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Yoshioka G, Tanaka A, Sonoda S, Kaneko T, Hongo H, Yokoi K, Natsuaki M, Node K. Importance of reassessment to identify trajectories of chronic transition of clinical indicators in post-myocardial infarction management. Cardiovasc Interv Ther 2024; 39:234-240. [PMID: 38615302 DOI: 10.1007/s12928-024-01000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
Despite advances in multidisciplinary acute care for myocardial infarction (MI), the clinical need to manage heart failure and elevated mortality risks in the remote phase of MI remains unmet. Various prognostic models have been established using clinical indicators obtained during the acute phase of MI; however, most of these indicators also show chronic changes in the post-MI phase. Although relevant guidelines recommend follow-up assessments of some clinical indicators in the chronic phase, systematic reassessment has not yet been fully established and implemented in a real-world clinical setting. Therefore, clinical evidence of the impact of such chronic transitions on the post-MI prognosis is lacking. We speculate that post-MI reassessment of key clinical indicators and the impact of their chronic transition patterns on long-term prognoses can improve the quality of post-MI risk stratification and help identify residual risk factors. Several recent studies have investigated the impact of the chronic transition of some clinical indicators, such as serum albumin level, mitral regurgitation, and left-ventricular dysfunction, on post-MI prognosis. Interestingly, even in MI survivors with these indicators within their respective normal ranges in the acute phase of MI, chronic transition to an abnormal range was associated with worsening cardiovascular outcomes. On the basis of these recent insights, we discuss the clinical significance of post-MI reassessment to identify the trajectories of several clinical indicators and elucidate the potential residual risk factors affecting adverse outcomes in MI survivors.
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Affiliation(s)
- Goro Yoshioka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Tetsuya Kaneko
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroshi Hongo
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kensuke Yokoi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Juntunen S, Holmström L, Vähätalo J, Mäntyniemi L, Tikkanen J, Pakanen L, Kaikkonen K, Perkiömäki J, Huikuri H, Junttila J. The burden of sudden cardiac arrest in the setting of acute coronary syndrome. Resuscitation 2024:110297. [PMID: 38942268 DOI: 10.1016/j.resuscitation.2024.110297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/05/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The incidence of sudden cardiac arrest (SCA) during acute coronary syndrome is somewhat unclear, since often subjects dying before the first healthcare contact are not included in the estimates. We aimed to investigate the complete incidence of SCA during ACS. METHODS The study population consists of two cohorts. The first cohort includes 472 ACS patients from Northern Ostrobothnia, Finland from year 2016 and the second cohort 162 autopsy-verified SCD subjects (extrapolated) from the same region and year, whose death was attributable to coronary artery disease (CAD) and ACS. An extrapolation of SCA incidence during ACS was done by utilizing autopsy data and data from prior autopsy study on this sample. RESULTS The overall incidence of SCA in the setting of ACS was 17.5%. The incidence of SCA was 20.6% in all ACS subjects without prior CAD diagnosis, and 25.4% in STEMI subjects without prior CAD diagnosis. In subjects with previously diagnosed CAD, the incidence of SCA was 10.9% in all ACS subjects and 16.1% in STEMI subjects. There was a statistically significant difference in the incidence of SCA between subjects with and without prior CAD diagnosis (p = 0.0052). CONCLUSION The inclusion of ACS-SCA subjects dying before the first emergency medical service (EMS) contact results in a higher and likely more accurate estimation of SCA during ACS. The incidence of SCA was higher among subjects without prior CAD diagnosis. The high mortality rate highlights the importance of early ACS detection to reduce the burden of CAD-related premature deaths.
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Affiliation(s)
- Samuli Juntunen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.
| | - Lauri Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Lassi Mäntyniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Jani Tikkanen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland; Department of Forensic Medicine, Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Kari Kaikkonen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
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Melberg MB, Flaa A, Andersen GØ, Sunde K, Bellomo R, Eastwood G, Olasveengen TM, Qvigstad E. Effects of mild hypercapnia on myocardial injury after out-of-hospital cardiac arrest. A sub-study of the TAME trial. Resuscitation 2024:110295. [PMID: 38936652 DOI: 10.1016/j.resuscitation.2024.110295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Mild hypercapnia did not improve neurological outcomes for resuscitated out-of-hospital cardiac arrest (OHCA) patients in the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. However, the effects of hypercapnic acidosis on myocardial injury in patients with cardiac arrest is unexplored. We investigated whether mild hypercapnia compared to normocapnia, following emergency coronary intervention, increased myocardial injury in comatose OHCA-patients with AMI. METHODS Single-centre, prospective, pre-planned sub-study of the TAME trial. Patients were randomised to targeted mild hypercapnia (PaCO2 = 6.7-7.3 kPa) or normocapnia (PaCO2 = 4.7-6.0 kPa) for 24 h. Myocardial injury was assessed with high-sensitive cardiac troponin T (hs-cTnT) measured at baseline, 24, 48 and 72 h. Haemodynamics were assessed with right heart catheterisation and blood-gas analyses every 4th hour for 48 h. RESULTS We included 125 OHCA-patients. 57 (46%) had an AMI, with 31 and 26 patients randomised to hypercapnia and normocapnia, respectively. Median peak hs-cTnT in AMI-patients was 58% lower in the hypercapnia-group: 2136 (IQR: 861-4462) versus 5165 ng/L (IQR: 2773-7519), p = 0.007. Lower average area under the hs-cTnT curve was observed in the hypercapnia-group: 2353 (95% CI 1388-3319) versus 4953 ng/L (95% CI 3566-6341), P-group = 0.002. Hypercapnia was associated with increased cardiac power output (CPO) and lower lactate levels in patients with AMI (P-group < 0.05). hs-cTnT, lactate and CPO were not significantly different between intervention groups in OHCA-patients without AMI (p > 0.05). CONCLUSIONS Mild hypercapnia was not associated with increased myocardial injury in resuscitated OHCA-patients. In AMI-patients, mild hypercapnia was associated with lower hs-cTnT and lactate, and improved cardiac performance. TRIAL REGISTRATION NUMBER NCT03114033.
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Affiliation(s)
- Mathias Baumann Melberg
- Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Arnljot Flaa
- Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Øystein Andersen
- Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Sunde
- Department of Anaesthesiology and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Norway
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Melbourne, Australia; Department of Critical Care, Melbourne University, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Melbourne, Australia
| | - Theresa Mariero Olasveengen
- Department of Anaesthesiology and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Norway
| | - Eirik Qvigstad
- Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway
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Sasaki S, Fujisaki K, Nishimura M, Nakano T, Abe M, Hanafusa N, Joki N. Association Between Disturbed Serum Phosphorus Levels and QT Interval Prolongation. Kidney Int Rep 2024; 9:1792-1801. [PMID: 38899225 PMCID: PMC11184388 DOI: 10.1016/j.ekir.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction QT interval prolongation is a risk factor for fatal arrhythmias and other cardiovascular complications. QT interval prolongation in patients on hemodialysis (HD) is not well understood. Hypocalcemia is a suspected, but poorly verified etiology in these patients, and the association between serum phosphorus levels and QT interval prolongation is unknown. We sought to determine the prevalence of QT interval prolongation in patients on HD and to verify the association between predialysis serum calcium (Ca) and phosphate (P) levels and QT interval prolongation. Methods A cross-sectional study was conducted on adult patients on maintenance HD who were enrolled in the Japanese Society for Dialysis Therapy and Renal Data Registry 2019. After assessing patient characteristics, linear regression analysis was performed with predialysis serum Ca and P levels as exposures and a rate-corrected QT (QTc) interval as the outcome. Results A total of 204,530 patients were analyzed with a mean QTc of 451.2 (standard deviation, 36.9) ms. After multivariable analysis, estimated change in QTc (coefficients; 95% confidence interval) per 1 mg/dl increase in serum Ca and P was -2.02 (-3.00 to -1.04) and 5.50 (3.92-7.09), respectively. In the restricted cubic spline curve, estimated change in QTc increased with lower values of serum Ca. The correlation between serum P and QTc showed a U-shaped curve. Conclusion Decreased serum Ca levels and decreased and increased serum P levels may be associated with QT interval prolongation in patients on maintenance HD.
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Affiliation(s)
- Sho Sasaki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | | | | | - Toshiaki Nakano
- Department of Medical and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women`s Medical University, Tokyo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Sourour N, Riveland E, Næsgaard P, Kjekshus H, Larsen AI, Røsjø H, Omland T, Myhre PL. Associations Between Biomarkers of Myocardial Injury and Systemic Inflammation and Risk of Incident Ventricular Arrhythmia. JACC Clin Electrophysiol 2024:S2405-500X(24)00295-0. [PMID: 38904572 DOI: 10.1016/j.jacep.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Cardiac troponins (cTns) and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VAs) is unclear. OBJECTIVES This study sought to assess whether cTnT, growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA. METHODS In a prospective, observational study of patients treated with implantable cardioverter-defibrillator, cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4 ± 0.5 years and were associated with implantable cardioverter-defibrillator-detected incident VA, HF hospitalizations, and mortality. RESULTS This study included 489 patients aged 66 ± 12 years and 83% were men. Median concentrations of cTnT were 15 (Q1-Q3: 9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease, and HF. During 3.1 ± 0.7 years of follow-up, 137 patients (28%) had ≥1 VA. cTnT concentrations were associated with an increased VA risk (per log-unit, HR: 1.63; 95% CI: 1.31-2.01; P < 0.001), also after adjustment for age, sex, body mass index, coronary artery disease, HF, renal function, and left ventricular ejection fraction (P < 0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4 years were not associated with subsequent VA. CONCLUSIONS Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predict incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.
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Affiliation(s)
- Nur Sourour
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil Riveland
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Patrycja Næsgaard
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Harald Kjekshus
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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6
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Bauer J, Vlcek J, Pauly V, Hesse N, Xia R, Mo L, Chivukula AS, Villgrater H, Dressler M, Hildebrand B, Wolf E, Rizas KD, Bauer A, Kääb S, Tomsits P, Schüttler D, Clauss S. Biomarker Periodic Repolarization Dynamics Indicates Enhanced Risk for Arrhythmias and Sudden Cardiac Death in Myocardial Infarction in Pigs. J Am Heart Assoc 2024; 13:e032405. [PMID: 38639363 PMCID: PMC11179938 DOI: 10.1161/jaha.123.032405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Periodic repolarization dynamics (PRD) is an electrocardiographic biomarker that captures repolarization instability in the low frequency spectrum and is believed to estimate the sympathetic effect on the ventricular myocardium. High PRD indicates an increased risk for postischemic sudden cardiac death (SCD). However, a direct link between PRD and proarrhythmogenic autonomic remodeling has not yet been shown. METHODS AND RESULTS We investigated autonomic remodeling in pigs with myocardial infarction (MI)-related ischemic heart failure induced by balloon occlusion of the left anterior descending artery (n=17) compared with pigs without MI (n=11). Thirty days after MI, pigs demonstrated enhanced sympathetic innervation in the infarct area, border zone, and remote left ventricle paralleled by altered expression of autonomic marker genes/proteins. PRD was enhanced 30 days after MI compared with baseline (pre-MI versus post-MI: 1.75±0.30 deg2 versus 3.29±0.79 deg2, P<0.05) reflecting pronounced autonomic alterations on the level of the ventricular myocardium. Pigs with MI-related ventricular fibrillation and SCD had significantly higher pre-MI PRD than pigs without tachyarrhythmias, suggesting a potential role for PRD as a predictive biomarker for ischemia-related arrhythmias (no ventricular fibrillation versus ventricular fibrillation: 1.50±0.39 deg2 versus 3.18±0.53 deg2 [P<0.05]; no SCD versus SCD: 1.67±0.32 deg2 versus 3.91±0.63 deg2 [P<0.01]). CONCLUSIONS We demonstrate that ischemic heart failure leads to significant proarrhythmogenic autonomic remodeling. The concomitant elevation of PRD levels in pigs with ischemic heart failure and pigs with MI-related ventricular fibrillation/SCD suggests PRD as a biomarker for autonomic remodeling and as a potential predictive biomarker for ventricular arrhythmias/survival in the context of MI.
