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Monda E, Prosnitz A, Aiello R, Lioncino M, Norrish G, Caiazza M, Drago F, Beattie M, Tartaglia M, Russo MG, Colan SD, Calcagni G, Gelb BD, Kaski JP, Roberts AE, Limongelli G. Natural History of Hypertrophic Cardiomyopathy in Noonan Syndrome With Multiple Lentigines. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:350-358. [PMID: 37199218 DOI: 10.1161/circgen.122.003861] [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: 06/20/2022] [Accepted: 03/10/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND We aimed to examine clinical features and outcomes of consecutive molecularly characterized patients with Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy. METHODS A retrospective, longitudinal multicenter cohort of consecutive children and adults with a genetic diagnosis of Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy between 2002 and 2019 was assembled. We defined a priori 3 different patterns of left ventricular remodeling during follow-up: (1) an increase in ≥15% of the maximal left ventricular wall thickness (MLVWT), both in mm and z-score (progression); (2) a reduction ≥15% of the MLVWT, both in mm and z-score (absolute regression); (3) a reduction ≥15% of the MLVWT z-score with a stable MLVWT in mm (relative regression). The primary study end point was a composite of cardiovascular death, heart transplantation, and appropriate implantable cardioverter defibrillator-shock. RESULTS The cohort comprised 42 patients with Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy, with a median age at diagnosis of 3.5 (interquartile range, 0.2-12.3) years. Freedom from primary end point was 92.7% (95% CI, 84.7%-100%) 1 year after presentation and 80.9% (95% CI, 70.1%-90.7%) at 5 years. Patients with MLVWT z-score >13.7 showed reduced survival compared with those with <13.7. During a median follow-up of 3.7 years (interquartile range, 2.6-7.9), absolute regression was the most common type of left ventricular remodeling (n=9, 31%), followed by progression (n=6, 21%), and relative regression (n=6, 21%). CONCLUSIONS These findings provide insights into the natural history of left ventricular hypertrophy, and can help inform clinicians regarding risk stratification and clinical outcomes in patients with Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Aaron Prosnitz
- Congenital Heart Center, Levine Children's Hospital, Atrium Health, Charlotte, NC (A.P.)
| | - Rossella Aiello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Gabrielle Norrish
- Centre for Pediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, United Kingdom (G.N., J.P.K.)
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., J.P.K.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (F.D., G.C.)
| | - Meaghan Beattie
- Department of Cardiology and Division of Genetics, Department of Pediatrics, Boston Children's Hospital, MA (M.B., S.D.C., A.E.R.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy (M.T.)
| | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Steven D Colan
- Department of Cardiology and Division of Genetics, Department of Pediatrics, Boston Children's Hospital, MA (M.B., S.D.C., A.E.R.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (F.D., G.C.)
| | - Bruce D Gelb
- Mindich Child Health and Development Institute and Departments of Pediatrics and Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.G.)
| | - Juan Pablo Kaski
- Centre for Pediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, United Kingdom (G.N., J.P.K.)
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., J.P.K.)
| | - Amy E Roberts
- Department of Cardiology and Division of Genetics, Department of Pediatrics, Boston Children's Hospital, MA (M.B., S.D.C., A.E.R.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
- Institute of Cardiovascular Sciences, University College of London and St Bartholomew's Hospital, United Kingdom (G.L.)
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Sachdeva R. Complexities of Normative Database for Neonatal Echocardiography: The Quest for Perfection Continues. J Am Coll Cardiol 2023; 81:2186-2188. [PMID: 37257954 DOI: 10.1016/j.jacc.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
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53
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Vøgg ROB, Sillesen AS, Wohlfahrt J, Pihl C, Raja AA, Vejlstrup N, Norsk JB, Elia E, Sleeper LA, Colan SD, Iversen KK, Boyd HA, Bundgaard H. Normative Echocardiographic Left Ventricular Parameters and Reference Intervals in Infants. J Am Coll Cardiol 2023; 81:2175-2185. [PMID: 37257953 DOI: 10.1016/j.jacc.2023.03.423] [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: 02/15/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND In pediatric echocardiography, reference intervals are required to distinguish normal variation from pathology. Left ventricular (LV) parameters are particularly important predictors of clinical outcome. However, data from healthy newborns are limited, and current reference intervals provide an inadequate approximation of normal reference ranges. OBJECTIVES Normative reference intervals and z-scores for 2-dimensional echocardiographic measurements of LV structure and function based on a large group of healthy newborns were developed. METHODS The study population included 13,454 healthy newborns from the Copenhagen Baby Heart Study who were born at term to healthy mothers, had an echocardiogram performed within 30 days of birth, and did not have congenital heart disease. To develop normative reference intervals, this study modeled 10 LV parameters as a function of body surface area through joint modeling of 4 statistical components. RESULTS Infants in the study population (48.5% were female) had a median body surface area of 0.23 m2 (IQR: 0.22-0.25 m2) and median age of 12.0 days (IQR: 8.0-15.0 days) at examination. All normative reference intervals performed well in both sexes without stratification on infant sex. In contrast, creation of separate reference models for infants examined at <7 days of age and those examined at 7-30 days of age was necessary to optimize the performance of the reference intervals. CONCLUSIONS This study provides normative reference intervals and z-scores for 10 clinical, widely used echocardiographic measures of LV structure and function based on a large cohort of newborns. These results provide highly needed reference material for clinical application by pediatric cardiologists.
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Affiliation(s)
- R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Eleni Elia
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kasper K Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather A Boyd
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jhaveri S, Battersby E, Stern KWD, Cohen J, Yang Y, Price A, Hughes E, Poston L, Pasupathy D, Taylor P, Vieira MC, Groves A. Normative ranges of biventricular volumes and function in healthy term newborns. J Cardiovasc Magn Reson 2023; 25:26. [PMID: 37095534 PMCID: PMC10127416 DOI: 10.1186/s12968-023-00932-1] [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: 08/11/2022] [Accepted: 03/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is increasingly used in newborns with congenital heart disease. However, reporting on ventricular volumes and mass is hindered by an absence of normative data in this population. DESIGN/METHODS Healthy term (37-41 weeks gestation) newborns underwent non-sedated, free-breathing CMR within the first week of life using the 'feed and wrap' technique. End-diastolic volume (EDV), end-systolic volume (ESV) stroke volume (SV) and ejection fraction (EF) were calculated for both left ventricle (LV) and right ventricle (RV). Papillary muscles were separately contoured and included in the myocardial volume. Myocardial mass was calculated by multiplying myocardial volume by 1.05 g/ml. All data were indexed to weight and body surface area (BSA). Inter-observer variability (IOV) was performed on data from 10 randomly chosen infants. RESULTS Twenty healthy newborns (65% male) with a mean (SD) birth weight of 3.54 (0.46) kg and BSA of 0.23 (0.02) m2 were included. Normative LV parameters were indexed EDV 39.0 (4.1) ml/m2, ESV 14.5 (2.5) ml/m2 and ejection fraction (EF) 63.2 (3.4)%. Normative RV indexed EDV, ESV and EF were 47.4 (4.5) ml/m2, 22.6 (2.9) ml/m2 and 52.5 (3.3)% respectively. Mean LV and RV indexed mass were 26.4 (2.8) g/m2 and 12.5 (2.0) g/m2, respectively. There was no difference in ventricular volumes by gender. IOV was excellent with an intra-class coefficient > 0.95 except for RV mass (0.94). CONCLUSION This study provides normative data on LV and RV parameters in healthy newborns, providing a novel resource for comparison with newborns with structural and functional heart disease.
