] [PMID: 29655825]
[12]
Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet 2013; 381(9862): 242-55.
[http://dx.doi.org/10.1016/S0140-6736(12)60397-3] [PMID: 22874472]
[13]
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.
[http://dx.doi.org/10.1016/j.jacc.2015.01.019] [PMID: 25814232]
[14]
Maron BJ. Hypertrophic cardiomyopathy: An important global disease. Am J Med 2004; 116(1): 63-5.
[http://dx.doi.org/10.1016/j.amjmed.2003.10.012] [PMID: 14706671]
[15]
Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: An overview. Am Fam Physician 2009; 79(9): 778-84.
[PMID: 20141097]
[16]
Ahmed W, Akhtar N, Bech HO, Mahdi BA, Otaibi TA, Fadel BM. Hypertrophic cardiomyopathy in the Saudi Arabian population: Clinical and echocardiographic characteristics and outcome analysis. J Saudi Heart Assoc 2014; 26(1): 7-13.
[http://dx.doi.org/10.1016/j.jsha.2013.08.003] [PMID: 24578595]
[17]
McKenna WJ, Maron BJ, Thiene G. Classification, epidemiology, and global burden of cardiomyopathies. Circ Res 2017; 121(7): 722-30.
[http://dx.doi.org/10.1161/CIRCRESAHA.117.309711] [PMID: 28912179]
[18]
Rizzo S, Carturan E, De Gaspari M, Pilichou K, Thiene G, Basso C. Update on cardiomyopathies and sudden cardiac death. Forensic Sci Res 2019; 4(3): 202-10.
[http://dx.doi.org/10.1080/20961790.2019.1631957] [PMID: 31489386]
[19]
Maron BJ. Clinical course and management of hypertrophic cardiomyopathy. N Engl J Med 2018; 379(7): 655-68.
[http://dx.doi.org/10.1056/NEJMra1710575] [PMID: 30110588]
[20]
Lopes LR, Aung N, Duijvenboden S, Munroe PB, Elliott PM, Petersen SE. Prevalence of hypertrophic cardiomyopathy in the UK biobank population. JAMA Cardiol 2021; 6(7): 852-4.
[http://dx.doi.org/10.1001/jamacardio.2021.0689] [PMID: 33851951]
[21]
Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999; 281(7): 650-5.
[http://dx.doi.org/10.1001/jama.281.7.650] [PMID: 10029128]
[22]
Liu Q, Li D, Berger AE, Johns RA, Gao L. Survival and prognostic factors in hypertrophic cardiomyopathy: A meta-analysis. Sci Rep 2017; 7(1): 11957.
[http://dx.doi.org/10.1038/s41598-017-12289-4] [PMID: 28931939]
[23]
Moon I, Lee SY, Kim HK, et al. Trends of the prevalence and incidence of hypertrophic cardiomyopathy in Korea: A nationwide population-based cohort study. PLoS One 2020; 15(1): e0227012.
[http://dx.doi.org/10.1371/journal.pone.0227012] [PMID: 31929538]
[24]
Cheng TO. Prevalence of hypertrophic cardiomyopathy in China. Chin Med J (Engl) 2004; 117(10): 1600.
[PMID: 15536665]
[25]
Agarwal AK, Venugopalan P, Bono D. Prevalence and aetiology of heart failure in an Arab population. Eur J Heart Fail 2001; 3(3): 301-5.
[http://dx.doi.org/10.1016/S1388-9842(00)00149-5] [PMID: 11378000]
[26]
Ansary LA, Esmaeil SA, Adi YA. Causes of death certification of adults: An exploratory cross sectional study at a university hospital in Riyadh, Saudi Arabia. Ann Saudi Med 2012; 32(6): 615-22.
[http://dx.doi.org/10.5144/0256-4947.2012.615] [PMID: 23396026]
[27]
Tyrovolas S, El Bcheraoui C, Alghnam SA, et al. The burden of disease in Saudi Arabia 1990-2017: Results from the Global Burden of Disease Study 2017. Lancet Planet Health 2020; 4(5): e195-208.
[http://dx.doi.org/10.1016/S2542-5196(20)30075-9] [PMID: 32442495]
[28]
National Heart Lung and Blood Institute (NIH). Study quality assessment tools. Study Quality Assessment Tools 2013. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools (Accessed on: 04 January, 2022).
[29]
Al-Nozha MM, Qaraqish A, Husain IS, Al-Harthi SS. Cardiomyopathy in Saudi Arabia: The King Khalid University hospital experience. Ann Saudi Med 1988; 8(6): 452-6.
[http://dx.doi.org/10.5144/0256-4947.1988.452]
[30]
Guindy RR, Halim MA, Fawzy ME, Ziady GM. Hypertrophic cardiomyopathy in patients over 50 years old. Ann Saudi Med 1984; 4(4): 301-5.
[http://dx.doi.org/10.5144/0256-4947.1984.301]
[31]
Aldwailah SS, Al-Dobai D, Alduaiji D, Almutari SN, Mahmud A, AlGhamdi M. Clinical characteristics and outcome of hypertrophic cardiomyopathy in the Saudi population - A single cardiac center experience. J Saudi Heart Assoc 2018; 30(4): 358-9.