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Affiliation(s)
- Julia Bauer
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Julia Vlcek
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Valerie Pauly
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Nora Hesse
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Ruibing Xia
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Li Mo
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Aparna Sharma Chivukula
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Hannes Villgrater
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Marie Dressler
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Bianca Hildebrand
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
| | - Eckhard Wolf
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU MunichMunichGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU MunichMunichGermany
| | - Konstantinos D. Rizas
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
| | - Axel Bauer
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- University Hospital for Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Stefan Kääb
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU MunichMunichGermany
| | - Philipp Tomsits
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Dominik Schüttler
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Sebastian Clauss
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU MunichMunichGermany
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Qayoumi P, Coronel R, Folke F, Arulmurugananthavadivel A, Parveen S, Yonis H, Meaidi A, Lamberts M, Schou M, Torp-Pedersen C, Hilmar Gislason G, Eroglu TE. Sleep apnea, the risk of out-of-hospital cardiac arrest, and potential benefits of continuous positive airway pressure therapy: A nationwide study. Resuscitation 2024; 198:110174. [PMID: 38479652 DOI: 10.1016/j.resuscitation.2024.110174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Patients with sleep apnea (SA) are at increased cardiovascular risk. However, little is known about the risk of out-of-hospital cardiac arrest (OHCA) in patients with SA. Therefore, we studied the relation between SA patients who did and did not receive continuous positive airway pressure (CPAP) therapy with OHCA in the general population. METHODS Using nationwide databases, we conducted a nested case-control study with OHCA-cases of presumed cardiac causes and age/sex/OHCA-date matched non-OHCA-controls from the general population. Conditional logistic regression models with adjustments for well-known OHCA risk factors were performed to generate odds ratio (OR) of OHCA comparing patients with SA receiving and not receiving CPAP therapy with individuals without SA. RESULTS We identified 46,578 OHCA-cases and 232,890 matched non-OHCA-controls [mean: 71 years, 68.8% men]. Compared to subjects without SA, having SA without CPAP therapy was associated with increased odds of OHCA after controlling for relevant confounders (OR:1.20, 95%-Cl:1.06-1.36), while having SA with CPAP therapy was not associated with OHCA (OR:1.04, 95%-Cl:0.93-1.36). Regardless of CPAP therapy, age and sex did not significantly influence our findings. Our findings were confirmed in: (I) patients with neither ischemic heart disease nor heart failure (untreated SA, OR:1.24, 95%-CI:1.04-1.47; SA with CPAP, OR:1.08, 95%-CI:0.93-1.25); and (II) in patients without cardiovascular disease (untreated SA, OR:1.33, 95%-CI:1.07-1.65; SA with CPAP, OR:1.14, 95%-CI:0.94-1.39). CONCLUSION SA not treated with CPAP was associated with OHCA, while no increased risk of OHCA was found for SA patients treated with CPAP.
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Affiliation(s)
- Pelpika Qayoumi
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Ruben Coronel
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital -Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | | | - Saaima Parveen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Harman Yonis
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Amani Meaidi
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
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8
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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Paludan-Müller C, Hassager C, Kjærgaard J, Tfelt-Hansen J, Winkel BG. Toxicological profile using mass spectrometry in sudden cardiac arrest survivors admitted to a tertiary centre. Resuscitation 2024; 198:110197. [PMID: 38582441 DOI: 10.1016/j.resuscitation.2024.110197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND There has been no previous thorough toxicological examination of a cohort of patients with resuscitated sudden cardiac arrest. We aimed to determine the qualitative and quantitative drug composition in a resuscitated sudden cardiac arrest population, using forensic toxicology, with focus on prescribed, non-prescribed, and commonly abused drugs. METHODS Individuals aged 18-90 years with resuscitated sudden cardiac arrest of presumed cardiac causes were prospectively included from a single tertiary center. Data from the sudden cardiac arrest hospitalization was collected from medical reports. Drugs used during resuscitation or before the blood sampling were identified and excluded in each patient. Mass spectrometry-based toxicology was performed to determine the absence or presence of most drugs and to quantify the findings. RESULTS Among 186 consecutively enrolled resuscitated sudden cardiac arrest patients (median age 62 years, 83% male), 90% had a shockable rhythm, and were primarily caused by ischemic heart disease (66%). In total, 90 different drugs (excluding metabolites) were identified, and 82% of patients had at least one drug detected (median of 2 detected drugs (IQR:1-4)) (polypharmacy). Commonly abused drugs were present in 16%, and QT-prolonging drugs were present in 12%. Polypharmacy (≥5drugs) were found in 19% of patients. Importantly, none had potentially lethal concentrations of any drugs. CONCLUSION In resuscitated sudden cardiac arrest patients with cardiac arrest of presumed cardiac cause, routine toxicological screening provides limited extra information. However, the role of polypharmacy in sudden cardiac arrest requires further investigation. No occult overdose-related cardiac arrests were identified.
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Affiliation(s)
- Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Brian Schou Rasmussen
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Paludan-Müller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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9
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Pandit SV, Lampe JW, Silver AE. Recurrence of ventricular fibrillation in out-of-hospital cardiac arrest: Clinical evidence and underlying ionic mechanisms. J Physiol 2024. [PMID: 38661672 DOI: 10.1113/jp284621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/08/2024] [Indexed: 04/26/2024] Open
Abstract
Defibrillation remains the optimal therapy for terminating ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients, with reported shock success rates of ∼90%. A key persistent challenge, however, is the high rate of VF recurrence (∼50-80%) seen during post-shock cardiopulmonary resuscitation (CPR). Studies have shown that the incidence and time spent in recurrent VF are negatively associated with neurologically-intact survival. Recurrent VF also results in the administration of extra shocks at escalating energy levels, which can cause cardiac dysfunction. Unfortunately, the mechanisms underlying recurrent VF remain poorly understood. In particular, the role of chest-compressions (CC) administered during CPR in mediating recurrent VF remains controversial. In this review, we first summarize the available clinical evidence for refibrillation occurring during CPR in OHCA patients, including the postulated contribution of CC and non-CC related pathways. Next, we examine experimental studies highlighting how CC can re-induce VF via direct mechano-electric feedback. We postulate the ionic mechanisms involved by comparison with similar phenomena seen in commotio cordis. Subsequently, the hypothesized contribution of partial cardiac reperfusion (either as a result of CC or CC independent organized rhythm) in re-initiating VF in a globally ischaemic heart is examined. An overview of the proposed ionic mechanisms contributing to VF recurrence in OHCA during CPR from a cellular level to the whole heart is outlined. Possible therapeutic implications of the proposed mechanistic theories for VF recurrence in OHCA are briefly discussed.
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Affiliation(s)
- Sandeep V Pandit
- University of Memphis, ZOLL Medical, Chelmsford, Massachusetts, USA
| | - Joshua W Lampe
- University of Pennsylvania, ZOLL Medical, Chelmsford, Massachusetts, USA
| | - Annemarie E Silver
- University of Colorado Boulder, ZOLL Medical, Chelmsford, Massachusetts, USA
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10
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Jha CK. Automated cardiac arrhythmia detection techniques: a comprehensive review for prospective approach. Comput Methods Biomech Biomed Engin 2024:1-16. [PMID: 38566498 DOI: 10.1080/10255842.2024.2332942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
Abnormal cardiac functionality produces irregular heart rhythms which are commonly known as arrhythmias. In some conditions, arrhythmias are treated as very dangerous which may lead to sudden cardiac arrest. The incidence and prevalence of cardiac anomalies seeks early detection of arrhythmias using automated classification techniques. In the past, numerous automated arrhythmia detection techniques have been developed that are based on electrocardiogram (ECG) signal analysis. Focusing on the prospective research in this field, this article reports a comprehensive review of existing techniques that are obtained using search engines such as IEEE explore, Google scholar and science direct. Based on the review, the existing techniques are broadly categorized into two types: machine-learning and deep-learning-based techniques. In this study, it is noticed that the performance of the machine-learning-based arrhythmia detection techniques depend on pre-processing of ECG signal, R-peaks detection, features extraction and classification tools while the deep-learning-based techniques do not require the features extraction step. Generally, the existing techniques utilize Massachusetts Institute of Technology-Beth Israel Hospital arrhythmia database to evaluate the classification performance. The classification performance of automated techniques also depends on ECG data used for training and testing of the classifier. It is expected that the performance should be evaluated using a variety of ECG signals including the cases of inter-patient and intra-patient paradigm. The existing techniques also require to deal with the class-imbalance problem. In addition to this, a specific partition-ratio between training and testing datasets should be maintained for fair comparison of performance of different techniques.
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Affiliation(s)
- Chandan Kumar Jha
- Department of Electronics & Communication Engineering, Indian Institute of Information Technology Bhagalpur, India
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11
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Li Z, Wang S, Qin Y, Yang B, Wang C, Lu T, Xu J, Zhu L, Yuan C, Han W. Gabapentin attenuates cardiac remodeling after myocardial infarction by inhibiting M1 macrophage polarization through the peroxisome proliferator-activated receptor-γ pathway. Eur J Pharmacol 2024; 967:176398. [PMID: 38350591 DOI: 10.1016/j.ejphar.2024.176398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES Inflammation regulates ventricular remodeling after myocardial infarction (MI), and gabapentin exerts anti-inflammatory effects. We investigated the anti-inflammatory role and mechanism of gabapentin after MI. METHODS Rats were divided into the sham group (n = 12), MI group (n = 20), and MI + gabapentin group (n = 16). MI was induced by left coronary artery ligation. The effects of gabapentin on THP-1-derived macrophages were examined in vitro. RESULTS In vivo, 1 week after MI, gabapentin significantly reduced inducible nitric oxide synthase (iNOS; M1 macrophage marker) expression and decreased pro-inflammatory factors (tumor necrosis factor [TNF]-α and interleukin [IL]-1β). Gabapentin upregulated the M2 macrophage marker arginase-1, as well as CD163 expression, and increased the expression of anti-inflammatory factors, including chitinase-like 3, IL-10, and transforming growth factor-β. Four weeks after MI, cardiac function, infarct size, and cardiac fibrosis improved after gabapentin treatment. Gabapentin inhibited sympathetic nerve activity and decreased ventricular electrical instability in rats after MI. Tyrosine hydroxylase and growth-associated protein 43 were suppressed after gabapentin treatment. Gabapentin downregulated nerve growth factor (NGF) and reduced pro-inflammatory factors (iNOS, TNF-α, and IL-1β). In vitro, gabapentin reduced NGF, iNOS, TNF-α, and IL-1β expression in lipopolysaccharide-stimulated macrophages. Mechanistic studies revealed that the peroxisome proliferator-activated receptor-γ antagonist GW9662 attenuated the effects of gabapentin. Moreover, gabapentin reduced α2δ1 expression in the macrophage plasma membrane and reduced the calcium content of macrophages. CONCLUSION Gabapentin attenuates cardiac remodeling by inhibiting inflammation via peroxisome proliferator-activated receptor-γ activation and preventing calcium overload.
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Affiliation(s)
- Zhenjun Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Shaoxian Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ying Qin
- College of Sports and Human Sciences, Harbin Sport University, Harbin, 150001, China
| | - Bo Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Chengcheng Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Tianyi Lu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jie Xu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Lige Zhu
- Medical Department, The Second Affiliated Hospital of Hei Long Jiang University of Chinese Medicine, Harbin, 150001, China
| | - Chen Yuan
- School of Basic Medical Sciences, Harbin Medical University, Harbin, 150081, China
| | - Wei Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China; Department of Heart Failure, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
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12
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Stampe NK, Ottenheijm ME, Drici L, Wewer Albrechtsen NJ, Nielsen AB, Christoffersen C, Warming PE, Engstrøm T, Winkel BG, Jabbari R, Tfelt-Hansen J, Glinge C. Discovery of plasma proteins associated with ventricular fibrillation during first ST-elevation myocardial infarction via proteomics. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:264-272. [PMID: 37811694 DOI: 10.1093/ehjacc/zuad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
AIMS The underlying biological mechanisms of ventricular fibrillation (VF) during acute myocardial infarction are largely unknown. To our knowledge, this is the first proteomic study for this trait, with the aim to identify and characterize proteins that are associated with VF during first ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS We included 230 participants from a Danish ongoing case-control study on patients with first STEMI with VF (case, n = 110) and without VF (control, n = 120) before guided catheter insertion for primary percutaneous coronary intervention. The plasma proteome was investigated using mass spectrometry-based proteomics on plasma samples collected within 24 h of symptom onset, and one patient was excluded in quality control. In 229 STEMI patients {72% men, median age 62 years [interquartile range (IQR): 54-70]}, a median of 257 proteins (IQR: 244-281) were quantified per patient. A total of 26 proteins were associated with VF; these proteins were involved in several biological processes including blood coagulation, haemostasis, and immunity. After correcting for multiple testing, two up-regulated proteins remained significantly associated with VF, actin beta-like 2 [ACTBL2, fold change (FC) 2.25, P < 0.001, q = 0.023], and coagulation factor XIII-A (F13A1, FC 1.48, P < 0.001, q = 0.023). None of the proteins were correlated with anterior infarct location. CONCLUSION Ventricular fibrillation due to first STEMI was significantly associated with two up-regulated proteins (ACTBL2 and F13A1), suggesting that they may represent novel underlying molecular VF mechanisms. Further research is needed to determine whether these proteins are predictive biomarkers or acute phase response proteins to VF during acute ischaemia.
