{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nznh21\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nznh21\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/4\\\/33\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/4\\\/33\u0022}],\u0022ac\u0022:{\u0022spmdc;12\\\/4\\\/33\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;12\\\/4\\\/33\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ENew practice guidelines for hypertrophic cardiomyopathy were issued in 2011 by the American College of Cardiology Foundation\/American Heart Association (ACCF\/AHA) [Gersh BJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ENew practice guidelines for hypertrophic cardiomyopathy (HCM) were issued in 2011 by the American College of Cardiology Foundation\/American Heart Association (ACCF\/AHA) [Gersh BJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMichael J Ackerman, MD, Mayo Clinic, Rochester, Minnesota, USA, discussed the new guidelines for genetic testing for HCM from both the ACCF\/AHA and from the Heart Rhythm Society\/European Heart Rhythm Association (HRS\/EHRA) [Ackerman MJ et al. \u003Cem\u003EHeart Rhythm\u003C\/em\u003E 2011.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EUnder the ACCF\/AHA guidelines genetic testing:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-5\u0022\u003Eis recommended in patients with atypical clinical presentation of HCM or when another genetic condition is suspected (Class I; Level of Evidence [LoE] B)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-6\u0022\u003Eis reasonable in the index patient to facilitate identification of first-degree family members who are at risk for developing HCM (Class IIa; LoE B)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-7\u0022\u003EUsing the HRS\/EHRA guidelines (both Class I; LoE C [ie Expert Consensus]):\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003Ecomprehensive or targeted HCM genetic testing is recommended for any patient in whom a cardiologist has established a clinical diagnosis of HCM based on examination of the patient\u0027s clinical history, family history, and electro-\/echocardiographic phenotype\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003Emutation\u2013specific genetic testing is recommended for family members and appropriate relatives following the identification of the HCM\u2013causative mutation in an index case\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-10\u0022\u003EMilind Y. Desai, MD, Cleveland Clinic, Cleveland, Ohio, USA, presented a summary of the recommendations for the use of echocardiography. Some of the specific recommendations concerned the use of transthoracic echo as part of:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003Ethe initial evaluation of all patients with suspected HCM (Class I; LoE B)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003Ethe screening algorithm for family members (Class I; LoE B)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \u003Cp id=\u0022p-13\u0022\u003Eperiodic screening for children of HCM patients (Class I; LoE C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-14\u0022\u003EMartin S. Maron, MD, Tufts Medical Center, Boston, Massachusetts, USA, presented the recommendations for the use of cardiac MRI (CMR). The new guidelines indicate the use of CMR imaging:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-4\u0022\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n            \u003Cp id=\u0022p-15\u0022\u003Ein patients with suspected HCM to detect segmental areas of increased left ventricular wall thickening that are not seen by echocardiography (eg, anterolateral wall, apex and posterior septum; Class I; LoE B)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n            \u003Cp id=\u0022p-16\u0022\u003Ein patients with HCM when this additional information might have an impact on risk assessment and treatment decisions regarding appropriate selection of invasive septal reduction therapy (Class I; LoE B)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n            \u003Cp id=\u0022p-17\u0022\u003Efor identification of high\u2013risk patients using late gadolinium enhancement in selected HCM patients in whom risk stratification remains uncertain after assessment with conventional sudden death markers (Class IIb; LoE C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-18\u0022\u003EPerry M. Elliott, MD, The Heart Hospital, University College London, London, United Kingdom, presented some of the new recommendations concerning the symptoms in HCM, such as chest pain, dyspnea and arrhythmia that may be explained by decreased myocardial perfusion and the resultant myocardial ischemia:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-5\u0022\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n            \u003Cp id=\u0022p-19\u0022\u003Eassessment of coronary anatomy with computed tomographic angiography is reasonable for HCM patients with chest discomfort and a low likelihood of coronary artery disease (CAD) to assess for possible concomitant CAD (Class IIa; LoE C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n            \u003Cp id=\u0022p-20\u0022\u003Ethe assessment of ischemia or perfusion abnormalities suggestive of CAD with single\u2013photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial perfusion imaging (MPI) is reasonable in patients with HCM with chest discomfort and a low likelihood of CAD to rule out possible concomitant CAD (Class IIa; LoE C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-13\u0022\u003E\n            \u003Cp id=\u0022p-21\u0022\u003Erecommendations do not support the use of routine SPECT MPI or stress echocardiography for detection of \u201csilent\u201d CAD\u2013related ischemia in patients with HCM who are asymptomatic; nor is the use of PET to detect the presence of microvascular ischemia recommended for the prognosis of HCM (Class III; LoE C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-22\u0022\u003EOverall there is a low annual rate of mortality from sudden cardiac arrest due to HCM. However, unacceptable death rates in the HCM population remain even in those being treated with medications, explained Matthew W. Martinez, MD, Lehigh Valley Health Network, Allentown, Pennsylvania, USA. Implantable cardioverter\u2013defibrillators (ICDs) are a useful treatment option in patients who are at high risk of SCD, defined as young patients with a positive family history of SCD, unexplained syncope, left ventricularwall thickness \u0026gt;30 mm, associated CAD, nonsustained ventricular tachycardia, exercised\u2013induced hypotension, or fibrosis detected by MRI (Class Ib; LoE B).\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003EPaul Sorajja, MD, Mayo Clinic, Rochester, Minnesota, USA, comparing the outcomes from myectomy and septal ablation, reported that myectomy is the recommended standard treatment for HCM (Class IIa; LoE C), as it offers low immediate post\u2013operative risk, a \u0026gt;95% chance of symptom relief and superb long\u2013term survival benefits. Septal ablation works well if patients are carefully selected (Class IIa or IIb; LoE B) but has higher acute complications, often including heart block, hence the need for a pacemaker following ablation. The two procedures appear to be comparable in terms of gradient relief, symptom relief, and early survival; however, there continues to be concern regarding the potential long\u2013term consequences of the ablation\u2013induced infarction, including data from ICD monitoring that suggest an increased risk of ventricular arrhythmia among HCM patients post ablation compared with septal myectomy. A definitive randomized trial that compared long\u2013term outcomes between these two procedures has yet to be performed.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/4\/33.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznh21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}