|
|
| (25 intermediate revisions by the same user not shown) |
| Line 28: |
Line 28: |
|
| |
|
| ==Guidelines== | | ==Guidelines== |
| ----
| | [[Cardiomyopathy 2023 ESC Guideline Recommendations|2023 ESC Guideline Recommendations]] | [[Cardiomyopathy 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy|2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy]] |
| === <b><font color="red"> 2023 ESC Guideline Recommendations </font> </b> <ref name="pmid37622657">{{cite journal| author=Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C | display-authors=etal| title=2023 ESC Guidelines for the management of cardiomyopathies. | journal=Eur Heart J | year= 2023 | volume= 44 | issue= 37 | pages= 3503-3626 | pmid=37622657 | doi=10.1093/eurheartj/ehad194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37622657 }} </ref>===
| |
| | |
| ====<u> Recommendations for the Provision of Service of [[Multidisciplinary]] [[Cardiomyopathy]] Teams </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. It is recommended that all [[patients]] with [[cardiomyopathy]] and their relatives have access to multidisciplinary teams with expertise in the [[diagnosis]] and [[management]] of [[cardiomyopathies]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | bgcolor="LightGray"|2. Timely and adequate preparation for transition of [[care]] from [[pediatric]] to [[adult]] services, including [[joint]] [[consultations]], is recommended in all [[adolescents]] with [[cardiomyopathy]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Diagnostic]] [[Work-up]] in [[Cardiomyopathies]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. It is recommended that all [[patients]] with suspected or established [[cardiomyopathy]] undergo [[systematic]] evaluation using a multiparametric approach that includes [[clinical]] evaluation, [[pedigree]] analysis, [[ECG]], [[Holter monitoring]], [[laboratory]] tests, and [[multimodality]] [[imaging]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | bgcolor="LightGray"|2. It is recommended that all [[patients]] with suspected [[cardiomyopathy]] undergo evaluation of [[family history]] and that a three- to four-[[generation]] [[family tree]] is created to aid in [[diagnosis]], provide clues to underlying [[etiology]], determine [[inheritance]] pattern, and identify at- [[risk]] [[relatives]]
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Laboratory Tests]] in the [[Diagnosis]] of [[Cardiomyopathies]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. Routine (first-level) [[laboratory]] tests are recommended in all [[patients]] with suspected or confirmed [[cardiomyopathy]] to evaluate [[etiology]], assess [[disease]] [[severity]], and aid in detection of extra-[[cardiac]] [[manifestations]] and assessment of secondary [[organ]] [[dysfunction]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Echocardiographic]] [[Evaluation]] in [[Patients]] with [[Cardiomyopathies]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. A comprehensive evaluation of [[cardiac]] dimensions and [[LV]] and [[RV]] [[systolic]] (global and regional) and [[LV]] [[diastolic]] function is recommended in all [[patients]] with [[cardiomyopathy]] at initial evaluation, and during follow-up, to monitor [[disease]] progression and aid [[risk stratification]] and [[management]].
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Cardiac]] [[Magnetic Resonance]] Indication in [[Patients]] with [[Cardiomyopathies]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. [[Contrast]]-enhanced [[CMR]] is recommended in [[patients]] with [[cardiomyopathy]] at initial evaluation.
| |
| |bgcolor= "Turquoise"; style="text-align:center; |B
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Computed Tomography]] and [[Nuclear Imaging]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. [[DPD]]/[[PYP]]/[[HMDP]] [[bone-tracer scintigraphy]] is recommended in [[patients]] with suspected [[ATTR]]-related [[cardiac]] [[amyloidosis]] to aid [[diagnosis]].
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Genetic Counselling]] and Testing in [[Cardiomyopathies]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>[[Genetic Counselling]]</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| |bgcolor="LightGray"|1. [[Genetic]] [[counselling]], provided by an appropriately trained [[healthcare]] [[professional]] and including [[genetic]] education to inform decision-making and [[psychosocial support]], is recommended for [[families]] with an [[inherited]] or suspected [[inherited]] [[cardiomyopathy]], regardless of whether [[genetic testing]] is being considered.