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Affiliation(s)
- Simone Jhaveri
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
| | - Ellie Battersby
- Center for the Developing Brain, Kings College London, London, UK
| | - Kenan W D Stern
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Cohen
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yang Yang
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Price
- Center for the Developing Brain, Kings College London, London, UK
| | - Emer Hughes
- Center for the Developing Brain, Kings College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Syndey, NSW, Australia
| | - Paul Taylor
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Matias C Vieira
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Alan Groves
- Department of Pediatrics, Dell Medical School at the University of Austin, Austin, TX, USA
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Channon-Wells S, Vito O, McArdle AJ, Seaby EG, Patel H, Shah P, Pazukhina E, Wilson C, Broderick C, D'Souza G, Keren I, Nijman RG, Tremoulet A, Munblit D, Ulloa-Gutierrez R, Carter MJ, Ramnarayan P, De T, Hoggart C, Whittaker E, Herberg JA, Kaforou M, Cunnington AJ, Blyuss O, Levin M. Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study. THE LANCET. RHEUMATOLOGY 2023; 5:e184-e199. [PMID: 36855438 PMCID: PMC9949883 DOI: 10.1016/s2665-9913(23)00029-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health.
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Affiliation(s)
- Samuel Channon-Wells
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ortensia Vito
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew J McArdle
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Eleanor G Seaby
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Genomic Informatics Group, University of Southampton, Southampton, UK
- Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Harsita Patel
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Priyen Shah
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | - Clare Wilson
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Claire Broderick
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Giselle D'Souza
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ilana Keren
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ruud G Nijman
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's hospital-Imperial College NHS Healthcare Trust, London, London, UK
| | - Adriana Tremoulet
- Department of Paediatrics, University of California San Diego-Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Daniel Munblit
- Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectologia Pediatrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
- Cátedra de Pediatría, Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Michael J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Padmanabhan Ramnarayan
- Anaesthetics, Pain Medicine, and Intensive Care (APMIC) Division, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tisham De
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Clive Hoggart
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elizabeth Whittaker
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Jethro A Herberg
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Myrsini Kaforou
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Aubrey J Cunnington
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Levin
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
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Reference Standards in Quantitative Pediatric Echocardiography: A Guide to the Nuanced World of Z Scores and Nomograms. J Am Soc Echocardiogr 2023; 36:324-326. [PMID: 36549924 DOI: 10.1016/j.echo.2022.12.003] [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: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
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Conal Septal Hypoplasia in Tetralogy of Fallot-Impact on Clinical Course, Treatment Strategies, and Outcomes After Surgical Intervention. Pediatr Cardiol 2023; 44:587-598. [PMID: 35852568 DOI: 10.1007/s00246-022-02962-5] [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] [Received: 05/11/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
We sought to characterize the clinical course and outcomes of intervention for Tetralogy of Fallot (TOF) with associated conal septal hypoplasia (CSH) compared to those with identifiable conal septum on initial newborn echocardiogram. We performed a retrospective, 1:2 case-control study of children with TOF anatomy, 33 with CSH and 66 with typical TOF, who underwent surgical repair from 1991-2019 at Children's Wisconsin. Data on echocardiographic anatomic features, systemic oxygen saturations, medical therapies, admissions, palliative interventions, operative strategies, and long-term follow-up were compared. The CSH group had fewer hypercyanotic spells (6% vs 42%, p < 0.001), beta-blockers prescribed (12% vs 41%, p = 0.005), and hospital admissions for cyanosis (12% vs 44%; p = 0.001) prior to any intervention. Of 14 who required palliative intervention, 8 had balloon pulmonary valvuloplasty (BPV) (7 from the CSH group and 1 from the control group), and 6 had systemic-to-pulmonary artery shunts (all from the control group). Definitive repair was performed at a significantly older age in the CSH group (10.2 ± 10 vs 5.6 ± 5.9 months, p = 0.011), with less subpulmonary muscle resection (57.6% in vs 92.4%, p < 0.001) and higher use of a transannular patch (84.8% vs 65.2%, p = 0.040). The average time to surgical reintervention was similar in both groups (9.7 ± 5.9 vs 8.6 ± 6.4 years in controls). We conclude that infants with TOF and CSH have a milder preoperative clinical course with fewer hypercyanotic spells or need for medical therapy. They also respond well to palliative BPV and can safely undergo later definitive repair compared to typical TOF with a well-developed conal septum.
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Guo H, Wu Z, Zhao T, Yang J, Hu S, Huang C, Yang Y, Xie L. Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot. Front Surg 2023; 10:1056772. [PMID: 36860944 PMCID: PMC9968738 DOI: 10.3389/fsurg.2023.1056772] [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: 09/29/2022] [Accepted: 01/16/2023] [Indexed: 02/15/2023] Open
Abstract
Background Right ventricular outflow tract (RVOT) stenting seems to be suggested as a promising treatment option and an alternative to modified Blalock-Taussig shunt (mBTS) in the initial palliation of patients with Fallot-type lesions in recent years. This study sought to assess the effect of RVOT stenting on the growth of the pulmonary artery (PA) in patients with Tetralogy of Fallot (TOF). Methods Retrospective review analyzing 5 patients with Fallot-type congenital heart disease with small pulmonary arteries who underwent palliative with RVOT stenting and 9 patients underwent modified Blalock-Taussig shunt within 9 years period. Differential left PA (LPA) and right PA (RPA) growth was measured by Cardiovascular Computed Tomography Angiography (CTA). Results RVOT stenting improved arterial oxygen saturation from median of 60% (interquartile range [IQR]: 37% to 79%) to 95% (87.5% to 97.5%) (p = 0.028). The LPA diameter Z-score improved from -2.843 (-3.51-2.037) to -0.78 (-2.3305-0.19) (p = 0.03), the RPA diameter Z-score improved from median -2.843 (-3.51-2.037) to -0.477 (-1.1145-0.459) (p = 0.002), the Mc Goon ratio increased from median 1 (0.8-1.105) to 1.32 (1.25-1.98) (p = 0.017). There were no procedural complications and all 5 patients have undergone final repair in the RVOT stent group. In the mBTS group, the LPA diameter Z-score improved from -1.494 (-2.242-0.6135) to -0.396 (-1.488-1.228) (p = 0.15), the RPA diameter Z-score improved from median -1.328 (-2.036-0.838) to 0.088 (-0.486-1.223) (p = 0.007), and there were 5 patients occur different complications and 4 patients was not attained the standards of final surgical repair. Conclusion RVOT stenting, compared with mBTS, seems to better promote pulmonary artery growth, improve arterial oxygen saturations, and have less procedure complications in patients with TOF who being absolute contraindicated for primary repair due to high risks.
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Affiliation(s)
- Hui Guo
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Zhongshi Wu
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Tianli Zhao
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Jinfu Yang
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Shijun Hu
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Can Huang
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Yifeng Yang
- The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
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Lee SO, Kim DH, Choi ES, Kwon BS, Yun TJ, Kim MJ, Cha S, Baek JS, Yu JJ, Park CS. Outcomes of Arterial Switch Operation With Aortic Arch Reconstruction. Ann Thorac Surg 2023:S0003-4975(23)00135-2. [PMID: 36791834 DOI: 10.1016/j.athoracsur.2023.02.010] [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: 08/19/2022] [Revised: 01/07/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND This study investigated the outcomes and factors associated with reintervention or development of significant pulmonary stenosis (PS) after repair of transposition of the great arteries (TGA) or Taussig-Bing anomaly (TBA) with aortic arch obstruction. METHODS A total of 51 patients with TGA or TBA who underwent an arterial switch operation and aortic arch reconstruction between 2004 and 2020 were included. The outcomes of interest were all-cause death, including heart transplantation, all-cause reintervention, right-sided reintervention, and development of significant PS. RESULTS The median age and body weight at repair were 9 days and 3.2 kg, respectively. Forty-nine patients (96.1%) underwent 1-stage repair. A total of 28 patients (54.9%) had TBA, and 8 patients (15.7%) had interrupted aortic arch. There were 5 early deaths (9.8%) and 2 late deaths during a median follow-up duration of 59 months. The transplant-free survival rate 10 years after repair was 82.6%. A total of 21 reinterventions were required in 10 patients. The significant PS-free survival rate 10 years after repair was 68.8%. In univariable analysis, a higher ratio of the diameter of the main pulmonary artery to the ascending aorta was associated with all-cause reintervention (P = .007) and right-sided reintervention (P = .002). A smaller aortic annulus z-score at the pulmonary position was associated with the development of significant PS (P = .049). CONCLUSIONS The rates of overall mortality and reintervention after repair were not negligible. A higher degree of size discrepancy between the 2 great arteries was associated with all-cause or right-sided reintervention. A smaller aortic annulus z-score at the pulmonary position was associated with the development of significant PS.