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Affiliation(s)
- Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Maud Eline Ottenheijm
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Lylia Drici
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Annelaura Bach Nielsen
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Centre of Diagnostic Investigation, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peder Emil Warming
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
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13
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Rahunen R, Tulppo M, Rinne V, Lepojärvi S, Perkiömäki JS, Huikuri HV, Ukkola O, Junttila J, Hukkanen J. Liver X Receptor Agonist 4β-Hydroxycholesterol as a Prognostic Factor in Coronary Artery Disease. J Am Heart Assoc 2024; 13:e031824. [PMID: 38390795 PMCID: PMC10944077 DOI: 10.1161/jaha.123.031824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Regardless of progress in treatment of coronary artery disease (CAD), there is still a significant residual risk of death in patients with CAD, highlighting the need for additional risk stratification markers. Our previous study provided evidence for a novel blood pressure-regulating mechanism involving 4β-hydroxycholesterol (4βHC), an agonist for liver X receptors, as a hypotensive factor. The aim was to determine the role of 4βHC as a prognostic factor in CAD. METHODS AND RESULTS The ARTEMIS (Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection) cohort consists of 1946 patients with CAD. Men and women were analyzed separately in quartiles according to plasma 4βHC. Basic characteristics, medications, ECG, and echocardiography parameters as well as mortality rate were analyzed. At baseline, subjects with a beneficial cardiovascular profile, as assessed with traditional markers such as body mass index, exercise capacity, prevalence of diabetes, and use of antihypertensives, had the highest plasma 4βHC concentrations. However, in men, high plasma 4βHC was associated with all-cause death, cardiac death, and especially sudden cardiac death (SCD) in a median follow-up of 8.8 years. Univariate and comprehensively adjusted hazard ratios for SCD in the highest quartile were 3.76 (95% CI, 1.6-8.7; P=0.002) and 4.18 (95% CI, 1.5-11.4; P=0.005), respectively. In contrast, the association of cardiac death and SCD in women showed the lowest risk in the highest 4βHC quartile. CONCLUSIONS High plasma 4βHC concentration was associated with death and especially SCD in men, while an inverse association was detected in women. Our results suggest 4βHC as a novel sex-specific risk marker of cardiac death and especially SCD in chronic CAD. REGISTRATION INFORMATION clinicaltrials.gov. Identifier NCT01426685.
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Affiliation(s)
- Roosa Rahunen
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Biocenter OuluUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Mikko Tulppo
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | | | - Samuli Lepojärvi
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Juha S. Perkiömäki
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Heikki V. Huikuri
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Olavi Ukkola
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Juhani Junttila
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Biocenter OuluUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Janne Hukkanen
- Research Unit of Biomedicine and Internal MedicineUniversity of OuluOuluFinland
- Biocenter OuluUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
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14
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Thakkar N, Alam P, Thaker A, Ahukla A, Shah J, Saxena D, Shah K. Incidence of Sudden Cardiac Death in Low- and Middle-Income Countries: A Systematic Review of Cohort Studies. Indian J Community Med 2024; 49:279-289. [PMID: 38665450 PMCID: PMC11042141 DOI: 10.4103/ijcm.ijcm_468_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/20/2023] [Indexed: 04/28/2024] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of mortality worldwide and, in recent years, has become an urgent public health concern in low- and middle-income countries (LMICs). Data from LMICs, however, remains limited. As such, the aim of this article is to systematically review the current literature on the incidence of SCD in LMICs to inform policymakers and identify potential research gaps. A search of PubMed and Embase was utilized to capture the targeted condition, outcome, and setting. Only peer-reviewed cohort studies in LMICs reporting SCD incidence estimates in the general population of individuals aged ≥1 year were eligible for selection. Papers providing incidence data for specific types of SCD, including sudden coronary death or death from sudden cardiac arrest, were also included. After deduplication, 1941 citations were identified and screened. Seven studies representing four countries-Cameroon, China, India, and Iran-met the criteria for inclusion and were considered in our analysis. The crude incidence rate for SCD ranged from 19.9 to 190 cases per 100,000 person-years, while age-adjusted rates ranged from 33.6 to 230 cases per 100,000 person-years. There was notable variability in methods utilized to ascertain SCD cases. These findings suggest that the incidence of all-cause SCD in LMICs and may exceed that of high-income countries; however, observed disparities may be partly attributable to differences in case ascertainment methods. Additional research is needed to better understand the true incidence of SCD in developing countries. It is crucial that future studies across regions utilize standard diagnostic criteria and methodology for identifying SCD, which would provide a framework by which to compare outcomes between settings.
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Affiliation(s)
- Nandan Thakkar
- Office of Graduate Education, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Prima Alam
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abhi Thaker
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Aakansha Ahukla
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Jay Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Komal Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
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15
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Oknińska M, Duda MK, Czarnowska E, Bierła J, Paterek A, Mączewski M, Mackiewicz U. Sex- and age-dependent susceptibility to ventricular arrhythmias in the rat heart ex vivo. Sci Rep 2024; 14:3460. [PMID: 38342936 PMCID: PMC10859380 DOI: 10.1038/s41598-024-53803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/13/2024] Open
Abstract
The incidence of life-threatening ventricular arrhythmias, the most common cause of sudden cardiac death (SCD), depends largely on the arrhythmic substrate that develops in the myocardium during the aging process. There is a large deficit of comparative studies on the development of this substrate in both sexes, with a particular paucity of studies in females. To identify the substrates of arrhythmia, fibrosis, cardiomyocyte hypertrophy, mitochondrial density, oxidative stress, antioxidant defense and intracellular Ca2+ signaling in isolated cardiomyocytes were measured in the hearts of 3- and 24-month-old female and male rats. Arrhythmia susceptibility was assessed in ex vivo perfused hearts after exposure to isoproterenol (ISO) and hydrogen peroxide (H2O2). The number of ventricular premature beats (PVBs), ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes, as well as intrinsic heart rate, QRS and QT duration, were measured in ECG signals recorded from the surfaces of the beating hearts. After ISO administration, VT/VFs were formed only in the hearts of males, mainly older ones. In contrast, H2O2 led to VT/VF formation in the hearts of rats of both sexes but much more frequently in older males. We identified several components of the arrhythmia substrate that develop in the myocardium during the aging process, including high spontaneous ryanodine receptor activity in cardiomyocytes, fibrosis of varying severity in different layers of the myocardium (nonheterogenic fibrosis), and high levels of oxidative stress as measured by nitrated tyrosine levels. All of these elements appeared at a much greater intensity in male individuals during the aging process. On the other hand, in aging females, antioxidant defense at the level of H2O2 detoxification, measured as glutathione peroxidase expression, was weaker than that in males of the same age. We showed that sex has a significant effect on the development of an arrhythmic substrate during aging. This substrate determines the incidence of life-threatening ventricular arrhythmias in the presence of additional stimuli with proarrhythmic potential, such as catecholamine stimulation or oxidative stress, which are constant elements in the pathomechanism of most cardiovascular diseases.
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Affiliation(s)
- Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Monika Katarzyna Duda
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Elżbieta Czarnowska
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-736, Warsaw, Poland
- Department of Pathology, Medical University of Warsaw, Żwirki i Wigury 61, 02-091, Warsaw, Poland
| | - Joanna Bierła
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-736, Warsaw, Poland
| | - Aleksandra Paterek
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland.
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16
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Ren H, Qu H, Zhang Y, Gu Y, Zhao Y, Xu W, Zhou M, Wang W. Detection of monosodium urate depositions and atherosclerotic plaques in the cardiovascular system by dual-energy computed tomography. Heliyon 2024; 10:e24548. [PMID: 38304777 PMCID: PMC10831746 DOI: 10.1016/j.heliyon.2024.e24548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
Aim The study aimed to explore the relationship between urate deposition and surrounding atherosclerotic plaques, and to confirm the contribution of urate deposition to the development of coronary atherosclerosis. Methods and results The present study employed Dual-energy CT (DECT) material separation technology through calcium score scan to access the presence of MSU crystal deposition in coronary atherosclerotic plaques in patients with clinically suspected coronary heart diseases undergoing DECT. DECT showed that among 872 patients, 441 had plaques in coronary arteries; the incidence of plaque was 50.6 %. The patients were divided in the atherosclerotic plaque vs. non-plaque groups. There were significant differences in age, sex, blood pressure, blood glucose, serum creatinine, and history of gout and hyperuricemia between the plaque and non-plaque groups (all P < 0.05). Among the patients with coronary plaques, there were 348 patients (78.9 %) with simple atherosclerotic plaque (AP), 8 (1.8 %) with simple urate depositions (UD), and 85 (19.3 %) with urate depositions and atherosclerotic plaques (UDAP). The multivariable analysis showed that urate deposition was independently associated with plaques after adjustment for age, sex, blood pressure, blood glucose, serum creatinine, history of gout, and history of hyperuricemia (OR = 13.69, 95%CI: 7.53-22.95, P = 0.035). UPAP patients had significantly higher coronary calcium scores than AP patients [210.1 (625.2) AU vs 58.2 (182.5) AU, P < 0.001] Urate deposition (16.7 mm3) positively correlated with plaque calcification (73.8 mm³) in UPAP patients (r = 0.325, P < 0.001). Conclusion Patients with gout or a history of hyperuricemia were more likely to exhibit UDAP. Urate deposition was independently associated with plaques.
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Affiliation(s)
- Haolin Ren
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Graduate School of Dalian Medical University, Dalian, China
| | - Hang Qu
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yong Zhang
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yue Gu
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yi Zhao
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Wenjuan Xu
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Mingsheng Zhou
- Department of Physiology, Shenyang Medical College, Shenyang, China
| | - Wei Wang
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
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17
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Ellenardóttir V, Coronel R, Folke F, Halili A, Arulmurugananthavadivel A, Parveen S, Andersen MP, Schou M, Torp-Pedersen C, Gislason G, Eroglu TE. Fluoroquinolones do not provide added risk of out-of-hospital cardiac arrest: a nationwide study. Open Heart 2024; 11:e002520. [PMID: 38216172 PMCID: PMC10806456 DOI: 10.1136/openhrt-2023-002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024] Open
Abstract
AIM Conflicting results have been reported regarding the association between fluoroquinolones (FQs) and the risk of out-of-hospital cardiac arrest (OHCA). In particular, it has not become clear whether OHCA in FQ users is related to the inherent comorbidities or whether there is a direct pro-arrhythmic effect of FQs. Therefore, we studied the relation between FQs and OHCA in the general population. METHODS Through Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the OR with 95% CI of OHCA comparing FQs with amoxicillin. RESULTS The study population consisted of 46 578 OHCA cases (mean: 71 years (SD: 14.40), 68.8% men) and 232 890 matched controls. FQ was used by 276 cases and 328 controls and conferred no increase in the odds of OHCA compared with amoxicillin use after controlling for the relevant confounders (OR: 0.91 (95% CI: 0.71 to 1.16)). The OR of OHCA associated with FQ use did not vary significantly by age (OR≤65: 0.96 (95% CI: 0.53 to 1.74), OR>65: 0.88 (95% CI: 0.67 to 1.16), p value interaction=0.7818), sex (ORmen: 0.96 (95% CI: 0.70 to 1.31), ORwomen: 0.80 (95% CI: 0.53 to 1.20), p value interaction=0.9698) and pre-existing cardiovascular disease (ORabsent: 1.02 (95% CI: 0.57 to 1.82), ORpresent: 0.98 (95% CI: 0.75 to 1.28), p value interaction=0.3884), including heart failure (ORabsent: 0.93 (95% CI: 0.72 to 1.22), ORpresent: 1.11 (95% CI: 0.61 to 2.02), p value interaction=0.7083) and ischaemic heart disease (ORabsent: 0.85 (95% CI: 0.64 to 1.12), ORpresent: 1.38 (95% CI: 0.86 to 2.21), p value interaction=0.6230). CONCLUSION Our findings do not support an association between FQ exposure and OHCA in the general population. This lack of association was consistent in men and women, in all age categories, and in the presence or absence of cardiovascular disease.