[http://dx.doi.org/10.1016/j.jsha.2018.05.010]
[32]
Maron BJ, Ommen SR, Semsarian C, Spirito P, Olivotto I, Maron MS. Hypertrophic cardiomyopathy. J Am Coll Cardiol 2014; 64(1): 83-99.
[http://dx.doi.org/10.1016/j.jacc.2014.05.003] [PMID: 24998133]
[33]
Hensley N, Dietrich J, Nyhan D, Mitter N, Yee MS, Brady M. Hypertrophic cardiomyopathy. Anesth Analg 2015; 120(3): 554-69.
[http://dx.doi.org/10.1213/ANE.0000000000000538] [PMID: 25695573]
[34]
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119(8): 1085-92.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.804617] [PMID: 19221222]
[35]
Geske JB, Ong KC, Siontis KC, et al. Women with hypertrophic cardiomyopathy have worse survival. Eur Heart J 2017; 38(46): 3434-40.
[http://dx.doi.org/10.1093/eurheartj/ehx527] [PMID: 29020402]
[36]
Olivotto I, Maron MS, Adabag AS, et al. Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46(3): 480-7.
[http://dx.doi.org/10.1016/j.jacc.2005.04.043] [PMID: 16053962]
[37]
Ho CY, Day SM, Ashley EA, et al. Genotype and lifetime burden of disease in hypertrophic cardiomyopathy. Circulation 2018; 138(14): 1387-98.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.117.033200] [PMID: 30297972]
[38]
O’Mahony C, Jichi F, Ommen SR, et al. International external validation study of the 2014 European Society of Cardiology guidelines on sudden cardiac death prevention in hypertrophic cardiomyopathy (EVIDENCE-HCM). Circulation 2018; 137(10): 1015-23.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.117.030437] [PMID: 29191938]
[39]
Trongtorsak A, Polpichai N, Thangjui S, et al. Gender related differences in hypertrophic cardiomyopathy: A systematic review and meta analysis. Pulse 2021; 9(1-2): 38-46.
[http://dx.doi.org/10.1159/000517618] [PMID: 34722354]
[40]
Husser D, Ueberham L, Jacob J, et al. Prevalence of clinically apparent hypertrophic cardiomyopathy in Germany-An analysis of over 5 million patients. PLoS One 2018; 13(5): e0196612.
[http://dx.doi.org/10.1371/journal.pone.0196612] [PMID: 29723226]
[41]
Canepa M, Fumagalli C, Tini G, et al. Temporal trend of age at diagnosis in hypertrophic cardiomyopathy: An analysis of the international sarcomeric human cardiomyopathy registry. Circ Heart Fail 2020; 13(9): e007230.
[http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.007230] [PMID: 32894986]
[42]
Saul PJ, Gajewski KK. Sudden cardiac death in children and adolescents (excluding Sudden Infant Death Syndrome). Ann Pediatr Cardiol 2010; 3(2): 107-12.
[http://dx.doi.org/10.4103/0974-2069.74035] [PMID: 21234187]
[43]
Cahill TJ, Ashrafian H, Watkins H. Genetic cardiomyopathies causing heart failure. Circ Res 2013; 113(6): 660-75.
[http://dx.doi.org/10.1161/CIRCRESAHA.113.300282] [PMID: 23989711]
[44]
Ingles J, Burns C, Bagnall RD, et al. Nonfamilial hypertrophic cardiomyopathy: Prevalence, natural history, and clinical implications. Circ Cardiovasc Genet 2017; 10(2): e001620.
[http://dx.doi.org/10.1161/CIRCGENETICS.116.001620] [PMID: 28408708]
[45]
Maron BJ, Maron MS, Semsarian C. Genetics of hypertrophic cardiomyopathy after 20 years: Clinical perspectives. J Am Coll Cardiol 2012; 60(8): 705-15.
[http://dx.doi.org/10.1016/j.jacc.2012.02.068] [PMID: 22796258]
[46]
Shinwari ZMA, Almesned A, Alakhfash A, et al. The phenotype and outcome of infantile cardiomyopathy caused by a homozygous ELAC2 Mutation. Cardiology 2017; 137(3): 188-92.
[http://dx.doi.org/10.1159/000465516] [PMID: 28441660]
[47]
Finocchiaro G, Magavern E, Sinagra G, et al. Impact of demographic features, lifestyle, and comorbidities on the clinical expression of hypertrophic cardiomyopathy. J Am Heart Assoc 2017; 6(12): e007161.
[http://dx.doi.org/10.1161/JAHA.117.007161] [PMID: 29237589]
[48]
Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas LM, McKenna WJ. Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy. J Am Coll Cardiol 2003; 42(5): 873-9.
[http://dx.doi.org/10.1016/S0735-1097(03)00827-1] [PMID: 12957435]
[49]
Maron BJ, Rowin EJ, Udelson JE, Maron MS. Clinical spectrum and management of heart failure in hypertrophic cardiomyopathy. JACC Heart Fail 2018; 6(5): 353-63.