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Affiliation(s)
- Sang On Lee
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seulgi Cha
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Jin Yu
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Yang Y, Wang L, Yang Y, Wu X, Xu L, Bi C. Z-score regression model for coronary artery diameter in healthy Chinese Han children. Acta Radiol 2023; 64:798-805. [PMID: 35306860 DOI: 10.1177/02841851221085685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery distension and aneurysm are complications of Kawasaki disease in children. PURPOSE To develop a Z-score regression model for coronary artery diameter in children that could be used as reference. MATERIAL AND METHODS This retrospective analysis included children with normal heart structure between March 2013 and April 2017. Body surface area (BSA) was calculated. The diameters of the right coronary, left main coronary, left anterior descending, and circumflex arteries were measured by echocardiography. Pearson correlation analysis was used to establish linear, exponential, logarithmic, power, and square root regression models. RESULTS The analysis included 509 children (280 boys) aged 1 day to 15.2 years. Coronary artery diameters were significantly correlated with age, height, body mass, BSA, and BSA (r = 0.663-0.826; P < 0.05), with a stronger correlation for BSA than BSA (P < 0.05). The adjusted determination coefficients (Ra2) were higher for the exponential and square root models than for the other models (P < 0.05). The random error term variance was constant for the exponential model (P > 0.05), and processing with the weighted least-square methods eliminated heteroscedasticity in the other models. The Z-scores were normally distributed for the exponential and square root models (P > 0.05). CONCLUSION Overall, the square root model was the optimal equation for the calculation of coronary artery Z-score in Chinese Han children. This model could be used to facilitate the diagnosis of coronary artery distension in children with suspected Kawasaki disease.
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Affiliation(s)
- Yanzhang Yang
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Li Wang
- Department of Pediatrics, Shijiazhuang Fifth Hospital, Shijiazhuang, Hebei, PR China
| | - Yanfang Yang
- Department of Medical Imaging, Gaocheng Integrated Traditional Chinese and Western Medicine Hospital, Shijiazhuang, Hebei, PR China
| | - Xiaojing Wu
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Lijin Xu
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Changbo Bi
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
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Schulte LJ, Miller PC, Bhat AN, Carvajal-Dominguez HG, Chomat MR, Miller JR, Nath D, Eghtesady P. Evolution of Pulmonary Valve Management During Repair of Tetralogy of Fallot: A 14-year Experience. Ann Thorac Surg 2023; 115:462-469. [PMID: 35779602 DOI: 10.1016/j.athoracsur.2022.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal repair strategy for tetralogy of Fallot remains controversial. This report presents a 14-year evolution of management of the pulmonary valve (PV) from transannular patch to valve-sparing repair to neovalve creation using living right atrial appendage tissue. METHODS A retrospective review of 172 consecutive patients undergoing complete repair for TOF between January 2007 and June 2021 was performed. Clinical and follow-up data were analyzed by repair group. Neopulmonary valve (NPV) creation using right atrial appendage tissue was introduced in 2019. Failure of valve-sparing repair was defined as needing reintervention for recurrent right ventricular outflow tract obstruction (RVOTO). RESULTS Median age and weight at repair were 4.9 months and 6 kg, respectively. Median preoperative PV size and z-score were 6.4 mm (5.2-8.3 mm) and -3.2 (-4.1 to -2.1), respectively. Patients who underwent valve-sparing repair had larger PV size and z-score compared with patients who underwent transannular patch procedures (8 mm vs 5.6 mm; -2.1 vs -3.2; both P < .001). There were no hospital mortalities. Overall follow-up was 44 months. At last follow-up, 10% of patients who underwent valve-sparing repair had repeat intervention for recurrent RVOTO. Patients who had failed valve-sparing repair had significantly lower PV z-scores (-2.6 vs -1.9; P = .01). An NPV was used in 8 patients with a median PV z-score of -4 (-4.7 to -3.9). At 6 months, 6 patients (75%) had mild or trivial pulmonary insufficiency after NPV placement. CONCLUSIONS Repair of tetralogy of Fallot is a safe operation with excellent outcomes. Valve-sparing repair avoids right ventricular dilation but may fail for RVOTO at a PV z-score <-2. NPV creation offers an alternative option in patients with a small PV.
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Affiliation(s)
- Linda J Schulte
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | | | - Amrita N Bhat
- Washington University School of Medicine, St Louis, Missouri
| | - Horacio G Carvajal-Dominguez
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri
| | - Michael R Chomat
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Jacob R Miller
- Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Dilip Nath
- Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri.
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Hopkin RJ, Cabrera GH, Jefferies JL, Yang M, Ponce E, Brand E, Feldt-Rasmussen U, Germain DP, Guffon N, Jovanovic A, Kantola I, Karaa A, Martins AM, Tøndel C, Wilcox WR, Yoo HW, Burlina AP, Mauer M. Clinical outcomes among young patients with Fabry disease who initiated agalsidase beta treatment before 30 years of age: An analysis from the Fabry Registry. Mol Genet Metab 2023; 138:106967. [PMID: 36709533 DOI: 10.1016/j.ymgme.2022.106967] [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: 07/30/2022] [Revised: 11/26/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Clinical manifestations of classic Fabry disease (α-galactosidase A deficiency) usually occur in childhood, while complications involving major organs typically develop in adulthood. Outcomes of Fabry-specific treatment among young patients have not been extensively reported. Our aim was to analyze clinical outcomes among patients aged 5-30 years at initiation of treatment with agalsidase beta using data from the Fabry Registry (NCT00196742, sponsor: Sanofi). METHODS Reported GLA variants were predicted to be associated with the classic phenotype or not classified in fabry-database.org. Linear mixed models were conducted to assess changes over ≥2-year follow-up in the estimated glomerular filtration rate (eGFR) stratified by low (LRI) and high (HRI) renal involvement (defined by proteinuria/albuminuria levels), and changes in interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) Z-scores stratified by median age at first treatment. Self-reports ('yes'/'no') of abdominal pain, diarrhea, chronic peripheral pain (denoting neuropathic pain), and acute pain crises at baseline were compared with reports after ≥0.5-year and ≥2.5-year follow-up using McNemar's test. RESULTS Male (n = 117) and female patients (n = 59) with LRI initiated treatment at a median age of 19.9 and 23.6 years, respectively, and were followed for a median of 6.3 and 5.0 years, respectively. The eGFR slopes were -1.18 (Pfrom 0 <0.001) and -0.92 mL/min/1.73 m2/year (Pfrom 0 = 0.040), respectively. Males with HRI (n = 23, median UPCR 1.0 g/g), who started treatment at a median age of 26.7 years, had an eGFR slope of -2.39 mL/min/1.73 m2/year (Pfrom 0 <0.001; Pdifference = 0.055, as compared with the slope of -1.18 mL/min/1.73 m2/year for LRI males) during a median follow-up of 5.6 years. Echocardiographic variables were stable among males, regardless of age, and among young females (median follow-up >5.5 years and ≥4.5 years, respectively). Older females (treatment initiation at median age 27.5 years) had a slope of LVPWT Z-scores of 0.18/year (n = 12, Pfrom 0 = 0.028), whereas IVST Z-scores remained stable (n = 13, 0.10/year, Pfrom 0 = 0.304) during a median follow-up of ≥3.7 years. These slopes did not significantly differ from slopes of younger females. Reports of chronic peripheral pain and acute pain crises by males, and of diarrhea and acute pain crises by females, significantly reduced after a median follow-up of ≥4.0 years. After a median follow-up of ≥5.4 years, reports of all four symptoms significantly decreased among males, whereas among females only reports of abdominal pain significantly decreased. CONCLUSIONS During sustained treatment with agalsidase beta in young Fabry patients with a predicted classic phenotype or with unclassified GLA variants with similar characteristics, the decline in eGFR was modest among male and female patients with LRI. The greater decline in eGFR among older, proteinuric (i.e., HRI) males may suggest a benefit of earlier treatment. Overall, echocardiographic variables remained stable, particularly among males and younger females. Significant reductions in symptom reports occurred primarily among males after longer follow-up and were less noticeable among females. These observed trends are suggestive of an overall improvement after treatment in young patients, but warrant larger longitudinal studies.
