title: The many faces of hypertrophic cardiomyopathy: from developmental biology to clinical practice.
abstract: Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, characterized by complex pathophysiology, heterogeneous morphology, and variable clinical manifestations over time. Besides cardiac hypertrophy, the HCM phenotype is characterized by a host of manifestations, including mitral valve and subvalvar abnormalities, subaortic and mid-ventricular left ventricular (LV) obstruction, microvascular dysfunction, myocardial fibrosis, disarray, atrial remodeling, myocardial bridging of epicardial coronary arteries, LV apical aneurysms, and autonomic nervous system abnormalities. Such heterogeneous phenotype still lacks a comprehensive explanation, which cannot be accounted solely by genetic heterogeneity, despite the large number of genes and mutations involved. It is likely that pre-natal and acquired features deriving from the primary genetic defect interact with the environment to produce the final result evident in each patient. Based on novel insights provided by cardiac developmental biology, a common lineage ancestry of several HCM manifestations might be traced back to the pluripotent epicardium-derived cells, which early during heart development differentiate into interstitial fibroblasts, coronary smooth muscle cells, and atrio-ventricular endocardial cushions as mesenchymal cells. To date, the different faces of HCM have not been sufficiently liked or explained. We here attempt to address these issues by describing the various components of the disease, their origin, interaction, and clinical significance.
authors.affiliation: Department of Cardiology, Careggi University Hospital, Florence, Italy. olivottoi@aou-careggi.toscana.it
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
authors.forename: Francesca
authors.initials: F
authors.lastname: Girolami
authors.forename: Stefano
authors.initials: S
authors.lastname: Nistri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rossi
authors.forename: Luigi
authors.initials: L
authors.lastname: Rega
authors.forename: Francesca
authors.initials: F
authors.lastname: Garbini
authors.forename: Camilla
authors.initials: C
authors.lastname: Grifoni
authors.forename: Franco
authors.initials: F
authors.lastname: Cecchi
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000818:Animals; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D024741:Cardiomyopathy, Hypertrophic, Familial / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D020022:Genetic Predisposition to Disease; D006439:Hemodynamics; D006801:Humans; D009206:Myocardium / Q000473:pathology; D010641:Phenotype; D039904:Pluripotent Stem Cells / Q000473:pathology; D057170:Translational Research, Biomedical; D016896:Treatment Outcome