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Affiliation(s)
- Viktoría Ellenardóttir
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Ruben Coronel
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen University Hospital -Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Andrim Halili
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Saaima Parveen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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18
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Mensah IK, Emerson ML, Tan HJ, Gowher H. Cardiomyocyte Differentiation from Mouse Embryonic Stem Cells by WNT Switch Method. Cells 2024; 13:132. [PMID: 38247824 PMCID: PMC10814988 DOI: 10.3390/cells13020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The differentiation of ESCs into cardiomyocytes in vitro is an excellent and reliable model system for studying normal cardiomyocyte development in mammals, modeling cardiac diseases, and for use in drug screening. Mouse ESC differentiation still provides relevant biological information about cardiac development. However, the current methods for efficiently differentiating ESCs into cardiomyocytes are limiting. Here, we describe the "WNT Switch" method to efficiently commit mouse ESCs into cardiomyocytes using the small molecule WNT signaling modulators CHIR99021 and XAV939 in vitro. This method significantly improves the yield of beating cardiomyocytes, reduces number of treatments, and is less laborious.
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Affiliation(s)
| | | | | | - Humaira Gowher
- Department of Biochemistry, Purdue University, West Lafayette, IN 47907, USA; (I.K.M.); (H.J.T.)
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19
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Webber M, Joy G, Bennett J, Chan F, Falconer D, Shiwani H, Davies RH, Krausz G, Tanackovic S, Guger C, Gonzalez P, Martin E, Wong A, Rapala A, Direk K, Kellman P, Pierce I, Rudy Y, Vijayakumar R, Chaturvedi N, Hughes AD, Moon JC, Lambiase PD, Tao X, Koncar V, Orini M, Captur G. Technical development and feasibility of a reusable vest to integrate cardiovascular magnetic resonance with electrocardiographic imaging. J Cardiovasc Magn Reson 2023; 25:73. [PMID: 38044439 PMCID: PMC10694972 DOI: 10.1186/s12968-023-00980-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo. METHODS CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests. RESULTS 77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively). CONCLUSION Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification. CLINICAL TRIAL REGISTRATION Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Bennett
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Hunain Shiwani
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Pablo Gonzalez
- ELEM Biotech, S.L, Barcelona, Spain
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
- Department of Information and Communication Technologies, Physense, Universitat Pempeu Fabra, Barcrlona, Spain
| | - Emma Martin
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kenan Direk
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Ramya Vijayakumar
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Xuyuan Tao
- École Nationale Supérieure des Arts et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix CEDEX 1, France
| | - Vladan Koncar
- École Nationale Supérieure des Arts et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix CEDEX 1, France
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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20
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Beni NH, Jiang N. Heartbeat detection from high-density EMG electrodes on the upper arm at different EMG intensity levels using Zephlet. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107828. [PMID: 37863012 DOI: 10.1016/j.cmpb.2023.107828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND OBJECTIVES A significant number of global deaths caused by cardiac arrhythmias can be prevented with accurate and immediate identification. Wearable devices can play a critical role in such identification by continuously monitoring cardiac activity using electrocardiogram (ECG). The existing body of research has focused on extracting cardiac information from the body surface by investigating various electrode locations and algorithm development for ECG interpretation. The present study was designed for heartbeat detection using the signals recorded from the upper arm. METHODS Firstly, optimal electrode locations on the upper arm were identified for Rest and elbow flexion (EF) conditions. Next, a synthesized ECG was generated using the selected electrodes with generalized weights over subjects and trials, and then zero-phase wavelet (Zephlet) was applied for feature extraction. Heartbeat detection was finally performed using the extracted detail coefficients incorporated with a multiagent detection scheme (MDS). RESULTS The F1-score for heartbeat detection was 0.94 ± 0.16, 0.86 ± 0.22, 0.79 ± 0.26, and 0.67 ± 0.31 for Rest and EF with three different levels of muscle contraction (C1 to C3), respectively. Changing the acceptable distance between the detected and actual heartbeats from 50 ms to 20 ms, the F1-score changed to 0.81 ± 0.20, 0.66 ± 0.26, 0.57 ± 0.26, and 0.44 ± 0.26 for Rest and C1 to C3, respectively. CONCLUSION These findings make several contributions to the current literature, summarized as precise and consistent electrode localization for various muscle contraction levels and accurate heartbeat detection method development for each of these conditions.
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Affiliation(s)
- Nargess Heydari Beni
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Ning Jiang
- National Clinical Research Center for Geriatrics, West China Hospital Sichuan University, China; The Med-X Center for Manufacturing, Sichuan University, Chengdu, Sichuan Province, China.
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21
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Dahlquist M, Frykman V, Hollenberg J, Jonsson M, Stafoggia M, Wellenius GA, Ljungman PLS. Short-Term Ambient Air Pollution Exposure and Risk of Out-of-Hospital Cardiac Arrest in Sweden: A Nationwide Case-Crossover Study. J Am Heart Assoc 2023; 12:e030456. [PMID: 37818697 PMCID: PMC10727387 DOI: 10.1161/jaha.123.030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023]
Abstract
Background Air pollution is one of the main risk factors for cardiovascular disease globally, but its association with out-of-hospital cardiac arrest at low air pollution levels is unclear. This nationwide study in Sweden aims to investigate if air pollution is associated with a higher risk of out-of-hospital cardiac arrest in an area with relatively low air pollution levels. Methods and Results This study was a nationwide time-stratified case-crossover study investigating the association between short-term air pollution exposures and out-of-hospital cardiac arrest using data from the SRCR (Swedish Registry for Cardiopulmonary Resuscitation) between 2009 and 2019. Daily air pollution levels were estimated in 1×1-km grids for all of Sweden using a satellite-based machine learning model. The association between daily air pollutant levels and out-of-hospital cardiac arrest was quantified using conditional logistic regression adjusted for daily air temperature. Particulate matter <2.5 μm exposure was associated with a higher risk of out-of-hospital cardiac arrest among a total of 29 604 cases. In a multipollutant model, the association was most pronounced for intermediate daily lags, with an increased relative risk of 6.2% (95% CI, 1.0-11.8) per 10 μg/m3 increase of particulate matter <2.5 μm 4 days before the event. A similar pattern of association was observed for particulate matter <10 μm. No clear association was observed for O3 and NO2. Conclusions Short-term exposure to air pollution was associated with higher risk of out-of-hospital cardiac arrest. The findings add to the evidence of an adverse effect of particulate matter on out-of-hospital cardiac arrest, even at very low levels below current regulatory standards.
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Affiliation(s)
- Marcus Dahlquist
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of CardiologyDanderyd University HospitalSweden
| | - Viveka Frykman
- Department of CardiologyDanderyd University HospitalSweden
- Department of Clinical SciencesDanderyd University Hospital, Karolinska InstitutetDanderydSweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Massimo Stafoggia
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of EpidemiologyLazio Region Health ServiceRoma 1Italy
| | - Gregory A. Wellenius
- Department of Environmental HealthBoston University School of Public HealthMAUSA
| | - Petter L. S. Ljungman
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of CardiologyDanderyd University HospitalSweden
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22
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Eroglu TE, Halili A, Arulmurugananthavadivel A, Coronel R, Kessing LV, Fosbøl EL, Folke F, Torp-Pedersen C, Gislason GH. Use of methylphenidate is associated with increased risk of out-of-hospital cardiac arrest in the general population: a nationwide nested case-control study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:658-665. [PMID: 37070942 DOI: 10.1093/ehjcvp/pvad028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/22/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023]
Abstract
AIM Methylphenidate, a sympathomimetic drug prescribed to treat attention-deficit/hyperactivity disorder (ADHD), is associated with cardiovascular events, but few studies have explored the risk of out-of-hospital cardiac arrest (OHCA). We investigated whether methylphenidate use is associated with OHCA in the general population. METHODS AND RESULTS Using Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA-date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the odds ratio (OR) of OHCA by comparing methylphenidate use with no use of methylphenidate.The study population consisted of 46 578 OHCA cases [median: 72 years (interquartile range: 62-81), 68.8% men] and 232 890 matched controls. Methylphenidate was used by 80 cases and 166 controls, and was associated with an increased OR of OHCA compared with non-users {OR: 1.78 [95% confidence interval (CI): 1.32-2.40]}. The OR was highest in recent starters (OR≤180 days: 2.59, 95% CI: 1.28-5.23). The OR of OHCA associated with methylphenidate use did not vary significantly by age (P-value interaction: 0.37), sex (P-value interaction: 0.94), and pre-existing cardiovascular disease (P-value interaction: 0.27). Furthermore, the ORs remained elevated when we repeated the analyses in individuals without registered hospital-based ADHD (OR: 1.85, 95% CI: 1.34-2.55), without severe psychiatric disorders (OR: 1.98, 95% CI: 1.46-2.67), without depression (OR: 1.93, 95% CI: 1.40-2.65), or in non-users of QT-prolonging drugs (OR: 1.79, 95% CI: 1.27-2.54). CONCLUSION Methylphenidate use is associated with an increased risk of OHCA in the general population. This increased risk applies to both sexes and is independent of age and the presence of cardiovascular disease.
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Affiliation(s)
- Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Andrim Halili
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anojhaan Arulmurugananthavadivel
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, Amsterdam UMC, Academic Medical Center, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
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23
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Ravi KS, Mavrakanas TA, Charytan DM, Mc Causland FR. The Association of Ejection Fraction With Hospital-Associated Cardiac Arrest and Heart Failure Hospitalization Differs According to Baseline Estimated GFR. Kidney Int Rep 2023; 8:2326-2332. [PMID: 38025227 PMCID: PMC10658283 DOI: 10.1016/j.ekir.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) and left ventricular (LV) dysfunction are risk factors for cardiovascular events. We explore whether the association of LV ejection fraction (LVEF) with cardiac arrest, heart failure hospitalization, and all-cause mortality differs across stages of kidney impairment. Methods We performed an observational cohort study of 19,032 patients from 2004 to 2014 with estimated glomerular filtration rate (eGFR) ≤90 ml/min per 1.73 m2 and without end-stage kidney disease (ESKD). Cox regression models, incorporating an interaction term for eGFR and LVEF, were fit and adjusted for relevant covariates. Results Mean age of the patients was 67 ± 14 years, and 51% were male. The mean eGFR was 64 ± 19 ml/min per 1.73 m2 and LVEF was 54 ± 13%. Over a median follow-up of 3.0 (0.7-6.0) years there were 504 cardiac arrests, 4181 heart failure hospitalizations, and 6989 deaths. The association of LVEF with cardiac arrest and heart failure hospitalization differed according to continuous eGFR (P-interaction <0.01 for both outcomes). The association of LVEF with cardiac arrest in the lowest quartile was attenuated (adjusted hazard ration [aHR] per 5% higher LVEF 0.92; 95% confidence interval [CI] 0.88-0.96) compared to the highest eGFR quartile (aHR per 5% higher LVEF 0.85; 95% CI 0.78-0.91). The association of LVEF with heart failure hospitalization was similarly attenuated in the lowest eGFR quartile. There was no effect modification of LVEF by continuous eGFR for all-cause mortality (P-interaction 0.26). Conclusion Among non-ESKD patients with eGFR ≤90 ml/min per 1.73 m2, the association of LVEF with cardiac arrest and heart failure hospitalization is attenuated at lower levels of kidney function. Further research is required to elucidate what factors beyond LVEF drive these observations.