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Affiliation(s)
- Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | - John L Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Münster, Münster, Germany
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Dominique P Germain
- French Referral Center for Fabry disease, Division of Medical Genetics, University of Versailles and APHP - Paris Saclay University, Garches, France
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Amel Karaa
- Department of Genetics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana M Martins
- Reference Center for Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Camilla Tøndel
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway, and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - William R Wilcox
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN, USA
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McClean G, Wilson MG, Riding NR, Pieles G, Watt V, Adamuz C, Shaw A, Harkness A, Johnson A, George KP, Oxborough D. A New Tool to Aid the Differential Diagnosis of Physiological Remodelling from Cardiac Pathology When Assessing Left Ventricle, Left Atrial and Aortic Structure and Function in Male Arab and Black Paediatric Athletes. J Cardiovasc Dev Dis 2023; 10:jcdd10020037. [PMID: 36826533 PMCID: PMC9963999 DOI: 10.3390/jcdd10020037] [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: 11/15/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/24/2023] Open
Abstract
Aim: To determine if published Z-scores for left ventricular (LV), left atrial (LA) and aortic structure as well as indices of LV function (Doppler and TDI) in paediatric athletes and non-athletes are appropriate for application in male Arab and black paediatric athletes. If inappropriate, we aim to provide new nomograms and Z-scores for clinical application. Methods: 417 (297 Arab, 120 black) male paediatric (11-18 years) athletes, were evaluated by 2D echocardiography as per British Society of Echocardiography recommendations, and biological age (by radiological X-ray) assessment. Z-scores were tested by residual and correlation analysis together with visual inspection. New Z-scores involved allometric (a*BSA(b+c*chronological age)) and second-order polynomial (y=a*chronological age2+b*chronological age+c) equations for measures of cardiac size and indices of LV function, respectively. Results: Residual linear regression, correlation analysis and visual inspection revealed published z-scores in white peri-pubertal footballers and paediatric non-athletes to be inappropriate for application in male Arab and black paediatric athletes. Residual linear regression revealed new Z-scores for measures of LV, LA and aortic root size to be independent of BSA, ethnicity, chronological and biological age. Residual linear regression revealed new Z-scores for measures of function to be independent of chronological age. Conclusion: Our new z-scores may aid differential diagnosis of suspected pathology versus physiology remodelling, in cardiac screening of the Arab and black paediatric athlete. Nomograms are provided to assist the tracking of the paediatric athlete necessitating annual follow-up and Excel z-score calculation to facilitate use in day-to-day practice.
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Affiliation(s)
- Gavin McClean
- Echocardiography Laboratory, St Bartholomew’s Hospital, Barts Health NHS, London EC1A 7BE, UK
- Echocardiography Laboratory, University College London Hospital, London NW1 2BU, UK
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Mathew G. Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
- Institute of Sport Exercise and Health (ISEH), University College London, London 1T 7HA, UK
| | - Nathan R. Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
- Institute of Sport Exercise and Health (ISEH), University College London, London 1T 7HA, UK
- Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Guido Pieles
- Institute of Sport Exercise and Health (ISEH), University College London, London 1T 7HA, UK
- Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol BS2 8ED, UK
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
| | - Victoria Watt
- Wythenshawe Hospital, Manchester University NHS Foundation Trust (MFT), Manchester M23 9LT, UK
| | - Carmen Adamuz
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
| | - Anthony Shaw
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
| | - Allan Harkness
- Colchester Hospital National Health Service Trust, Colchester CO4 5JL, UK
| | - Amanda Johnson
- Health Sciences Department, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Keith P. George
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
- Correspondence:
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Singh V, Satheesh S, Ganapathy S, Nair NPS, Mondal N, Selvaraj R, Mishra N, Anantharaj A. Echocardiographic nomograms and Z-scores for term Indian neonates. Ann Pediatr Cardiol 2023; 16:11-17. [PMID: 37287836 PMCID: PMC10243653 DOI: 10.4103/apc.apc_128_22] [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: 10/16/2022] [Revised: 11/13/2022] [Accepted: 01/19/2023] [Indexed: 06/09/2023] Open
Abstract
Background The availability of nomograms is crucial for the correct interpretation of pediatric and neonatal echocardiograms. Echocardiographic Z-score applications/websites use Western nomograms as reference, which may not be an appropriate standard for gauging Indian neonates. Currently available Indian pediatric nomograms either have not included neonates or have not been specifically designed for neonates. This gross underrepresentation of neonates renders available nomograms unreliable for use as standards for comparison. Objectives The objective of this study was to collect normative data for the measurement of various cardiac structures using M-Mode and two-dimensional (2D) echo in healthy Indian neonates and to derive Z-scores for each measured parameter. Methods Echocardiograms were performed on healthy term neonates (within first 5 days of life). Birth weight and length were recorded, and body surface area was calculated using Haycock's formula. Twenty M-mode and 2D-echo parameters were measured (including left ventricular dimensions, atrioventricular valves, and semilunar valves' annuli sizes, pulmonary artery and branches, aortic root, and arch). Results We studied 142 neonates (73 males) with a mean age of 1.83 ± 1.12 days and mean birth weight of 2.89 ± 0.39 Kg. Regression equations with linear, logarithmic, exponential and square root models were tested to select the best model of fit for the relationship between birth weight and each echocardiographic parameter. Scatter plots and nomogram charts with Z-scores were prepared for each echocardiographic parameter. Conclusions Our study provides nomograms with Z-scores for term Indian neonates weighing between 2 kg and 4 kg at birth, within first 5 days of life, for a set of echocardiographic parameters that are frequently used in clinical practice. This nomogram has poor predictability for babies at extremes of birth weight. There is a need for further indigenous studies to include neonates at extremes of weight, both term, and preterm.