[http://dx.doi.org/10.1016/j.jchf.2017.09.011] [PMID: 29655822]
[50]
Sen CS, Jacoby D, Moon JC, McKenna WJ. Update on hypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol 2016; 13(11): 651-75.
[http://dx.doi.org/10.1038/nrcardio.2016.140] [PMID: 27681577]
[51]
Díez LC, Salazar MJ. Clinical presentations of hypertrophic cardiomyopathy and implications for therapy. Glob Cardiol Sci Pract 2018; 2018(3): 19.
[http://dx.doi.org/10.21542/gcsp.2018.19] [PMID: 30393631]
[52]
Maron MS, Olivotto I, Harrigan C, et al. Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy. Circulation 2011; 124(1): 40-7.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.110.985812] [PMID: 21670234]
[53]
Yonezawa Y, Nihoyannopoulos P, McKenna WJ, Doi YL, Ozawa T. Mitral regurgitation in hypertrophic cardiomyopathy. Am J Noninvas Cardio 1988; 2(4-5): 195-8.
[http://dx.doi.org/10.1159/000470686]
[54]
Raphael CE, Cooper R, Parker KH, et al. Mechanisms of myocardial ischemia in hypertrophic cardiomyopathy: Insights from wave intensity analysis and magnetic resonance. J Am Coll Cardiol 2016; 68(15): 1651-60.
[http://dx.doi.org/10.1016/j.jacc.2016.07.751] [PMID: 27712778]
[55]
Maron MS, Olivotto I, Maron BJ, et al. The case for myocardial ischemia in hypertrophic cardiomyopathy. J Am Coll Cardiol 2009; 54(9): 866-75.
[http://dx.doi.org/10.1016/j.jacc.2009.04.072] [PMID: 19695469]
[56]
Wolf MK, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289(18): 2363-9.
[http://dx.doi.org/10.1001/jama.289.18.2363] [PMID: 12746359]
[57]
Sorajja P, Ommen SR, Nishimura RA, Gersh BJ, Berger PB, Tajik AJ. Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease. Circulation 2003; 108(19): 2342-8.
[http://dx.doi.org/10.1161/01.CIR.0000097110.55312.BF] [PMID: 14581405]
[58]
Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ. Atrial fibrillation in hypertrophic cardiomyopathy: Prevalence, clinical correlations, and mortality in a large high risk population. J Am Heart Assoc 2014; 3(3): e001002.
[http://dx.doi.org/10.1161/JAHA.114.001002] [PMID: 24965028]
[59]
Lin TT, Sung YL, Ko TY, et al. Risk of ischemic stroke in patients with hypertrophic cardiomyopathy in the absence of atrial fibrillation - a nationwide cohort study. Aging (Albany NY) 2019; 11(23): 11347-57.
[http://dx.doi.org/10.18632/aging.102532] [PMID: 31794426]
[60]
Alfonso F, Nihoyannopoulos P, Stewart J, Dickie S, Lemery R, McKenna WJ. Clinical significance of giant negative T waves in hypertrophic cardiomyopathy. J Am Coll Cardiol 1990; 15(5): 965-71.
[http://dx.doi.org/10.1016/0735-1097(90)90225-E] [PMID: 2312983]
[61]
Savage DD, Seides SF, Clark CE, et al. Electrocardiographic findings in patients with obstructive and nonobstructive hypertrophic cardiomyopathy. Circulation 1978; 58(3): 402-8.
[http://dx.doi.org/10.1161/01.CIR.58.3.402] [PMID: 567104]
[62]
McLeod CJ, Ackerman MJ, Nishimura RA, Tajik AJ, Gersh BJ, Ommen SR. Outcome of patients with hypertrophic cardiomyopathy and a normal electrocardiogram. J Am Coll Cardiol 2009; 54(3): 229-33.
[http://dx.doi.org/10.1016/j.jacc.2009.02.071] [PMID: 19589435]
[63]
Doi YL, McKenna WJ, Oakley CM, Goodwin JF. ‘Pseudo’ systolic anterior motion in patients with hypertensive heart disease. Eur Heart J 1983; 4(12): 838-45.
[http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a061411] [PMID: 6686523]
[64]
Maron BJ, McKenna WJ, Danielson GK, et al. 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 2003; 42(9): 1687-713.
[http://dx.doi.org/10.1016/S0735-1097(03)00941-0] [PMID: 14607462]
[65]
Elliott P, Andersson B, Arbustini E, et al. Classification of the cardiomyopathies: A position statement from the european society of cardiology working group on myocardial and pericardial diseases. Eur Heart J 2007; 29(2): 270-6.
[http://dx.doi.org/10.1093/eurheartj/ehm342] [PMID: 17916581]
[66]
Losi MA, Nistri S, Galderisi M, et al. Echocardiography in patients with hypertrophic cardiomyopathy: Usefulness of old and new techniques in the diagnosis and pathophysiological assessment. Cardiovasc Ultrasound 2010; 8(1): 7.
[http://dx.doi.org/10.1186/1476-7120-8-7] [PMID: 20236538]

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