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Affiliation(s)
- Katherine Scovner Ravi
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas A. Mavrakanas
- Division of Nephrology, Department of Medicine, McGill University Health Center & Research Institute, Montreal, Quebec, Canada
| | - David M. Charytan
- New York University Grossman School of Medicine and NYU Langone Medical Center, New York, New York, USA
| | - Finnian R. Mc Causland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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24
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Hjärtstam N, Rawshani A, Hellsén G, Råmunddal T. Comorbidities prior to out-of-hospital cardiac arrest and diagnoses at discharge among survivors. Open Heart 2023; 10:e002308. [PMID: 37963682 PMCID: PMC10649799 DOI: 10.1136/openhrt-2023-002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) has a dismal prognosis with overall survival around 10%. Previous studies have shown conflicting results regarding the prevalence and significance of comorbidities in OHCA, as well as the underlying causes. Previously, 80% of sudden cardiac arrest have been attributed to coronary artery disease. We studied comorbidities and discharge diagnoses in OHCA in all of Sweden. METHODS We used the Swedish Registry of Cardiopulmonary Resuscitation, merged with the Inpatient Registry and Outpatient Registry to identify patients with OHCA from 2010 to 2020 and to collect all their comorbidities as well as discharge diagnoses (among those admitted to hospital). Patient characteristics were described using means, medians and SD. Survival curves were performed among hospitalised patients with acute myocardial infarction (AMI) as well as heart failure. RESULTS A total of 54 484 patients with OHCA were included, of whom 35 894 (66%) were men. The most common comorbidities prior to OHCA were hypertension (43.6%), heart failure (23.6%), chronic ischaemic heart disease (23.6%) and atrial fibrillation (22.0%). Previous AMI was prevalent in 14.8% of men and 10.9% of women. Among women, 18.0% had type 2 diabetes, compared with 19.6% of the men. Among hospitalised patients, 30% were diagnosed with AMI, 27% with hypertension, 20% with ischaemic heart disease and 18% with heart failure as discharge diagnoses. CONCLUSION In summary, we find evidence that nowadays a minority of cardiac arrests are due to coronary artery disease and AMIs and its complications. Only 30% of all cases of OHCA admitted to hospital were diagnosed with AMI. Coronary artery disease is now likely in the minority with regard to causes of OHCA.
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Affiliation(s)
- Nellie Hjärtstam
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Gustaf Hellsén
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
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25
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Wang S, Chen Y, Du J, Wang Z, Lin Z, Hong G, Qu D, Shen Y, Li L. Post-mortem genetic analysis of sudden unexplained death in a young cohort: a whole-exome sequencing study. Int J Legal Med 2023; 137:1661-1670. [PMID: 37624372 DOI: 10.1007/s00414-023-03075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
Sudden unexplained death (SUD) constitutes a considerable portion of unexpected sudden death in the young. Molecular autopsy has proved to be an efficient diagnostic tool in the multidisciplinary management of SUD. Yet, many cases remain undiagnosed using the widely adopted targeted genetic screening strategies. Here, we investigated the genetic substrates of a young SUD cohort (18-40 years old) from China using whole-exome sequencing (WES), with the primary aim to identify novel SUD susceptibility genes. Within 255 previously acknowledged SUD-associated genes, 21 variants with likely functional effects (pathogenic/likely pathogenic) were identified in 51.9% of the SUD cases. More importantly, a set of 33 candidate genes associated with myopathy were identified to be novel susceptibility genes for SUD. Comparative analysis of the cumulative PHRED-scaled CADD score and polygenetic burden score showed that the amount and deleteriousness of variants in the 255 SUD-associated genes and the 33 candidate genes identified by this study were significantly higher compared with 289 randomly selected genes. A significantly higher genetic burden of rare variants (MAF < 0.1%) in the 33 candidate genes also highlighted putative roles of these genes in SUD. After incorporating these novel genes, the genetic testing yields of the current SUD cohort elevated from 51.9 to 66.7%. Our study expands understanding of the genetic variants underlying SUD and presents insights that improve the utility of genetic screenings.
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Affiliation(s)
- Shouyu Wang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Yongsheng Chen
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Public Security Bureau, Shanghai, 200083, People's Republic of China
| | - Jianghua Du
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Zhimin Wang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Zijie Lin
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Guanghui Hong
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Dong Qu
- Institute of Legal Medicine, Hannover Medical School, 30625, Hannover, Germany
| | - Yiwen Shen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Liliang Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 131 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China.
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26
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Oh IY. Multicenter Cohort Analysis Unveil Inherited Arrhythmia in Korea. Korean Circ J 2023; 53:708-709. [PMID: 37880831 PMCID: PMC10625853 DOI: 10.4070/kcj.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Il-Young Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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27
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Kaplan A, Lakkis B, El-Samadi L, Karaayvaz EB, Booz GW, Zouein FA. Cooling Down Inflammation in the Cardiovascular System via the Nicotinic Acetylcholine Receptor. J Cardiovasc Pharmacol 2023; 82:241-265. [PMID: 37539950 DOI: 10.1097/fjc.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
ABSTRACT Inflammation is a major player in many cardiovascular diseases including hypertension, atherosclerosis, myocardial infarction, and heart failure. In many individuals, these conditions coexist and mutually exacerbate each other's progression. The pathophysiology of these diseases entails the active involvement of both innate and adaptive immune cells. Immune cells that possess the α7 subunit of the nicotinic acetylcholine receptor on their surface have the potential to be targeted through both pharmacological and electrical stimulation of the cholinergic system. The cholinergic system regulates the inflammatory response to various stressors in different organ systems by systematically suppressing spleen-derived monocytes and chemokines and locally improving immune cell function. Research on the cardiovascular system has demonstrated the potential for atheroma plaque stabilization and regression as favorable outcomes. Smaller infarct size and reduced fibrosis have been associated with improved cardiac function and a decrease in adverse cardiac remodeling. Furthermore, enhanced electrical stability of the myocardium can lead to a reduction in the incidence of ventricular tachyarrhythmia. In addition, improving mitochondrial dysfunction and decreasing oxidative stress can result in less myocardial tissue damage caused by reperfusion injury. Restoring baroreflex activity and reduction in renal damage can promote blood pressure regulation and help counteract hypertension. Thus, the present review highlights the potential of nicotinic acetylcholine receptor activation as a natural approach to alleviate the adverse consequences of inflammation in the cardiovascular system.
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Affiliation(s)
- Abdullah Kaplan
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
- Department of Cardiology, Kemer Public Hospital, Kemer, Antalya, Turkey
- The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
| | - Bachir Lakkis
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Lana El-Samadi
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Ekrem Bilal Karaayvaz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS; and
| | - Fouad A Zouein
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
- The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS; and
- Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Inserm, Université Paris-Saclay, France
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Moinuddin A, Ali SY, Goel A, Sethi Y, Patel N, Kaka N, Satapathy P, Sah R, Barboza JJ, Suhail MK. The age of computational cardiology and future of long-term ablation target prediction for ventricular tachycardia. Front Cardiovasc Med 2023; 10:1233991. [PMID: 37817867 PMCID: PMC10561379 DOI: 10.3389/fcvm.2023.1233991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023] Open
Abstract
Ventricular arrhythmias, particularly ventricular tachycardia, are ubiquitously linked to 300,000 deaths annually. However, the current interventional procedure-the cardiac ablation-predict only short-term responses to treatment as the heart constantly remodels itself post-arrhythmia. To assist in the design of computational methods which focuses on long-term arrhythmia prediction, this review postulates three interdependent prospectives. The main objective is to propose computational methods for predicting long-term heart response to interventions in ventricular tachycardia Following a general discussion on the importance of devising simulations predicting long-term heart response to interventions, each of the following is discussed: (i) application of "metabolic sink theory" to elucidate the "re-entry" mechanism of ventricular tachycardia; (ii) application of "growth laws" to explain "mechanical load" translation in ventricular tachycardia; (iii) derivation of partial differential equations (PDE) to establish a pipeline to predict long-term clinical outcomes in ventricular tachycardia.
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Affiliation(s)
- Arsalan Moinuddin
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Syed Yusuf Ali
- Department of Biomedical Engineering, Johns Hopkins University, Balimore, MD, United States
| | - Ashish Goel
- Department of Medicine, Government Doon Medical College, Dehradun, India
| | - Yashendra Sethi
- Department of Medicine, Government Doon Medical College, Dehradun, India
- PearResearch, Dehradun, India
| | - Neil Patel
- PearResearch, Dehradun, India
- Department of Medicine, GMERS Medical College, Himmatnagar, India
| | - Nirja Kaka
- PearResearch, Dehradun, India
- Department of Medicine, GMERS Medical College, Himmatnagar, India
| | - Prakasini Satapathy
- Global Center for Evidence Synthesis, Chandigarh, India
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
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29
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Luo L, Zhao C, Chen N, Dong Y, Li Z, Bai Y, Wu P, Gao C, Guo X. Characterization of global research trends and prospects on sudden coronary death: A literature visualization analysis. Heliyon 2023; 9:e18586. [PMID: 37576229 PMCID: PMC10413084 DOI: 10.1016/j.heliyon.2023.e18586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Background Sudden coronary death is a major global public health issue that has a significant impact on both individuals and society. Nowadays, scholars are active in sudden coronary death all over the world. However, no relevant bibliometric studies have been published. Here, we aim to gain a better understanding the current state of research and to explore potential new research directions through bibliometric analysis. Methods Articles and reviews on sudden coronary death from 2012 to 2023 were retrieved from the Web of Science Core Collection (WoSCC). The topic search was conducted using the following keywords: ((("sudden cardiac death" OR "sudden death") AND (coronary OR "myocardial infarction")) OR "sudden coronary death"). Knowledge maps of authors, countries, institutions, journals, keywords, and citations were conducted by CiteSpace. Publication dynamics, hotspots, and frontiers were analyzed independently by authors. Results A total of 2914 articles were identified from January 1, 2012 to June 20, 2023. The USA (n = 972) contributed the greatest absolute productivity and UK (centrality = 0.13) built a robust global collaboration. Harvard University was the institution with the highest number of publications (n = 143). Huikuri HV and Junttila MJ were the most published authors who devoted to searching for biomarkers of sudden coronary death. American Journal of Cardiology was the journal with the most publications, and Circulation was the most cited journal. Left ventricular ejection fraction, society, inflammation, and fractional flow reserve became novel burst words that lasted until 2023. Research on etiology and pathology, role of early risk factors in risk stratification, potential predictive biomarkers and novel measurement methods for the prevention and management of sudden coronary death were identified as the research hotspots and frontiers. Conclusion Our knowledge and understanding of sudden coronary death have significantly improved. Ongoing efforts should focus on the various etiologies and pathologies of sudden coronary death. Furthermore, a novel sudden coronary death risk model, large-scale population studies, and the rational use of multiple indicators to individualize the assessment of sudden coronary death and other risk factors are other emerging research trends.
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Affiliation(s)
- Li Luo
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Chunmei Zhao
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Niannian Chen
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Yiming Dong
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Zhanpeng Li
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Yaqin Bai
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Peng Wu
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Cairong Gao
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Xiangjie Guo
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
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30
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Noordman ABP, Rienstra M, Blaauw Y, Mulder BA, Maass AH. Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients with Ventricular Arrhythmia of Unclear Cause in Secondary Prevention of Sudden Cardiac Death. J Clin Med 2023; 12:4479. [PMID: 37445514 DOI: 10.3390/jcm12134479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
In this study, we sought to investigate the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapies and inappropriate shocks in secondary prevention ICD recipients with ventricular arrhythmia of unclear cause and ventricular arrhythmia in the context of underlying heart disease. In this retrospective study, consecutive patients with an ICD implanted for secondary prevention in the University Medical Center Groningen (UMCG), the Netherlands between 1 January 2012 and 31 December 2018 were included. Patients were classified as having ventricular arrhythmia of unclear cause if no clear cause was found which could explain the index ventricular arrhythmia. The primary outcome was appropriate ICD therapy. The study population consisted of 257 patients. In 220 patients, an underlying heart disease could be identified as the cause of ventricular arrhythmia, while 37 patients had an unclear cause of ventricular arrhythmia. The median age was 64 years (interquartile range (IQR) 53-72 years). Forty-five (18%) patients were women. During a median duration of follow-up of 6.2 years (IQR 4.8-7.8 years), appropriate ICD therapy occurred in 95 (37%) patients. This number was 90 (41%) in the group with a clear etiology and 5 (14%) in the group with an unclear etiology. In multivariable analysis, index ventricular arrhythmia of unclear cause was associated with fewer appropriate ICD therapies (HR 0.37 [95% CI 0.14-0.99]; p = 0.048), as well as an increased risk of inappropriate ICD shocks (HR 3.71 [95% CI 1.17-11.80]; p = 0.026). Index ventricular arrhythmia of unclear cause was significantly associated with fewer appropriate ICD therapies.