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Affiliation(s)
- Vatsal Singh
- Department of Cardiology, JIPMER, Puducherry, India
| | | | | | | | | | | | - Neeraj Mishra
- Department of Neonatology, JIPMER, Puducherry, India
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Forså MI, Bjerring AW, Haugaa KH, Smedsrud MK, Sarvari SI, Landgraff HW, Hallén J, Edvardsen T. Young athlete's growing heart: sex differences in cardiac adaptation to exercise training during adolescence. Open Heart 2023; 10:openhrt-2022-002155. [PMID: 36596623 DOI: 10.1136/openhrt-2022-002155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Athlete's heart is a condition of exercise-induced cardiac remodelling. Adult male endurance athletes more often remodel beyond reference values. The impact of sex on remodelling through adolescence remains unclear. Paediatric reference values do not account for patient sex or exercise history. We aimed to study the effect of sex on cardiac remodelling throughout adolescence. METHODS We recruited 76 male (M) and female (F) 12-year-old cross-country skiers in a longitudinal cohort study. Echocardiography was performed and analysed according to guidelines at age 12 (48 M, 28 F), 15 (34 M, 14 F) and 18 (23 M, 11 F). Repeated echocardiographic measurements were analysed by linear mixed model regression. RESULTS Males displayed greater indexed left ventricular end-diastolic volumes (LV EDVi) from age 12 (M 81±7 vs F 76±7, mL/m², p≤0.01), and progressed further until follow-up at age 18 (M 2.3±9.7 vs F -3.9±4.5 ΔmL/m², p≤0.01). LV EDVi remained above adult upper reference values in both groups. Males increased LV Mass Index from age 12 to 18 (M 33±27 vs F 4±19, Δg/m², p≤0.01). Males displayed LV mass above paediatric reference values at ages 15 and 18. A subset of males (35%) and females (25%) displayed wall thickness above paediatric reference values at age 12. Cardiac function was normal. There was no sex difference in exercise hours. CONCLUSION Sex-related differences in athlete's heart were evident from age 12, and progressed throughout adolescence. Remodelling beyond reference values was more frequent than previously reported, particularly affecting males. Age, sex and exercise history may assist clinicians in distinguishing exercise-induced remodelling from pathology in adolescents.
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Affiliation(s)
- Marianne Inngjerdingen Forså
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders W Bjerring
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Kristine Smedsrud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Paediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sebastian I Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hege W Landgraff
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Jostein Hallén
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Brüning J, Kramer P, Goubergrits L, Schulz A, Murin P, Solowjowa N, Kuehne T, Berger F, Photiadis J, Weixler VHM. 3D modeling and printing for complex biventricular repair of double outlet right ventricle. Front Cardiovasc Med 2022; 9:1024053. [PMID: 36531701 PMCID: PMC9748612 DOI: 10.3389/fcvm.2022.1024053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/07/2022] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Double outlet right ventricle (DORV) describes a group of congenital heart defects where pulmonary artery and aorta originate completely or predominantly from the right ventricle. The individual anatomy of DORV patients varies widely with multiple subtypes classified. Although the majority of morphologies is suitable for biventricular repair (BVR), complex DORV anatomy can render univentricular palliation (UVP) the only option. Thus, patient-specific decision-making is critical for optimal surgical treatment planning. The evolution of image processing and rapid prototyping techniques facilitate the generation of detailed virtual and physical 3D models of the patient-specific anatomy which can support this important decision process within the Heart Team. MATERILAS AND METHODS The individual cardiovascular anatomy of nine patients with complex DORV, in whom surgical decision-making was not straightforward, was reconstructed from either computed tomography or magnetic resonance imaging data. 3D reconstructions were used to characterize the morphologic details of DORV, such as size and location of the ventricular septal defect (VSD), atrioventricular valve size, ventricular volumes, relationship between the great arteries and their spatial relation to the VSD, outflow tract obstructions, coronary artery anatomy, etc. Additionally, physical models were generated. Virtual and physical models were used in the preoperative assessment to determine surgical treatment strategy, either BVR vs. UVP. RESULTS Median age at operation was 13.2 months (IQR: 9.6-24.0). The DORV transposition subtype was present in six patients, three patients had a DORV-ventricular septal defect subtype. Patient-specific reconstruction was feasible for all patients despite heterogeneous image quality. Complex BVR was feasible in 5/9 patients (55%). Reasons for unsuitability for BVR were AV valve chordae interfering with potential intraventricular baffle creation, ventricular hypoplasia and non-committed VSD morphology. Evaluation in particular of qualitative data from 3D models was considered to support comprehension of complex anatomy. CONCLUSION Image-based 3D reconstruction of patient-specific intracardiac anatomy provides valuable additional information supporting decision-making processes and surgical planning in complex cardiac malformations. Further prospective studies are required to fully appreciate the benefits of 3D technology.
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Affiliation(s)
- Jan Brüning
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Antonia Schulz
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Peter Murin
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Viktoria Heide-Marie Weixler
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Circulating Serum Cystatin C as an Independent Risk Biomarker for Vascular Endothelial Dysfunction in Patients with COVID-19-Associated Multisystem Inflammatory Syndrome in Children (MIS-C): A Prospective Observational Study. Biomedicines 2022; 10:biomedicines10112956. [PMID: 36428524 PMCID: PMC9687890 DOI: 10.3390/biomedicines10112956] [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: 11/01/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity that has emerged in the context of the COVID-19 pandemic. Despite the less severe course of the disease, varying degrees of cardiovascular events may occur in MIS-C; however, data on vascular changes occurring in MIS-C are still lacking. Endothelial dysfunction (ED) is thought to be one of the key risk factors contributing to MIS-C. BACKGROUND We conducted a prospective observational study. We investigated possible manifestations of cardiac and endothelial involvement in MIS-C after the treatment of the acute stage and potential predictive biomarkers in patients with MIS-C. METHODS Twenty-seven consecutive pediatric subjects (≥9 years), at least three months post-treated MIS-C of varying severity, in a stable condition, and twenty-three age- and sex-matched healthy individuals (HI), were enrolled. A combined non-invasive diagnostic approach was used to assess endothelial function as well as markers of organ damage using cardiac examination and measurement of the reactive hyperemia index (RHI), by recording the post- to pre-occlusion pulsatile volume changes and biomarkers related to ED and cardiac disease. RESULTS MIS-C patients exhibited a significantly lower RHI (indicative of more severe ED) than those in HI (1.32 vs. 1.80; p = 0.001). The cutoff of RHI ≤ 1.4 was independently associated with a higher cardiovascular risk. Age and biomarkers significantly correlated with RHI, while serum cystatin C (Cys C) levels were independently associated with a diminished RHI, suggesting Cys C as a surrogate marker of ED in MIS-C. CONCLUSIONS Patients after MIS-C display evidence of ED, as shown by a diminished RHI and altered endothelial biomarkers. Cys C was identified as an independent indicator for the development of cardiovascular disease. The combination of these factors has the potential to better predict the cardiovascular consequences of MIS-C. Our study suggests that ED may be implicated in the pathophysiology of this disease.
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Maternal obesity in pregnancy and children’s cardiac function and structure: A systematic review and meta-analysis of evidence from human studies. PLoS One 2022; 17:e0275236. [DOI: 10.1371/journal.pone.0275236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
The prevalence of obesity is increasing worldwide. Experimental animal studies demonstrate that maternal obesity during pregnancy directly affects cardiac structure and function in their offspring, which could contribute to their increased cardiovascular disease (CVD) risk. Currently, a systematic overview of the available evidence regarding maternal obesity and alterations in cardiac structure and function in human offspring is lacking. We systematically searched the electronic databases Embase, MEDLINE and NARCIS from inception to June 29, 2022 including human studies comparing cardiac structure and function from fetal life onwards in offspring of women with and without obesity. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (identifier: CRD42019125071). Risk of bias was assessed using a modified Newcastle-Ottawa scale. Results were expressed using standardized mean differences (SMD). The search yielded 1589 unique publications, of which thirteen articles were included. Compared to offspring of women without obesity, fetuses of women with obesity had lower left ventricular strain, indicative of reduced systolic function, that persisted in infancy (SMD -2.4, 95% confidence interval (CI) -4.4 standard deviation (SD) to -0.4 SD during fetal life and SMD -1.0, 95% CI -1.6 SD to -0.3 SD in infancy). Furthermore, infants born to women with obesity had a thicker interventricular septum (SMD 0.6 SD, 95% CI 0.0 to 1.2 SD) than children born to women without obesity. In conclusion, cardiac structure and function differs between fetuses and children of women with and without obesity. Some of these differences were present in fetal life, persisted in childhood and are consistent with increased CVD risk. Long-term follow-up research is warranted, as studies in offspring of older age are lacking.
