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Magnetic Resonance Imaging Screening for Postinfarct Life-Threatening Ventricular Arrhythmia. JACC Cardiovasc Imaging 2021; 14:2479-2481. [PMID: 34419394 DOI: 10.1016/j.jcmg.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
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52
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Cheng YJ, Chen ZG, Yao FJ, Liu LJ, Zhang M, Wu SH. Airflow obstruction, impaired lung function and risk of sudden cardiac death: a prospective cohort study. Thorax 2021; 77:652-662. [PMID: 34417352 DOI: 10.1136/thoraxjnl-2020-215632] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Growing evidence suggests that compromised lung health may be linked to cardiovascular disease. However, little is known about its association with sudden cardiac death (SCD). OBJECTIVES We aimed to assess the link between impaired lung function, airflow obstruction and risk of SCD by race and gender in four US communities. METHODS A total of 14 708 Atherosclerosis Risk in Communities (ARIC) study participants who underwent spirometry and were asked about lung health (1987-1989) were followed. The main outcome was physician-adjudicated SCD. Fine-Gray proportional subdistribution hazard models with Firth's penalised partial likelihood correction were used to estimate the HRs. RESULTS Over a median follow-up of 25.4 years, 706 (4.8%) subjects experienced SCD. The incidence of SCD was inversely associated with FEV1 in each of the four race and gender groups and across all smoking status categories. After adjusting for multiple measured confounders, HRs of SCD comparing the lowest with the highest quintile of FEV1 were 2.62 (95% CI 1.62 to 4.26) for white males, 1.80 (95% CI 1.03 to 3.15) for white females, 2.07 (95% CI 1.05 to 4.11) for black males and 2.62 (95% CI 1.21 to 5.65) for black females. The above associations were consistently observed among the never smokers. Moderate to very severe airflow obstruction was associated with increased risk of SCD. Addition of FEV1 significantly improved the predictive power for SCD. CONCLUSIONS Impaired lung function and airflow obstruction were associated with increased risk of SCD in general population. Additional research to elucidate the underlying mechanisms is warranted.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhen-Guang Chen
- Department of Thoracic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng-Juan Yao
- Department of Medical Ultrasonics, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li-Juan Liu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Ming Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Su-Hua Wu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China .,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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53
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Zegard A, Okafor O, de Bono J, Kalla M, Lencioni M, Marshall H, Hudsmith L, Qiu T, Steeds R, Stegemann B, Leyva F. Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35. Europace 2021; 24:31-39. [PMID: 34379762 PMCID: PMC8742629 DOI: 10.1093/europace/euab167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%. METHODS AND RESULTS In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P < 0.001]. A weaker association was observed for TF2SD mass ≥23 g [sHR 10.4 (95% CI 4.22-25.8); AUC: 0.80, P < 0.001]. The range of sHRs for GZF3SD mass (1-527) was wider than for TF2SD mass (1-37.6). CONCLUSIONS In CAD patients with an LVEF >35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events.
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Affiliation(s)
- Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Manish Kalla
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Mauro Lencioni
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Howard Marshall
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Lucy Hudsmith
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Tian Qiu
- Aston Medical School, Aston University, Birmingham, UK
| | - Richard Steeds
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
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54
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Verrier RL, Pang TD, Nearing BD, Schachter SC. Epileptic heart: A clinical syndromic approach. Epilepsia 2021; 62:1780-1789. [PMID: 34236079 DOI: 10.1111/epi.16966] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
Prevention of premature death in patients with chronic epilepsy remains a major challenge. Multiple pathophysiologic factors have been implicated, with intense investigation of cardiorespiratory mechanisms. Up to four in five patients with chronic epilepsy exhibit cardiovascular comorbidities. These findings led us to propose the concept of an "epileptic heart," defined as "a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxemia leading to electrical and mechanical dysfunction." Among the most prominent changes documented in the literature are high incidence of myocardial infarction and arrhythmia, altered autonomic tone, diastolic dysfunction, hyperlipidemia, and accelerated atherosclerosis. This suite of pathologic changes prompted us to propose for the first time in this review a syndromic approach for improved clinical detection of the epileptic heart condition. In this review, we discuss the key pathophysiologic mechanisms underlying the candidate criteria along with standard and novel techniques that permit evaluation of each of these factors. Specifically, we present evidence of the utility of standard 12-lead, ambulatory, and multiday patch-based electrocardiograms, along with measures of cardiac electrical instability, including T-wave alternans, heart rate variability to detect altered autonomic tone, echocardiography to detect diastolic dysfunction, and plasma biomarkers for assessing hyperlipidemia and accelerated atherosclerosis. Ultimately, the proposed clinical syndromic approach is intended to improve monitoring and evaluation of cardiac risk in patients with chronic epilepsy to foster improved therapeutic strategies to reduce premature cardiac death.