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| |bgcolor="LightGray"|2. It is recommended that [[genetic testing]] for [[cardiomyopathy]] is performed with access to a [[multidisciplinary]] team, including those with
| |
| expertise in [[genetic testing]] [[methodology]], sequence variant interpretation, and [[clinical]] application of [[genetic testing]], typically in a specialized
| |
| [[cardiomyopathy]] service or in a network model with access to equivalent expertise.
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| |bgcolor="LightGray"|3. Pre- and post-test [[genetic]] [[counselling]] is recommended in all [[individuals]] undergoing [[genetic testing]] for [[cardiomyopathy]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>Index [[Patients]]</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1.[[Genetic testing]] is recommended in [[patients]] fulfilling [[diagnostic]] criteria for [[cardiomyopathy]] in cases where it enables [[diagnosis]],
| |
| [[prognostication]]], [[therapeutic]] stratification, or [[reproductive]] [[management]] of the [[patient]], or where it enables cascade [[genetic]] evaluation of their [[relatives]] who would otherwise be enrolled into long-term surveillance.
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| | bgcolor="LightGray"|2. [[Genetic testing]] is recommended for a [[deceased]] [[individual]] identified to have [[cardiomyopathy]] at [[post-mortem]] if a [[genetic]] [[diagnosis]] would facilitate [[management]] of surviving [[relatives]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>[[Family Members]]</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. It is recommended that cascade [[genetic testing]], with pre- and post-test [[counselling]], is offered to [[adult]] at-risk [[relatives]] if a confident [[genetic]] [[diagnosis]] (i.e. a P/LP variant) has been established in an [[individual]] with [[cardiomyopathy]] in the [[family]] (starting with first-degree [[relatives]] if available, and cascading out sequentially).
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightCoral"| [[ESC #Classification of Recommendations|Class III]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|2. [[Diagnostic]] [[genetic testing]] is not recommended in a [[phenotype]]-negative [[relative]] of a [[patient]] with [[cardiomyopathy]] in the absence of a confident [[genetic]] [[diagnosis]] (i.e. a P/LP variant) in the [[family]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Cardiac]] [[Implantation]] in [[Patients]] with [[Cardiomyopathy]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. [[Orthotopic cardiac transplantation]] is recommended for eligible [[cardiomyopathy]] [[patients]] with advanced [[heart failure]] ([[NYHA class III–IV]]) or intractable [[ventricular arrhythmia]] refractory to [[medical]]/[[invasive]]/[[device therapy]], and who do not have absolute [[contraindications]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | bgcolor="LightGray"|2. It is recommended that all [[patients]] with suspected [[cardiomyopathy]] undergo evaluation of [[family history]] and that a three- to four-[[generation]] [[family tree]] is created to aid in [[diagnosis]], provide clues to underlying [[etiology]], determine [[inheritance]] pattern, and identify at- [[risk]] [[relatives]]
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Management]] of [[Atrial Fibrillation]] and [[Atrial Flutter]] in [[Patients]] with [[Cardiomyopathy]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>[[Anticoagulation]]</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| |bgcolor="LightGray"|1. [[Oral anticoagulation]] in order to reduce the risk of [[stroke]] and [[thromboembolic]] events is recommended in all [[patients]] with [[HCM]] or [[cardiac]] [[amyloidosis]] and [[AF]] or [[atrial flutter]] (unless contraindicated).
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| |bgcolor="LightGray"|2. [[Oral anticoagulation]] to reduce the risk of [[stroke]] and [[thromboembolic]] events is recommended in [[patients]] with [[DCM]], [[NDLVC]], or [[ARVC]], and [[AF]] or [[atrial flutter]] with a [[CHA2DS2-VASc score]] ≥2 in [[men]] or ≥3 in [[women]].
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b> Control of [[symptoms]] and [[heart failure]]</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1.[[Atrial fibrillation]] [[catheter ablation]] is recommended for[[ rhythm control]] after one failed or intolerant [[class I]] or [[III]] [[AAD]] to improve [[symptoms]] of [[AF]] recurrences in [[patients]] with [[paroxysmal]] or persistent [[AF]] and [[cardiomyopathy]].