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Rahde Bischoff A, Bhombal S, Altman CA, Fraga MV, Punn R, Rohatgi RK, Lopez L, McNamara PJ. Targeted Neonatal Echocardiography in Patients With Hemodynamic Instability. Pediatrics 2022; 150:189890. [PMID: 36317979 DOI: 10.1542/peds.2022-056415i] [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] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
Targeted neonatal echocardiography (TNE) has been increasingly used at the bedside in neonatal care to provide an enhanced understanding of physiology, affecting management in hemodynamically unstable patients. Traditional methods of bedside assessment, including blood pressure, heart rate monitoring, and capillary refill are unable to provide a complete picture of tissue perfusion and oxygenation. TNE allows for precision medicine, providing a tool for identifying pathophysiology and to continually reassess rapid changes in hemodynamics. A relationship with cardiology is integral both in training as well as quality assurance. It is imperative that congenital heart disease is ruled out when utilizing TNE for hemodynamic management, as pathophysiology varies substantially in the assessment and management of patients with congenital heart disease. Utilizing TNE for longitudinal hemodynamic assessment requires extensive training. As the field continues to grow, guidelines and protocols for training and indications are essential for ensuring optimal use and providing a platform for quality assurance.
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Affiliation(s)
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California.,Contributed equally as co-first authors
| | - Carolyn A Altman
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - María V Fraga
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajesh Punn
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Ram K Rohatgi
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Leo Lopez
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Patrick J McNamara
- Departments of Pediatrics.,Internal Medicine, University of Iowa, Iowa City, Iowa
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Yoo GH. Characteristics of z score systems for diagnosing coronary abnormalities in Kawasaki disease. Clin Exp Pediatr 2022; 65:448-449. [PMID: 35287256 PMCID: PMC9441612 DOI: 10.3345/cep.2021.01886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gyeong-Hee Yoo
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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71
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Kato Y, Nozaki Y, Takahashi-Igari M, Sugano M, Makita N, Horigome H. Progressive atrial myocardial fibrosis in a 4-year-old girl with atrial standstill associated with an SCN5A gene mutation. HeartRhythm Case Rep 2022; 8:636-638. [PMID: 36147716 PMCID: PMC9485770 DOI: 10.1016/j.hrcr.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Yoshiaki Kato
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Division of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Address reprint requests and correspondence: Dr Yoshiaki Kato, Division of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
| | - Yoshihiro Nozaki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miho Takahashi-Igari
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masato Sugano
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naomasa Makita
- Research Institute and Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Huuskonen A, Hui L, Runeckles K, Hui W, Barron DJ, Friedberg MK, Honjo O. Growth of unrepaired hypoplastic proximal aortic arch and reintervention rate after aortic coarctation repair. J Thorac Cardiovasc Surg 2022; 165:1631-1640.e1. [PMID: 36202666 DOI: 10.1016/j.jtcvs.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Treatment of tubular hypoplasia of the aortic arch (THAA) associated with aortic coarctation (CoA) remains controversial. We aimed to evaluate growth of unrepaired hypoplastic proximal aortic arches (PAAs) after surgical repair for CoA. METHODS Preoperative and follow-up echocardiographic images of 139 patients who underwent CoA repairs from 2005 to 2012 were reviewed. THAA was defined as PAA z-score <-3 and non-THAA group z-score ≥-3. Reintervention rates due to aortic obstruction were assessed using competing risk models and diameters of the aorta were compared with Mann-Whitney U tests. RESULTS Fifty patients (36%) had THAA and 89 (64%) had non-THAA. The survival rate was 94% at 10 years. The overall reintervention rate at 10 years was 9% in the THAA group and 16% in the non-THAA group (P = .54). The catheter reintervention rate at ten years was 2% in the THAA group and 16% in the non-THAA group (P = .031). The surgical reintervention rate at ten years was 7% in the THAA group and 0% in the non-THAA group (P = .016). All 4 patients who required surgical reintervention were in the THAA group and 3 patients with PAA obstruction had preoperative PAA z-scores -3.6, -4.2, and -4.3. Follow-up echocardiograms showed PAA catch-up growth in the THAA group compared with the non-THAA group (preoperative z-score of -3.6 vs -2.3, and at 7 years of -1.1 vs -1.2; P < .001). CONCLUSIONS Unrepaired PAA hypoplasia grows after CoA repair. Reintervention rates were comparable between groups but those with THAA had higher surgical reintervention rates.
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Imaging Evaluation of Kawasaki Disease. Curr Cardiol Rep 2022; 24:1487-1494. [DOI: 10.1007/s11886-022-01768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/26/2022]
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Patukale A, Shikata F, Marathe SS, Patel P, Marathe SP, Colen T, Venugopal P, Suna J, Betts K, Karl TR, Johnson J, Versluis K, Alphonso N. A single-centre, retrospective study of mid-term outcomes of aortic arch repair using a standardized resection and patch augmentation technique. Interact Cardiovasc Thorac Surg 2022; 35:6594494. [PMID: 35640134 PMCID: PMC9419687 DOI: 10.1093/icvts/ivac135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/19/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to evaluate the mid-term outcomes after the repair of aortic arch using a standard patch augmentation technique.
METHODS
The study included all patients who underwent repair of a hypoplastic/interrupted aortic arch (IAA) in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). End points evaluated were reintervention for arch obstruction and persistent/new-onset hypertension.
RESULTS
The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), IAA, n = 9 (6%), Norwood procedure, n = 48 (32%)]. The patch material used for augmentation of the aortic arch included pulmonary homograft (n = 120, 81%), homograft pericardium (n = 18, 12%), CardioCel® (n = 9, 6%) and glutaraldehyde-treated autologous pericardium (n = 2, 1%). The median age and weight at surgery were 7 days [interquartile range (IQR) 5–17 days] and 3.5 kg (IQR 3–3.9 kg), respectively. The median follow-up was 3.27 years (IQR 1.28, 5.08), range (0.02, 8.76). Freedom from reintervention at 1, 3 and 5 years was 95% [95% confidence interval (CI) = 89%, 98%], 93% (95% CI = 86%, 96%) and 93% (95% CI = 86%, 96%) respectively. One patient (0.6%) had persistent hypertension 8 years after correction for interrupted arch with truncus arteriosus.
CONCLUSIONS
Repair of hypoplastic/IAA by transection and excision of all ductal tissue and standardized patch augmentation provide good mid-term durability. The freedom from reintervention at 5 years is >90%. The incidence of persistent systemic hypertension following arch reconstruction is low. The technique is reproducible and applicable irrespective of underlying arch anatomy.