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Affiliation(s)
- Alwin B P Noordman
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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31
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Holz D, Martonová D, Schaller E, Duong MT, Alkassar M, Weyand M, Leyendecker S. Transmural fibre orientations based on Laplace-Dirichlet-Rule-Based-Methods and their influence on human heart simulations. J Biomech 2023; 156:111643. [PMID: 37321157 DOI: 10.1016/j.jbiomech.2023.111643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
It is well known that the orthotropic tissue structure decisively influences the mechanical and electrical properties of the heart. Numerous approaches to compute the orthotropic tissue structure in computational heart models have been developed in the past decades. In this study, we investigate to what extent different Laplace-Dirichlet-Rule-Based-Methods (LDRBMs) influence the local orthotropic tissue structure and thus the electromechanical behaviour of the subsequent cardiac simulation. In detail, we are utilising three Laplace-Dirichlet-Rule-Based-Methods and compare: (i) the local myofibre orientation; (ii) important global characteristics (ejection fraction, peak pressure, apex shortening, myocardial volume reduction, fractional wall thickening); (iii) local characteristics (active fibre stress, fibre strain). We observe that the orthotropic tissue structures for the three LDRBMs show significant differences in the local myofibre orientation. The global characteristics myocardial volume reduction and peak pressure are rather insensitive to a change in local myofibre orientation, while the ejection fraction is moderately influenced by the different LDRBMs. Moreover, the apical shortening and fractional wall thickening exhibit a sensitive behaviour to a change in the local myofibre orientation. The highest sensitivity can be observed for the local characteristics.
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Affiliation(s)
- David Holz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Applied Dynamics, Immerwahrstraße 1, Erlangen, 91058, Germany.
| | - Denisa Martonová
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Applied Dynamics, Immerwahrstraße 1, Erlangen, 91058, Germany
| | - Emely Schaller
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Applied Dynamics, Immerwahrstraße 1, Erlangen, 91058, Germany
| | - Minh Tuan Duong
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Applied Dynamics, Immerwahrstraße 1, Erlangen, 91058, Germany; School of Mechanical Engineering, Hanoi University of Science and Technology, Hanoi, 1 DaiCoViet Road, Viet Nam
| | - Muhannad Alkassar
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Cardiac Surgery, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Michael Weyand
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Cardiac Surgery, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Sigrid Leyendecker
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Applied Dynamics, Immerwahrstraße 1, Erlangen, 91058, Germany
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Choi Y, Lee KY, Kim SH, Kim KA, Hwang BH, Choo EH, Lim S, Kim CJ, Kim JJ, Byeon J, Oh GC, Jeon DS, Yoo KD, Park HW, Kim MC, Ahn Y, Ho Jeong M, Hwang Y, Chang K. Predictors for early cardiac death after discharge from successfully treated acute myocardial infarction. Front Med (Lausanne) 2023; 10:1165400. [PMID: 37396907 PMCID: PMC10310993 DOI: 10.3389/fmed.2023.1165400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The use of a cardioverter defibrillator for the primary prevention of sudden cardiac death is not recommended within 40 days after acute myocardial infarction (AMI). We investigated the predictors for early cardiac death among patients who were admitted for AMI and successfully discharged. Methods Consecutive patients with AMI were enrolled in a multicenter prospective registry. Among 10,719 patients with AMI, 554 patients with in-hospital death and 62 patients with early non-cardiac death were excluded. Early cardiac death was defined as a cardiac death within 90 days after index AMI. Results Early cardiac death after discharge occurred in 168/10,103 (1.7%) patients. A defibrillator was not implanted in all patients with early cardiac death. Killip class ≥3, chronic kidney disease stage ≥4, severe anemia, cardiopulmonary support usage, no dual antiplatelet therapy at discharge, and left ventricular ejection fraction (LVEF) ≤35% were independent predictors for early cardiac death. The incidence of early cardiac death according to the number of factors added to LVEF criteria in each patient was 3.03% for 0 factor, 8.11% for 1 factor, and 9.16% for ≥2 factors. Each model that sequentially added the factors in the presence of LVEF criteria showed a significant gradual increase in predictive accuracy and an improvement in reclassification capability. A model with all factors showed C-index 0.742 [95% CI 0.702-0.781], p < 0.001; IDI 0.024 [95% CI 0.015-0.033], p < 0.001; and NRI 0.644 [95% CI 0.492-0.795], p < 0.001. Conclusion We identified six predictors for early cardiac death after discharge from AMI. These predictors would help to discriminate high-risk patients over current LVEF criteria and to provide an individualized therapeutic approach in the subacute stage of AMI.
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Affiliation(s)
- Young Choi
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung An Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ho Choo
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Chan Jun Kim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Jin-Jin Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaeho Byeon
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Gyu Chul Oh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Ki Dong Yoo
- Cardiovascular Center and Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Ha-Wook Park
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngdeok Hwang
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York, New York, NY, United States
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Agarwal MA, Sridharan A, Pimentel RC, Markowitz SM, Rosenfeld LE, Fradley MG, Yang EH. Ventricular Arrhythmia in Cancer Patients: Mechanisms, Treatment Strategies and Future Avenues. Arrhythm Electrophysiol Rev 2023; 12:e16. [PMID: 37457438 PMCID: PMC10345968 DOI: 10.15420/aer.2023.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 07/18/2023] Open
Abstract
Cardiovascular disease and cancer are the leading causes of morbidity and mortality in the US. Despite the significant progress made in cancer treatment leading to improved prognosis and survival, ventricular arrhythmias (VA) remain a known cardiovascular complication either exacerbated or induced by the direct and indirect effects of both traditional and novel cancer treatments. Although interruption of cancer treatment because of VA is rarely required, knowledge surrounding this issue is essential for optimising the overall care of patients with cancer. The mechanisms of cancer-therapeutic-induced VA are poorly understood. This review will discuss the ventricular conduction (QRS) and repolarisation abnormalities (QTc prolongation), and VAs associated with cancer therapies, as well as existing strategies for the identification, prevention and management of cancer-treatment-induced VAs.
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Affiliation(s)
- Manyoo A Agarwal
- Heart, Vascular and Thoracic Institute, Cardio-Oncology Program, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Aadhavi Sridharan
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Banner Health, University of Arizona – Tucson, Tucson, AZ, US
| | - Rhea C Pimentel
- Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS, US
| | - Steven M Markowitz
- Division of Cardiovascular Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, US
| | - Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Michael G Fradley
- Thalheimer Center for Cardio-Oncology, Division of Cardiology, Department of Medicine, University of Pennsylvania, PA, US
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, US
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Gentile FR, Wik L, Aramendi E, Baldi E, Isasi I, Steen-Hansen JE, Compagnoni S, Fasolino A, Contri E, Palo A, Primi R, Bendotti S, Currao A, Savastano S. aMplitude spectral area of ventricular fibrillation and amiOdarone Study in patients with out-of-hospital cArdIaC arrest. The MOSAIC study. Front Cardiovasc Med 2023; 10:1179815. [PMID: 37255711 PMCID: PMC10226588 DOI: 10.3389/fcvm.2023.1179815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/14/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Antiarrhythmic drugs are recommended for out of hospital cardiac arrest (OHCA) with shock-refractory ventricular fibrillation (VF). Amplitude Spectral Area (AMSA) of VF is a quantitative waveform measure that describes the amplitude-weighted mean frequency of VF, it correlates with intramyocardial adenosine triphosphate (ATP) concentration, it is a predictor of shock efficacy and an emerging indicator to guide defibrillation and resuscitation efforts. How AMSA might be influenced by amiodarone administration is unknown. Methods In this international multicentre observational study, all OHCAs receiving at least one shock were included. AMSA values were calculated by retrospectively analysing the pre-shock ECG interval of 2 s. Multivariable models were run and a propensity score based on the probability of receiving amiodarone was created to compare two randomly matched samples. Results 2,077 shocks were included: 1,407 in the amiodarone group and 670 in the non-amiodarone group. AMSA values were lower in the amiodarone group [8.8 (6-12.7) mV·Hz vs. 9.8 (6-14) mV·Hz, p = 0.035]. In two randomly matched propensity score-based groups of 261 shocks, AMSA was lower in the amiodarone group [8.2 (5.8-13.5) mV·Hz vs. 9.6 (5.6-11.6), p = 0.042]. AMSA was a predictor of shock success in both groups but the predictive power was lower in the amiodarone group [Area Under the Curve (AUC) non-amiodarone group 0.812, 95%CI: 0.78-0.841 vs. AUC amiodarone group 0.706, 95%CI: 0.68-0.73; p < 0.001]. Conclusions Amiodarone administration was independently associated with the probability of recording lower values of AMSA. In patients who have received amiodarone during cardiac arrest the predictive value of AMSA for shock success is significantly lower, but still statistically significant.
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Affiliation(s)
- Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Lars Wik
- Oslo University Hospital, Division of Prehospital Emergency Medicine, National Service of Competence for Prehospital Acute Medicine (NAKOS), Ullevål Hospital, Oslo, Norway
- Oslo University Hospital HF, Ullevål Hospital, Oslo, Norway
| | | | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Iraia Isasi
- BioRes Group, University of the Basque Country, Bilbao, Spain
| | | | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Enrico Contri
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Beni NH, Jiang N. Heartbeat detection from single-lead ECG contaminated with simulated EMG at different intensity levels: A comparative study. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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36
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Li L, Zhang Z, Zhou L, Zhang Z, Xiong Y, Hu Z, Yao Y. Use of machine learning algorithms to predict life-threatening ventricular arrhythmia in sepsis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:245-253. [PMID: 37265863 PMCID: PMC10232270 DOI: 10.1093/ehjdh/ztad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/24/2023] [Accepted: 04/05/2023] [Indexed: 06/03/2023]
Abstract
Aims Life-threatening ventricular arrhythmias (LTVAs) are common manifestations of sepsis. The majority of sepsis patients with LTVA are unresponsive to initial standard treatment and thus have a poor prognosis. There are very limited studies focusing on the early identification of patients at high risk of LTVA in sepsis to perform optimal preventive treatment interventions. We aimed to develop a prediction model to predict LTVA in sepsis using machine learning (ML) approaches. Methods and results Six ML algorithms including CatBoost, LightGBM, and XGBoost were employed to perform the model fitting. The least absolute shrinkage and selection operator (LASSO) regression was used to identify key features. Methods of model evaluation involved in this study included area under the receiver operating characteristic curve (AUROC), for model discrimination, calibration curve, and Brier score, for model calibration. Finally, we validated the prediction model both internally and externally. A total of 27 139 patients with sepsis were identified in this study, 1136 (4.2%) suffered from LTVA during hospitalization. We screened out 10 key features from the initial 54 variables via LASSO regression to improve the practicability of the model. CatBoost showed the best prediction performance among the six ML algorithms, with excellent discrimination (AUROC = 0.874) and calibration (Brier score = 0.157). The remarkable performance of the model was presented in the external validation cohort (n = 9492), with an AUROC of 0.836, suggesting certain generalizability of the model. Finally, a nomogram with risk classification of LTVA was shown in this study. Conclusion We established and validated a machine leaning-based prediction model, which was conducive to early identification of high-risk LTVA patients in sepsis, thus appropriate methods could be conducted to improve outcomes.
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Affiliation(s)
- Le Li
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
| | - Zhuxin Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
| | - Likun Zhou
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
| | - Zhenhao Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
| | - Yulong Xiong
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
| | - Zhao Hu
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
| | - Yan Yao
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Beilishi Road 167#, Xicheng District, Beijing, China
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Eroglu TE, Coronel R, Halili A, Kessing LV, Arulmurugananthavadivel A, Parveen S, Folke F, Torp-Pedersen C, Gislason GH. Long-term stress conditions and out-of-hospital cardiac arrest risk: a nested case-control study. Open Heart 2023; 10:openhrt-2022-002223. [PMID: 37147025 PMCID: PMC10163588 DOI: 10.1136/openhrt-2022-002223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/11/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE Patients with stress-related disorders and anxiety are at increased risk of developing cardiovascular disease. However, the risk of out-of-hospital cardiac arrest (OHCA) is scarcely investigated. We aimed to establish whether long-term stress (post-traumatic stress disorder, adjustment disorder) or anxiety is associated with OHCA in the general population. METHODS We conducted a nested case-control study in a nationwide cohort of individuals between 1 June 2001 and 31 December 2015 in Denmark. Cases were OHCA patients with presumed cardiac causes. Each case was matched by age, sex and date of OHCA with 10 non-OHCA controls from the general population. HRs for OHCA were derived from Cox models after controlling for common OHCA risk factors. Stratified analyses were performed according to sex, age and pre-existing cardiovascular disease. RESULTS We included 35 195 OHCAs and 351 950 matched controls (median age 72 years; 66.8% male). Long-term stress conditions were diagnosed in 324 (0.92%) OHCA cases and 1577 (0.45%) non-OHCA controls, and were associated with higher rate of OHCA (HR 1.44, 95% CI 1.27 to 1.64). Anxiety was diagnosed in 299 (0.85%) OHCA cases and 1298 (0.37%) controls, and was associated with increased rate of OHCA (HR 1.56, 95% CI1.37 to 1.79). We found no interaction with sex, age or history of cardiovascular diseases. CONCLUSION Patients with stress-related disorders or anxiety have an increased rate of OHCA. This association applies equally to men and women and is independent from the presence of cardiovascular disease. Awareness of the higher risks of OHCA in patients with stress-related disorders and anxiety is important when treating these patients.