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Affiliation(s)
- Richard L Verrier
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Trudy D Pang
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bruce D Nearing
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steven C Schachter
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Consortia for Improving Medicine with Innovation and Technology, Boston, Massachusetts, USA
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55
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Toupin S, Pezel T, Bustin A, Cochet H. Whole-Heart High-Resolution Late Gadolinium Enhancement: Techniques and Clinical Applications. J Magn Reson Imaging 2021; 55:967-987. [PMID: 34155715 PMCID: PMC9292698 DOI: 10.1002/jmri.27732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
In cardiovascular magnetic resonance, late gadolinium enhancement (LGE) has become the cornerstone of myocardial tissue characterization. It is widely used in clinical routine to diagnose and characterize the myocardial tissue in a wide range of ischemic and nonischemic cardiomyopathies. The recent growing interest in imaging left atrial fibrosis has led to the development of novel whole‐heart high‐resolution late gadolinium enhancement (HR‐LGE) techniques. Indeed, conventional LGE is acquired in multiple breath‐holds with limited spatial resolution: ~1.4–1.8 mm in plane and 6–8 mm slice thickness, according to the Society for Cardiovascular Magnetic Resonance standardized guidelines. Such large voxel size prevents its use in thin structures such as the atrial or right ventricular walls. Whole‐heart 3D HR‐LGE images are acquired in free breathing to increase the spatial resolution (up to 1.3 × 1.3 × 1.3 mm3) and offer a better detection and depiction of focal atrial fibrosis. The downside of this increased resolution is the extended scan time of around 10 min, which hampers the spread of HR‐LGE in clinical practice. Initially introduced for atrial fibrosis imaging, HR‐LGE interest has evolved to be a tool to detect small scars in the ventricles and guide ablation procedures. Indeed, the detection of scars, nonvisible with conventional LGE, can be crucial in the diagnosis of myocardial infarction with nonobstructed coronary arteries, in the detection of the arrhythmogenic substrate triggering ventricular arrhythmia, and improve the confidence of clinicians in the challenging diagnoses such as the arrhythmogenic right ventricular cardiomyopathy. HR‐LGE also offers a precise visualization of left ventricular scar morphology that is particularly useful in planning ablation procedures and guiding them through the fusion of HR‐LGE images with electroanatomical mapping systems. In this narrative review, we attempt to summarize the technical particularities of whole‐heart HR‐LGE acquisition and provide an overview of its clinical applications with a particular focus on the ventricles.
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Affiliation(s)
- Solenn Toupin
- Siemens Healthcare France, Saint-Denis, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Théo Pezel
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Cardiology, Lariboisiere Hospital, APHP, University of Paris, Paris, France
| | - Aurélien Bustin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Bordeaux University Hospital (CHU), Pessac, France
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56
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Arai AE, Bradley AJ, Sirajuddin A. Risk Stratification for Sudden Death and Arrhythmias: A Role for Gadolinium-Enhanced CMR. J Am Coll Cardiol 2021; 77:42-44. [PMID: 33413939 DOI: 10.1016/j.jacc.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
| | - Andrew J Bradley
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Arlene Sirajuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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57
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Sudden Cardiac Death in Patients with Heart Disease and Preserved Systolic Function: Current Options for Risk Stratification. J Clin Med 2021; 10:jcm10091823. [PMID: 33922111 PMCID: PMC8122448 DOI: 10.3390/jcm10091823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
Sudden cardiac death (SCD) is the leading cause of cardiovascular mortality in patients with coronary artery disease without severe systolic dysfunction and in heart failure with preserved ejection fraction. From a global health perspective, while risk may be lower, the absolute number of SCDs in patients with left ventricle ejection fraction >35% is higher than in those with severely reduced left ventricle ejection fraction (defined as ≤35%). Despite these observations and the high amount of available data, to date there are no clear recommendations to reduce the sudden cardiac death burden in the population with mid-range or preserved left ventricle ejection fraction. Ongoing improvements in risk stratification based on electrophysiological and imaging techniques point towards a more precise identification of patients who would benefit from ICD implantation, which is still an unmet need in this subset of patients. The aim of this review is to provide a state-of-the-art approach in sudden cardiac death risk stratification of patients with mid-range and preserved left ventricular ejection fraction and one of the following etiologies: ischemic cardiomyopathy, heart failure, atrial fibrillation or myocarditis.