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Affiliation(s)
- Aditya Patukale
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
| | | | - Shilpa S Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
| | - Pervez Patel
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
| | - Supreet P Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
- Children’s Health Research Centre, University of Queensland , Brisbane, QLD, Australia
| | - Timothy Colen
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
- Children’s Health Research Centre, University of Queensland , Brisbane, QLD, Australia
| | | | | | | | | | | | - Nelson Alphonso
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
- Children’s Health Research Centre, University of Queensland , Brisbane, QLD, Australia
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Beauchamp DN, Ramaciotti C, Brown P, Thankavel PP. Coronary Artery Origins Pattern in Pediatric Patients with Right-Left Fusion Bicuspid Aortic Valve. Pediatr Cardiol 2022; 43:1229-1238. [PMID: 35187607 DOI: 10.1007/s00246-022-02843-x] [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: 11/29/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
Bicuspid aortic valve (BAV) is a common congenital heart defect associated with coronary artery (CA) variants, including higher incidence of left CA dominance and shorter left main CA length. We observed by transthoracic echocardiography that left and right CA origins appear closer together in pediatric patients with right-left fusion (R/L) BAV compared to patients with trileaflet aortic valves. We sought to objectively confirm this observation. A retrospective review of pediatric echocardiograms with R/L BAV at a single institution (12/2010-11/2018) was performed. The 'coronary angle' was defined as the angle between the left and right coronary artery origins in the parasternal short axis view relative to the center of the aortic valve orifice. Values were compared to age-matched controls. Patients with inadequate images, anomalous coronary origins, or predefined significant congenital heart defects were excluded. We compared 191 R/L BAV patients (64% male) to 136 controls (57% male). Coronary angle was significantly more acute in R/L BAV than in controls (117.9° ± 16.7° vs 139.0° ± 10.1°, p < 0.0001). This was independent of age and gender. The difference persisted when BAV patients with abnormal aortic annulus/root diameters were removed from analysis (119.5° ± 15.1° vs 139.0° ± 10.1°, p < 0.0001). CA origins are closer together in R/L BAV independent of age, gender, or annulus/root size. This new anatomical description may aid in the diagnosis of subtle ('forme fruste') R/L BAV, assist in interventional planning, and improve understanding of the relationship between BAV and CA development.
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Affiliation(s)
- Daniel N Beauchamp
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Claudio Ramaciotti
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Paul Brown
- Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA
- Medical City Children's Cardiology Specialists, 7777 Forest Ln, Ste A337, Dallas, TX, 75230, USA
| | - Poonam P Thankavel
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA
- Medical City Children's Cardiology Specialists, 7777 Forest Ln, Ste A337, Dallas, TX, 75230, USA
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76
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Field E, Norrish G, Acquaah V, Dady K, Cicerchia MN, Ochoa JP, Syrris P, McLeod K, McGowan R, Fell H, Lopes LR, Cervi E, Kaski JPP. Cardiac myosin binding protein-C variants in paediatric-onset hypertrophic cardiomyopathy: natural history and clinical outcomes. J Med Genet 2022; 59:768-775. [PMID: 34400558 PMCID: PMC7613139 DOI: 10.1136/jmedgenet-2021-107774] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Variants in the cardiac myosin-binding protein C gene (MYBPC3) are a common cause of hypertrophic cardiomyopathy (HCM) in adults and have been associated with late-onset disease, but there are limited data on their role in paediatric-onset HCM. The objective of this study was to describe natural history and clinical outcomes in a large cohort of children with HCM and pathogenic/likely pathogenic (P/LP) MYBPC3 variants. METHODS AND RESULTS Longitudinal data from 62 consecutive patients diagnosed with HCM under 18 years of age and carrying at least one P/LP MYBPC3 variant were collected from a single specialist referral centre. The primary patient outcome was a major adverse cardiac event (MACE). Median age at diagnosis was 10 (IQR: 2-14) years, with 12 patients (19.4%) diagnosed in infancy. Forty-seven (75%) were boy and 31 (50%) were probands. Median length of follow-up was 3.1 (IQR: 1.6-6.9) years. Nine patients (14.5%) experienced an MACE during follow-up and five (8%) died. Twenty patients (32.3%) had evidence of ventricular arrhythmia, including 6 patients (9.7%) presenting with out-of-hospital cardiac arrest. Five-year freedom from MACE for those with a single or two MYBPC3 variants was 95.2% (95% CI: 78.6% to 98.5%) and 68.4% (95% CI: 40.6% to 88.9%), respectively (HR 4.65, 95% CI: 1.16 to 18.66, p=0.03). CONCLUSIONS MYBPC3 variants can cause childhood-onset disease, which is frequently associated with life-threatening ventricular arrhythmia. Clinical outcomes in this cohort vary substantially from aetiologically and genetically mixed paediatric HCM cohorts described previously, highlighting the importance of identifying specific genetic subtypes for clinical management of childhood HCM.
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Affiliation(s)
- Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Vanessa Acquaah
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kathleen Dady
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | | | | | - Petros Syrris
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Ruth McGowan
- West of Scotland Centre for Genomic Medicine, Glasgow, UK
| | - Hannah Fell
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Luis R Lopes
- Institute of Cardiovascular Science, University College London, London, UK
- Inherited Cardiovascular Disease Unit, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Juan Pablo Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
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Chan W, Yang S, Wang J, Tong S, Lin M, Lu P, Yao R, Wu L, Chen L, Guo Y, Shen J, Liu T, Li F, Chen H, Zhang H, Wang S, Fu L. Clinical characteristics and survival of children with hypertrophic cardiomyopathy in China: A multicentre retrospective cohort study. EClinicalMedicine 2022; 49:101466. [PMID: 35747179 PMCID: PMC9157015 DOI: 10.1016/j.eclinm.2022.101466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Few data on paediatric hypertrophic cardiomyopathy (HCM) are available in developing countries. A multicentre, retrospective, cohort study was conducted to profile the clinical characteristics and survival of children with HCM in China. METHODS We collected longitudinal data on children with HCM aged 0-18 years at three participating institutions between January 1, 2010 and December 31, 2019. Patients were identified by searching for the diagnosis using ICD-10 codes from the electronic medical records database. HCM was diagnosed morphologically with echocardiography or cardiovascular magnetic resonance imaging. The exclusion criteria were secondary aetiologies of myocardial hypertrophy. The primary outcomes were all-cause death or heart transplantation. The Kaplan-Meier method was used to estimate the survival rate of different groups. FINDINGS A total of 564 children were recruited, with a median age at diagnosis of 1.0 year (interquartile range, IQR: 0.4-8.0 years), followed for a median of 2.6 years (1977 patient-years, IQR:0.5, 5.9 years). The underlying aetiology was sarcomeric (382, 67.7%), inborn errors of metabolism (IEMs) (108, 19.2%), and RASopathies (74, 13.1%). A total of 149 patients (26.4%) died and no patients underwent heart transplantation during follow-up. The survival probability was 71.1% (95% confidence interval [CI], 66.3%-75.3%) at 5 years. Patients with IEMs or those diagnosed during infancy had the poorest outcomes, with an estimated 5-year survival rate of 16.9% (95% CI, 7.7%-29.1%) and 56.0% (95% CI, 48.8%-62.5%), respectively. Heart failure was the leading cause of death in the cohort (90/149, 60.4%), while sudden cardiac death was the leading cause in patients with sarcomeric HCM (32/66, 48.5%). INTERPRETATION There is a high proportion of patients with IEM and a low proportion of patients with neuromuscular disease in children with HCM in China. Overall, mortality remains high in China, especially in patients with IEMs and those diagnosed during infancy. FUNDING National Natural Science Fund of China (81770380, 81974029), China Project of Shanghai Municipal Science and Technology Commission (20MC1920400, 21Y31900301).
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Affiliation(s)
- Wenxiu Chan
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jian Wang
- Research Division of Birth Defects, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shilu Tong
- Department of Clinical epidemiology and Biostatistics, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Minyin Lin
- Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Pengtao Lu
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Ruen Yao
- Research Division of Birth Defects, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lanping Wu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lijun Chen
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ying Guo
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Tingliang Liu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Fen Li
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Huiwen Chen
- Shanghai Clinical Research Centre for Rare Paediatric Disease, Shanghai 200127, China
| | - Hao Zhang
- Shanghai Clinical Research Centre for Rare Paediatric Disease, Shanghai 200127, China
- Corresponding author at: Shanghai Clinical Research Centre for Rare Paediatric Disease, No. 1678 Dongfang Road, Shanghai 200127, China.
| | - Shushui Wang
- Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China
- Corresponding author at: Department of Paediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China.