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Affiliation(s)
- Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ruben Coronel
- Heart Failure Research Center, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Andrim Halili
- Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Cardiology, Bispebjerg Hospital, Kobenhavn, Denmark
| | | | | | - Saaima Parveen
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
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Gomes HJA, Figueredo Junior ARD. The Challenge of Making Cardiac Resonance a Global Reality. Arq Bras Cardiol 2023; 120:e20230187. [PMID: 37098993 PMCID: PMC10124572 DOI: 10.36660/abc.20230187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Hélder Jorge Andrade Gomes
- Departamento de Clínica Médica - Faculdade de Medicina de Jundiaí, Jundiaí, SP - Brasil
- Tomografia e Ressonância Cardiovascular - ICON Diagnósticos por Imagem, Jundiaí, SP - Brasil
- Hospital Vera Cruz, Campinas, SP - Brasil
- Prevent Senior, São Paulo, SP - Brasil
- Hospital Samaritano de São Paulo, São Paulo, SP - Brasil
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Buchan S, Kar R, John M, Post A, Razavi M. Electrical Stimulation for Low-Energy Termination of Cardiac Arrhythmias: a Review. Cardiovasc Drugs Ther 2023; 37:323-340. [PMID: 34363570 DOI: 10.1007/s10557-021-07236-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
Cardiac arrhythmias are a leading cause of morbidity and mortality in the developed world, estimated to be responsible for hundreds of thousands of deaths annually. Our understanding of the electrophysiological mechanisms of such arrhythmias has grown since they were formally characterized in the late nineteenth century, and this has led to the development of numerous devices and therapies that have markedly improved outcomes for patients affected by such conditions. Despite these advancements, the application of a single large shock remains the clinical standard for treating deadly tachyarrhythmias. Such defibrillating shocks are undoubtedly effective in terminating such arrhythmias; however, they are applied without forewarning, contributing to the patient's stress and anxiety; they can be intensely painful; and they can have adverse psychological and physiological effects on patients. In recent years, there has been interest in developing defibrillation protocols that can terminate arrhythmias without crossing the human pain threshold for energy delivery, generally estimated to be between 0.1 and 1 J. In this article, we review existing literature on the development of such low-energy defibrillation methods and their underlying mechanisms, in an attempt to broadly describe the current landscape of these technologies.
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Affiliation(s)
- Skylar Buchan
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Ronit Kar
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.,Department of Biomedical Engineering, The University of Texas At Austin, Austin, TX, 78712, USA
| | - Mathews John
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Allison Post
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA. .,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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40
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Koivunen M, Tynkkynen J, Oksala N, Eskola M, Hernesniemi J. Incidence of sudden cardiac arrest and sudden cardiac death after unstable angina pectoris and myocardial infarction. Am Heart J 2023; 257:9-19. [PMID: 36384178 DOI: 10.1016/j.ahj.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sudden cardiac arrests (SCA) and sudden cardiac deaths (SCD) are believed to account for a large proportion of deaths due to cardiovascular causes. The purpose of this study is to provide comprehensive information on the epidemiology of SCAs and SCDs after acute coronary syndrome. METHODS The incidence of SCA (including SCDs) was studied retrospectively among 10,316 consecutive patients undergoing invasive evaluation for acute coronary syndrome (ACS) between 2007 and 2018 at Tays Heart Hospital (sole provider of specialized cardiac care for a catchment area of over 0.5 million residents). Baseline and follow-up information was collected by combining information from the hospital's electronic health records, death certificate data, and a full-disclosure review of written patient records and accounts of the circumstances leading to death. RESULTS During 12 years of follow-up, the cumulative incidence of SCAs (including SCDs) was 9.8% (0.8% annually) and that of SCDs 5.4% (0.5% annually). Cumulative incidence of SCAs in patients with ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina pectoris were: 11.9%,10.2% and 5.7% at 12 years. SCAs accounted for 30.5% (n = 528/1,732) of all deaths due to cardiovascular causes. The vast majority of SCAs (95.6%) occurred in patients without implantable cardioverter defibrillator (ICD) devices or among patients with no recurrent hospitalizations for coronary artery disease (89.1%). CONCLUSIONS SCAs accounted for less than a third of all deaths due to cardiovascular causes among patients with previous ACS. Incidence of SCA is highest among STEMI and NSTEMI patients. After the hospital discharge, most of SCAs happen to NSTEMI patients.
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Affiliation(s)
- Minna Koivunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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41
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de Groot JR. Implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy: a need or not? Neth Heart J 2023; 31:87-88. [PMID: 36808402 PMCID: PMC9950296 DOI: 10.1007/s12471-023-01765-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Affiliation(s)
- Joris R. de Groot
- grid.7177.60000000084992262Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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42
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Zuin M, Rigatelli G, Bilato C. Sudden Cardiac Death in Patients With Mitral Valve Prolapse in US (1999-2020). Am J Cardiol 2023; 193:34-36. [PMID: 36867916 DOI: 10.1016/j.amjcard.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 03/05/2023]
Abstract
Data regarding the mortality rate in patients with mitral valve prolapse (MVP) experiencing sudden cardiac death (SCD) remains scant. To further elucidate this issue in the US population, we analyzed the death records provided in the publicly available Multiple Cause of Death Dataset of the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research) between 1999 and 2020. In this cohort study, 824 US subjects with MVP died from SCD between 1999 and 2020, representing about the 0.3% of all SCDs. The higher mortality rate was observed among women aged <44 years, of White ethnicity, living in urban areas. In conclusion, although the mortality rate of SCD in patients with MVP remains low among the general population, the identification of demographic features and risk factors for SCD may enable strategies for the risk stratification of MVP.
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Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza, Italy; Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza, Italy
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Chiu CH, Hsuan CF, Lin SH, Hung YJ, Hwu CM, Hee SW, Lin SW, Fong SW, Hsieh PCH, Yang WS, Lin WC, Lee HL, Hsieh ML, Li WY, Lin JW, Hsu CN, Wu VC, Chuang GT, Chang YC, Chuang LM. ER ribosomal-binding protein 1 regulates blood pressure and potassium homeostasis by modulating intracellular renin trafficking. J Biomed Sci 2023; 30:13. [PMID: 36803854 PMCID: PMC9940419 DOI: 10.1186/s12929-023-00905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Genome-wide association studies (GWASs) have linked RRBP1 (ribosomal-binding protein 1) genetic variants to atherosclerotic cardiovascular diseases and serum lipoprotein levels. However, how RRBP1 regulates blood pressure is unknown. METHODS To identify genetic variants associated with blood pressure, we performed a genome-wide linkage analysis with regional fine mapping in the Stanford Asia-Pacific Program for Hypertension and Insulin Resistance (SAPPHIRe) cohort. We further investigated the role of the RRBP1 gene using a transgenic mouse model and a human cell model. RESULTS In the SAPPHIRe cohort, we discovered that genetic variants of the RRBP1 gene were associated with blood pressure variation, which was confirmed by other GWASs for blood pressure. Rrbp1- knockout (KO) mice had lower blood pressure and were more likely to die suddenly from severe hyperkalemia caused by phenotypically hyporeninemic hypoaldosteronism than wild-type controls. The survival of Rrbp1-KO mice significantly decreased under high potassium intake due to lethal hyperkalemia-induced arrhythmia and persistent hypoaldosteronism, which could be rescued by fludrocortisone. An immunohistochemical study revealed renin accumulation in the juxtaglomerular cells of Rrbp1-KO mice. In the RRBP1-knockdown Calu-6 cells, a human renin-producing cell line, transmission electron and confocal microscopy revealed that renin was primarily retained in the endoplasmic reticulum and was unable to efficiently target the Golgi apparatus for secretion. CONCLUSIONS RRBP1 deficiency in mice caused hyporeninemic hypoaldosteronism, resulting in lower blood pressure, severe hyperkalemia, and sudden cardiac death. In juxtaglomerular cells, deficiency of RRBP1 reduced renin intracellular trafficking from ER to Golgi apparatus. RRBP1 is a brand-new regulator of blood pressure and potassium homeostasis discovered in this study.
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Affiliation(s)
- Chu-Hsuan Chiu
- grid.19188.390000 0004 0546 0241Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100 Taiwan ,grid.28665.3f0000 0001 2287 1366Institute of Biomedical Sciences, Academia Sinica, Taipei, 115 Taiwan
| | - Chin-Feng Hsuan
- grid.414686.90000 0004 1797 2180Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, 824410 Taiwan ,Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, Kaohsiung, 82445 Taiwan ,grid.411447.30000 0004 0637 1806School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 840203 Taiwan
| | - Shih-Hua Lin
- grid.260565.20000 0004 0634 0356Graduate Institute of Medical Science, National Defense Medical Center, Taipei, 114 Taiwan ,grid.278247.c0000 0004 0604 5314Section of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, 111 Taiwan
| | - Yi-Jen Hung
- grid.260565.20000 0004 0634 0356Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 100 Taiwan
| | - Chii-Min Hwu
- grid.260539.b0000 0001 2059 7017Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, 112 Taiwan ,grid.278244.f0000 0004 0638 9360Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, 114 Taiwan
| | - Siow-Wey Hee
- grid.412094.a0000 0004 0572 7815Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100 Taiwan
| | - Shu-Wha Lin
- grid.19188.390000 0004 0546 0241Division of Genomic Medicine, Research Center for Medical Excellence, Transgenic Mouse Models Core, National Taiwan University, Taipei, 100 Taiwan
| | - Sitt-Wai Fong
- grid.28665.3f0000 0001 2287 1366Institute of Biomedical Sciences, Academia Sinica, Taipei, 115 Taiwan
| | - Patrick Ching-Ho Hsieh
- grid.28665.3f0000 0001 2287 1366Institute of Biomedical Sciences, Academia Sinica, Taipei, 115 Taiwan
| | - Wei-Shun Yang
- grid.19188.390000 0004 0546 0241Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100 Taiwan ,grid.412094.a0000 0004 0572 7815Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, 302 Taiwan
| | - Wei-Chou Lin
- grid.412094.a0000 0004 0572 7815Department of Pathology, National Taiwan University Hospital, Taipei, 100 Taiwan
| | - Hsiao-Lin Lee
- grid.412094.a0000 0004 0572 7815Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100 Taiwan
| | - Meng-Lun Hsieh
- grid.412094.a0000 0004 0572 7815Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100 Taiwan ,grid.15276.370000 0004 1936 8091Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610 USA
| | - Wen-Yi Li
- grid.412094.a0000 0004 0572 7815Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640 Taiwan
| | - Jou-Wei Lin
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640 Taiwan
| | - Chih-Neng Hsu
- grid.412094.a0000 0004 0572 7815Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640 Taiwan
| | - Vin-Cent Wu
- grid.412094.a0000 0004 0572 7815Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100 Taiwan
| | - Gwo-Tsann Chuang
- grid.19188.390000 0004 0546 0241Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100 Taiwan ,grid.412094.a0000 0004 0572 7815Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100 Taiwan
| | - Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan. .,Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan. .,Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan. .,Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan.
| | - Lee-Ming Chuang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan. .,Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan. .,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, 100, Taiwan.
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El-Azrak M, Darar C, Boutaybi M, El Ouafi N, Bazid Z. Sudden Cardiac Death Risk Stratification of the Early Repolarization Syndrome: An Updated Review of the Literature. Curr Cardiol Rep 2023; 25:203-212. [PMID: 36763218 DOI: 10.1007/s11886-023-01842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW Early repolarization syndrome (ERS), once thought to be innocuous, has now been shown to be responsible for ventricular arrythmias and sudden cardiac death occurrence. This review will help the clinician to identify the patients who are most at risk for arrhythmias, so that they can adopt a preventive or secondary treatment approach, either of which is still poorly defined. RECENT FINDINGS Patients at high risk are found to be particularly young men, with a personal or family history of syncope or sudden death, who have an inferolateral ER on the electrocardiogram, more elevated J-point, longer J-wave duration and wider J angle, a horizontal or descending ST segment, lower T/R ratio, and small and/or inverted waves. The association with a structural heart disease or another channelopathy potentiates this arrhythmic risk. Taken together, these parameters allow prediction of the malignancy of ER pattern with a certain reliability. Further research is however needed to develop concrete risk stratification algorithms and the therapeutic strategies taken in function of it.
