Factors Contributing to Increased Left Ventricle Size in Patients With Abnormally Enlarged Hearts

Hypertrophic cardiomyopathy (HCM) is a genetic disease with an autosomal dominant pattern of inheritance which is characterized by left ventricular hypertrophy (LVH). HCM is often caused by missense mutations of genes that encode for sarcomeric proteins. The LVH varies markedly in patients with identical sarcomeric gene mutations, and notably, 20 to 40% of subjects with disease mutation do not have LVH as assessed by echocardiography. These findings suggest that other factors affect LV wall thickness in HCM. We wish (1) to investigate the potential role of IGF-I and its binding protein, IGFBP3, in determining increased LV mass in HCM caused by sarcomeric mutations; and (2) to assess myocardial ultrasound backscatter, exercise tolerance, and propensity to arrhythmias, in subjects who have inherited sarcomeric mutations but who do not have LVH.

Inclusion criteria

HCM subjects 5 years or older, with distinct sarcomeric gene mutations and LV wall thickness greater than 15 mm in subjects older than 18 years, and greater than 2 SDs in subjects 18 years of age or younger, as assessed by MRI.

Age- and gender-matched blood relatives with sarcomeric gene mutations but without LVH.

Age- and gender-matched blood relatives without sarcomeric gene mutations.

Exclusion criteria

History of hypertension (basal systolic and diastolic pressures above 170 mm Hg and 95 mm Hg, respectively) or another systemic or cardiac disease that may cause cardiac hypertrophy.

History of recent acute illness or other chronic illness that might affect plasma levels of IGF-I and IGFBP3.

History of thyrotoxicosis, diabetes mellitus or abnormally elevated fasting blood sugar.

Any conditions which would exclude patients from undergoing MRI scan.