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| | bgcolor="LightGray"|2. [[Atrial fibrillation]] [[catheter ablation]] is recommended to reverse [[LV dysfunction]] in [[AF]] [[patients]] with [[cardiomyopathy]] when a
| |
| [[tachycardia]]-induced component is highly probable, independent of their [[symptom]] status.
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>[[Comorbidities]] and associated [[risk factor]] [[management]]</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|1. Modification of an un[[healthy]] [[lifestyle]] and targeted [[therapy]] of intercurrent conditions is recommended to reduce [[AF]] burden and [[symptom]] severity in [[patients]] with [[cardiomyopathy]].
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |}
| |
| | |
| ====<u> Recommendations for [[Implantable Cardioverter Defibrillator]] in [[Patients]] with [[Cardiomyopathy]] </u>====
| |
| | |
| {|class="wikitable" style="width:80%"
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>General Recommendations</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| |bgcolor="LightGray"|1. [[Implantation]] of a [[cardioverter defibrillator]] is only recommended in [[patients]] who have an expectation of good quality[[ survival]] >1 year.
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| |bgcolor="LightGray"|2. It is recommended that ICD implantation be guided by shared decision-making that:
| |
| *Is [[evidence-based]];
| |
| *Considers a [[person]]’s [[individual]] preferences, beliefs, circumstances, and values; and
| |
| *Ensures that the [[person]] understands the benefits, [[harm]], and possible consequences of different [[treatment]] options
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | bgcolor="LightGray"|3. It is recommended that prior to [[ICD]] [[implantation]], [[patients]] are counselled on the [[risk]] of inappropriate [[shocks]], [[implant]] [[complications]], and the social, occupational, and driving implications of the [[device]].
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightCoral"| [[ESC #Classification of Recommendations|Class III]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| | bgcolor="LightGray"|4. It is not recommended to [[implant]] an [[ICD]] in [[patients]] with incessant [[ventricular arrhythmias]] until the [[ventricular arrhythmia]] is controlled.
| |
| |bgcolor= "LightBlue"; style="text-align:center;|C
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>[[Secondary Prevention]]</b>
| |
| |-
| |
| | colspan="2" style="text-align:center; background:WhiteSmoke" | <b>[[Implantation]] of an [[ICD]] is recommended:</b>
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| |bgcolor="LightGray"|1. In [[patients]] with [[HCM]], [[DCM]], and [[ARVC]] who have survived a [[cardiac arrest]] due to [[VT]] or [[VF]], or who have spontaneous sustained
| |
| [[ventricular arrhythmia]] causing [[syncope]] or [[hemodynamic]] compromise in the absence of reversible causes.
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |-
| |
| |colspan="1" style="text-align:center; background:LightGreen"| [[ESC #Classification of Recommendations|Class I]]
| |
| |colspan="0.5" style="text-align:center; background:LightGray"|[[ESC #Level of Evidence|'''Level of Evidence''']]
| |
| |-
| |
| |bgcolor="LightGray"|2. In [[patients]] with [[NDLVC]] and [[RCM]] who have survived a [[cardiac arrest]] due to [[VT]] or [[VF]], or who have spontaneous sustained [[ventricular arrhythmia]] causing [[syncope]] or [[hemodynamic]] compromise in the absence of reversible causes.
| |
| |bgcolor= "Turquoise"; style="text-align:center;|B
| |
| |}
| |
| | |
| ----
| |
| ----
| |
| | |
| === <b><font color="red"> 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy</font> </b> <ref name="pmid33215931">{{cite journal| author=Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P | display-authors=etal| title=2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2020 | volume= 142 | issue= 25 | pages= e558-e631 | pmid=33215931 | doi=10.1161/CIR.0000000000000937 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33215931 }} </ref>===
| |
|
| |
|
| == Case Studies == | | == Case Studies == |
| Line 276: |
Line 56: |
| [[Category:Up-To-Date cardiology]] | | [[Category:Up-To-Date cardiology]] |
| [[Category:Disease]] | | [[Category:Disease]] |
| | |
| | ==References== |