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Affiliation(s)
- Mohammed El-Azrak
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco.
| | - Charmake Darar
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Mohammed Boutaybi
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
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Eroglu TE, Folke F, Coronel R, Torp-Pedersen C, Gislason GH. Risk of out-of-hospital cardiac arrest in patients with sarcoidosis: a Danish nationwide nested case-control study. Open Heart 2023; 10:openhrt-2022-002088. [PMID: 36759010 PMCID: PMC9923298 DOI: 10.1136/openhrt-2022-002088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
ObjectiveSarcoidosis is over-represented among victims of cardiac arrest. We aimed to establish whether sarcoidosis is associated with out-of-hospital cardiac arrest (OHCA) in the general population.MethodsWe conducted a nested case-control study in a nationwide cohort of individuals between 1 June 2001 and 31 December 2015 in Denmark. OHCA cases from presumed cardiac causes were matched 1:10 by sex and age on OHCA date with non-OHCA controls from the general population. The association between sarcoidosis and OHCA was assessed using Cox regression by calculating HR and 95% CIs. Models were adjusted for cardiovascular disease. Finally, stratified analyses were performed according to sex, heart failure and ischaemic heart disease. RESULTS: We identified 35 195 OHCA cases and 351 950 matched controls without OHCA (median age 72 years and 66.8% male). Patients with sarcoidosis had higher rate of OHCA compared with the general population after adjustments for common OHCA risk factors (HR 1.51, 95% CI 1.19 to 1.92). This increased OHCA rate occurred in women (HR 2.11, 95% CI 1.42 to 3.12) but not in men (HR 1.27, 95% CI 0.93 to 1.72; p value interaction=0.033), and was larger in patients with than without heart failure (HRheart failure: 2.59, 95% CI 1.42 to 4.73; HRno heart failure: 1.33, 95% CI 1.01 to 1.74; p value interaction: 0.007). The HR associated with sarcoidosis did not vary by the presence of ischaemic heart disease. CONCLUSION: Patients with sarcoidosis have a higher OHCA rate than the general population. This increased OHCA rate occurred in women but not in men, and was larger in patients with than without heart failure.
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Affiliation(s)
- Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark,Copenhagen University Hospital – Copenhagen Emergency Medical Services, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark,Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark,The Danish Heart Foundation, Copenhagen, Denmark
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Haugsten Hansen M, Sadredini M, Hasic A, Anderson ME, Sjaastad I, Korseberg Stokke M. CaMKII and reactive oxygen species contribute to early reperfusion arrhythmias, but oxidation of CaMKIIδ at methionines 281/282 is not a determining factor. J Mol Cell Cardiol 2023; 175:49-61. [PMID: 36528076 DOI: 10.1016/j.yjmcc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Available evidence suggest that Ca2+/calmodulin-dependent protein kinase type IIδ (CaMKIIδ) and reactive oxygen species (ROS) are important in early ischemia-reperfusion arrhythmias (IRA). Since ROS can activate CaMKIIδ by oxidation of two methionines at positions 281/282, oxidized-CaMKIIδ (Ox-CaMKIIδ) has been proposed to be important for IRA. However, direct evidence for this is missing. METHODS We exposed Langendorff-perfused hearts and ventricular cardiomyocytes from C57BL/6 mice to global and simulated ischemia, respectively, and recorded arrhythmic events during early reperfusion. Hearts were collected for immunoblotting of key phosphoproteins. We evaluated the effects of beta-adrenoceptor stimulation, inhibition of CaMKII, and reduced ROS levels with isoprenaline, KN93/AIP and N-acetylcysteine (NAC), respectively. We further tested the importance of Ox-CaMKIIδ by using hearts and cardiomyocytes from mice with CaMKIIδ resistant to oxidation of methionines 281 and 282 (MMVV). RESULTS Hearts treated with KN93, AIP or NAC had lower incidence of early IRA, and NAC-treated cardiomyocytes had lower incidence of arrhythmogenic events. However, hearts from MMVV mice had a similar incidence of early IRA to wild type mice (WT), and MMVV and WT cardiomyocytes had a similar frequency of Ca2+ waves and Ca2+ sparks. Immunoblotting confirmed high levels of oxidation in early reperfusion, but revealed no significant differences in the phosphorylation levels of Ca2+-handling proteins in MMVV and WT hearts. CONCLUSIONS Although CaMKII and ROS both contribute to early IRA, hearts from mice with CaMKII resistant to oxidation at methionines 281/282 were not protected from such arrhythmias, suggesting that oxidation at these sites is not a determining factor.
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Affiliation(s)
- Marie Haugsten Hansen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mani Sadredini
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Almira Hasic
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mark E Anderson
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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Erbel R, Lehmann N, Schramm S, Schmidt B, Hüsing A, Kowall B, Hermann DM, Gronewold J, Schmermund A, Möhlenkamp S, Moebus S, Grönemeyer D, Seibel R, Stang A, Jöckel KH. Diagnostic Cardiac CT for the Improvement of Cardiovascular Event Prediction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:25-32. [PMID: 36518091 PMCID: PMC10043455 DOI: 10.3238/arztebl.m2022.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/20/2022] [Accepted: 10/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of the long-term Heinz Nixdorf Recall Study (observation period 20 years) was to establish the extent to which computed tomography (CT) improves the predictability of cardiovascular events relative to determination of risk factors alone. METHODS In the period 2000-2003, study staff examined 4355 probands (53% of them female) aged 45-75 years with no signs of cardiovascular disease. The Atherosclerotic Cardiovascular Disease (ASCVD) score was calculated on the basis of demographic data and cardiovascular risk factors. Cardiac CT was carried out over the same period and coronary artery calcification (CAC) was graded according to the Agatston score. RESULTS The median duration of follow-up was 18.2 years for men and 17.8 years for women. Myocardial infarction or stroke occurred in 458 (11%) of the 4154 participants with complete data. Overall, estimation of risk using a combination of ASCVD score and CAC grade was superior to the ASCVD score alone-even after 10 and 20 years. Classification into established risk categories improved by 12.2% (95% confidence interval: [5.3%; 18.1%]). In the highest ASCVD risk category, we observed occurrence of a cardiovascular event over 20 years for 14% [5.0%; 23.1%] of probands with a CAC score = 0 but for 34.2% [27.5%; 41.4%] of those with a CAC score ≥ 400. In the lowest ASCVD risk category, an event occurred in 2.4% [1.4%; 3.7%] of probands with a CAC score = 0 and in 23.5% [2.3%; 35.8%] of those with a CAC score ≥ 400. CONCLUSION Even after 20 years, individual risk prediction is improved by addition of CT-based determination of coronary artery calcification to the ASCVD score. Therefore, assessment of ASCVD risk factors should be complemented more widely by cardiac CT in the primary prevention of cardiovascular disease.
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Affiliation(s)
- Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, University of Duisburg-Essen; Department of Neurology, Essen University Hospital, University Duisburg-Essen; Institute for Urban Public Health, Essen University Hospital, University Duisburg-Essen; School of Public Health, Department of Epidemiology, Boston University; Cardioangological Center Bethanien, Frankfurt; Department of Cardiology, Bethanien Hospital Moers, Moers; Grönemeyer Institute, Bochum; Diagnostikum, Mülheim an der Ruhr
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Plijter IS, Verkerk AO, Wilders R. The Antidepressant Paroxetine Reduces the Cardiac Sodium Current. Int J Mol Sci 2023; 24:ijms24031904. [PMID: 36768229 PMCID: PMC9915920 DOI: 10.3390/ijms24031904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
A considerable amount of literature has been published on antidepressants and cardiac ion channel dysfunction. The antidepressant paroxetine has been associated with Brugada syndrome and long QT syndrome, albeit on the basis of conflicting findings. The cardiac voltage-gated sodium channel (NaV1.5) is related to both of these syndromes, suggesting that paroxetine may have an effect on this channel. In the present study, we therefore carried out patch clamp experiments to examine the effect of paroxetine on human NaV1.5 channels stably expressed in human embryonic kidney 293 (HEK-293) cells as well as on action potentials of isolated rabbit left ventricular cardiomyocytes. Additionally, computer simulations were conducted to test the functional effects of the experimentally observed paroxetine-induced changes in the NaV1.5 current. We found that paroxetine led to a decrease in peak NaV1.5 current in a concentration-dependent manner with an IC50 of 6.8 ± 1.1 µM. In addition, paroxetine caused a significant hyperpolarizing shift in the steady-state inactivation of the NaV1.5 current as well as a significant increase in its rate of inactivation. Paroxetine (3 µM) affected the action potential of the left ventricular cardiomyocytes, significantly decreasing its maximum upstroke velocity and amplitude, both of which are mainly regulated by the NaV1.5 current. Our computer simulations demonstrated that paroxetine substantially reduces the fast sodium current of human left ventricular cardiomyocytes, thereby slowing conduction and reducing excitability in strands of cells, in particular if conduction and excitability are already inhibited by a loss-of-function mutation in the NaV1.5 encoding SCN5A gene. In conclusion, paroxetine acts as an inhibitor of NaV1.5 channels, which may enhance the effects of loss-of-function mutations in SCN5A.
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Affiliation(s)
- Ingmar S. Plijter
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arie O. Verkerk
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Ronald Wilders
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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Ernst P, Bidwell PA, Dora M, Thomas DD, Kamdar F. Cardiac calcium regulation in human induced pluripotent stem cell cardiomyocytes: Implications for disease modeling and maturation. Front Cell Dev Biol 2023; 10:986107. [PMID: 36742199 PMCID: PMC9889838 DOI: 10.3389/fcell.2022.986107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
Human induced pluripotent stem cell cardiomyocytes (hiPSC-CMs) are based on ground-breaking technology that has significantly impacted cardiovascular research. They provide a renewable source of human cardiomyocytes for a variety of applications including in vitro disease modeling and drug toxicity testing. Cardiac calcium regulation plays a critical role in the cardiomyocyte and is often dysregulated in cardiovascular disease. Due to the limited availability of human cardiac tissue, calcium handling and its regulation have most commonly been studied in the context of animal models. hiPSC-CMs can provide unique insights into human physiology and pathophysiology, although a remaining limitation is the relative immaturity of these cells compared to adult cardiomyocytes Therefore, this field is rapidly developing techniques to improve the maturity of hiPSC-CMs, further establishing their place in cardiovascular research. This review briefly covers the basics of cardiomyocyte calcium cycling and hiPSC technology, and will provide a detailed description of our current understanding of calcium in hiPSC-CMs.
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Affiliation(s)
- Patrick Ernst
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Philip A. Bidwell
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Michaela Dora
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, United States
| | - David D. Thomas
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, United States
| | - Forum Kamdar
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States,*Correspondence: Forum Kamdar,
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Chen M, Zhu T, Wu Z, Hu L, Wu Z, Liu Q, Zhou S. LL-VNS attenuates SK2 expression and incidence of arrhythmias following acute myocardial infarction in rats. Front Cardiovasc Med 2023; 9:1034888. [PMID: 36712237 PMCID: PMC9874093 DOI: 10.3389/fcvm.2022.1034888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives Our previous study has demonstrated that low-level vagus nerve stimulation (LL-VNS) protects the heart against ventricular arrhythmias (VAs) induced by acute myocardial infarction (AMI). However, the potential mechanisms by which it influences ventricular electrophysiology remain unknown. Materials and methods Forty-five rats were divided into three groups: a Control group (sham AMI followed by sham LL-VNS, n = 15), an AMI group (AMI followed by sham LL-VSN for 60 mins, n = 15), and an AMI + LL-VNS group (AMI followed by LL-VSN for 60 mins, n = 15). Heart rate variability (HRV), ventricular effective refractory period (ERP), ventricular fibrillation threshold (VFT), and left stellate ganglion (LSG) activity were measured at baseline and during AMI. Finally, myocardial tissues were collected for tissue analysis. Results AMI directly induced hyperactivity in the LSG and reduced vagal tone as indexed by HRV. AMI also decreased VFT, and shortened ERP but increased ERP dispersion. AMI resulted in an increase in expression of ventricular small-conductance Ca2+-activated K+ (SK2). However, LL-VNS significantly mitigated or eliminated the effects of AMI. Conclusion LL-VNS altered the electrophysiological properties of the ventricles through inhibition of cardiac sympathetic nervous activity and reduction in SK2 expression.
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Affiliation(s)
- Mingxian Chen
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tongjian Zhu
- Xiangyang Central Hospital, Xiangyang, Hubei, China
| | - Zhihong Wu
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lin Hu
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhijian Wu
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiming Liu
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shenghua Zhou
- The Second Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Shenghua Zhou,
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