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58
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Kordalis AA, Gatzoulis KA, Arsenos PP, Tsiachris DL, Tsioufis CP. Magnetic Resonance for Risk Stratification of Coronary Artery Disease Patients: Toward an Electrophysiology-Guided Approach? J Am Coll Cardiol 2021; 77:2157. [PMID: 33888257 DOI: 10.1016/j.jacc.2021.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
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59
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Reply: Magnetic Resonance for Risk Stratification of Coronary Artery Disease Patients: Toward an Electrophysiology-Guided Approach? J Am Coll Cardiol 2021; 77:2158. [PMID: 33888258 DOI: 10.1016/j.jacc.2021.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
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60
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Butter C, Sperzel J. Gerätebasierte rhythmologische Diagnostik und Therapie in COVID-19-Zeiten. DER KARDIOLOGE 2021; 15:272-281. [PMCID: PMC8130805 DOI: 10.1007/s12181-021-00482-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/14/2023]
Abstract
Die COVID-Pandemie mit ihrer ersten und zweiten Welle hat uns gezwungen, über eine sinnvolle Nutzung unserer medizinischen Ressourcen nachzudenken und Eingriffe nach ihrer Notwendigkeit und Dringlichkeit zu graduieren. Diese Selektion ist insbesondere in der Kardiologie in jedem einzelnen Fall schwierig und riskant. Die aktuellen Empfehlungen in der Herzschrittmacher‑, Defibrillatortherapie und Nachsorge werden aufgezeigt mit dem Ziel, die individuelle ärztliche Entscheidung auf nachvollziehbare und belastbare Argumente zu stützen und diese auch den Patienten gegenüber begründen zu können. Diese Überlegungen haben in einzelnen Ländern zu einem deutlichen Rückgang von Schrittmacher- und Defibrillatorimplantationen geführt ebenso wie Ablation bei supraventrikulären Arrhythmien. Die Auswirkungen der Pandemie lassen sich aus den Aktivitätsprofilen der rhythmologischen Implantate nachvollziehen. Die Notwendigkeit und Chancen einer telemedizinischen Überwachung sind in dieser Zeit nachdrücklich deutlich geworden, ebenso wie die bislang unzureichende Nutzung und mangelnde Struktur. Die aktuelle positive G‑BA(Gemeinsamer Bundesausschuss)-Bewertung der telemedizinischen Überwachung bei Herzinsuffizienz weist in die richtige Richtung, die Umsetzung und Vergütung wird jedoch für weitere Diskussionen sorgen. Ein neuer Algorithmus, der auf einer Herztonerkennung beruht und im ersten AV(atrioventrikulären)-sequenziellen sondenlosen Herzschrittmacher Verwendung findet, wird diskutiert. Bisher stützen sich die Indikationen für eine primärprophylaktische ICD(implantierbarer Kardioverter-Defibrillator)-Implantation im Wesentlichen auf die linksventrikuläre Ejektionsfraktion insbesondere bei der nichtischämischen Kardiomyopathie. Die Notwendigkeit und Bedeutung von intramuralem Fibrose- und Narbennachweis in der Magnetresonanztomographie (MRT) werden diskutiert und könnten die Entscheidungsfindung unterstützen.
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Affiliation(s)
- Christian Butter
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Universitätsklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321 Bernau bei Berlin, Deutschland
| | - Johannes Sperzel
- Abteilung für Kardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
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