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Research Division of Cardiovascular Disease, Institute of Paediatric Translational Medicine, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Corresponding author at: Department of Cardiology, Shanghai Children's Medical Centre, Shanghai Jiao Tong University School of Medicine, No. 1678 Dongfang Road, Shanghai 200127, China.
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Prominent prolapsing Chiari network: presentation and prognosis in paediatric patients. Cardiol Young 2022; 32:1071-1076. [PMID: 34494516 DOI: 10.1017/s1047951121003668] [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] [Indexed: 11/07/2022]
Abstract
Chiari network is an infrequently visualized web-like structure in the right atrium that is usually thin and small. Rarely, it can be prominent and elongated with protrusion into the right ventricle during diastole and complications have been reported. Thirty-eight patients (median age 2.5 years) with prolapsing Chiari network were identified and associated cardiac abnormalities documented. Echocardiographic right and left heart parameters were measured and compared to normative data. At presentation, the extent of Chiari network prolapse below the tricuspid annulus was 9.1 ± 3.5 mm (mean ± standard deviation), mean pulmonary valve annulus diameter z-value was reduced (-0.91 ± 0.64), and mean aortic valve z-value was enlarged (+0.97 ± 0.87). Fourteen patients exhibited no other cardiac abnormality. Eight were noted to have atrial septal defects, eight demonstrated supraventricular dysrhythmias, six had mild to moderate tricuspid valve regurgitation, and one patient each had an atrial septal aneurysm, severe pulmonic valve stenosis, small perimembranous ventricular septal defect, bicuspid aortic valve, and mild right upper pulmonary vein stenosis. Fourteen patients (37%) were seen in follow-up from 1 to 8.5 years later (median 3.2 years). During that time, the magnitude of prolapse across the tricuspid valve decreased by up to 7 mm (median 2 mm). Interventions were required in three patients, but many associated cardiac abnormalities resolved spontaneously with growth. Thus, the presence of a prolapsing Chiari network has a substantial risk of associated CHDs. However, the extent of Chiari network prolapse gradually decreases and many related abnormalities resolve during growth.
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79
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Kocher MR, Waltz J, Collins H, Schoepf UJ, Tran T, Guruvadoo K, Lehew H, Kabakus IM, Akkaya S, McBee MP, Gregg D, Zahergivar A, Burt JR. Normative Values of Pediatric Thoracic Aortic Diameters Indexed to Body Surface Area Using Computed Tomography. J Thorac Imaging 2022; 37:231-238. [PMID: 34710892 DOI: 10.1097/rti.0000000000000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to establish normative values for the thoracic aorta diameter in pediatric patients from birth to 18 years of age using computed tomography (CT) measurements and to create nomograms related to body surface area (BSA). METHODS A total of 623 pediatric patients without cardiovascular disease (42.1% females; from 3 d to 18 y old) with high-quality, non-electrocardiogram-gated, contrast-enhanced CT imaging of the chest were retrospectively evaluated. Systematic measurements of the aortic diameter at predetermined levels were recorded, and demographic data including age, sex, ethnicity, and BSA were collected. Reference graphs plotting BSA over aortic diameter included the mean and Z -3 to Z +3, where Z represents SDs from the mean. RESULTS The study population was divided into 2 groups (below 2 and greater than or equal to 2 y old). There were no significant differences in average aortic measurements between males and females. Both age groups exhibited significant positive correlations among all size-related metrics (all P <0.001) with BSA having the highest correlation. For both groups, the average orthogonal thoracic aortic diameters at each level of the thoracic aorta were used to create nomograms. CONCLUSION This study establishes clinically applicable, BSA-specific reference values of the normal thoracic aorta for the pediatric population from CT imaging.
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Affiliation(s)
- Madison R Kocher
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Jeffrey Waltz
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Heather Collins
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - U Joseph Schoepf
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Tri Tran
- Department of Radiology, AdventHealth Orlando, Orlando, FL
| | | | - Haley Lehew
- Department of Radiology, AdventHealth Orlando, Orlando, FL
| | - Ismail M Kabakus
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Selcuk Akkaya
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Morgan P McBee
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - David Gregg
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Aryan Zahergivar
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Jeremy R Burt
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
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High heritability of ascending aortic diameter and trans-ancestry prediction of thoracic aortic disease. Nat Genet 2022; 54:772-782. [PMID: 35637384 DOI: 10.1038/s41588-022-01070-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/31/2022] [Indexed: 12/24/2022]
Abstract
Enlargement of the aorta is an important risk factor for aortic aneurysm and dissection, a leading cause of morbidity in the developed world. Here we performed automated extraction of ascending aortic diameter from cardiac magnetic resonance images of 36,021 individuals from the UK Biobank, followed by genome-wide association. We identified lead variants across 41 loci, including genes related to cardiovascular development (HAND2, TBX20) and Mendelian forms of thoracic aortic disease (ELN, FBN1). A polygenic score significantly predicted prevalent risk of thoracic aortic aneurysm and the need for surgical intervention for patients with thoracic aneurysm across multiple ancestries within the UK Biobank, FinnGen, the Penn Medicine Biobank and the Million Veterans Program (MVP). Additionally, we highlight the primary causal role of blood pressure in reducing aortic dilation using Mendelian randomization. Overall, our findings provide a roadmap for using genetic determinants of human anatomy to understand cardiovascular development while improving prediction of diseases of the thoracic aorta.
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81
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Nagueh SF, Phelan D, Abraham T, Armour A, Desai MY, Dragulescu A, Gilliland Y, Lester SJ, Maldonado Y, Mohiddin S, Nieman K, Sperry BW, Woo A. Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy: An Update from the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2022; 35:533-569. [PMID: 35659037 DOI: 10.1016/j.echo.2022.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is defined by the presence of left ventricular hypertrophy in the absence of other potentially causative cardiac, systemic, syndromic, or metabolic diseases. Symptoms can be related to a range of pathophysiologic mechanisms including left ventricular outflow tract obstruction with or without significant mitral regurgitation, diastolic dysfunction with heart failure with preserved and heart failure with reduced ejection fraction, autonomic dysfunction, ischemia, and arrhythmias. Appropriate understanding and utilization of multimodality imaging is fundamental to accurate diagnosis as well as longitudinal care of patients with HCM. Resting and stress imaging provide comprehensive and complementary information to help clarify mechanism(s) responsible for symptoms such that appropriate and timely treatment strategies may be implemented. Advanced imaging is relied upon to guide certain treatment options including septal reduction therapy and mitral valve repair. Using both clinical and imaging parameters, enhanced algorithms for sudden cardiac death risk stratification facilitate selection of HCM patients most likely to benefit from implantable cardioverter-defibrillators.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Saidi Mohiddin
- Inherited/Acquired Myocardial Diseases, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Koen Nieman
- Cardiovascular Medicine and Radiology (CV Imaging), Stanford University Medical Center, CA
| | - Brett W Sperry
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Anna Woo
- Toronto General Hospital, Toronto, Canada
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Abstract
BACKGROUND Coronary artery aneurysms are well-described in Kawasaki disease and the Multisystem Inflammatory Syndrome in Children and are graded using Z scores. Three Z score systems (Boston, Montreal, and DC) are widely used in North America. The recent Pediatric Heart Network Z score system is derived from the largest diverse sample to-date. The impact of Z score system on the rate of coronary dilation and management was assessed in a large real-world dataset. METHODS Using a combined dataset of patients with acute Kawasaki disease from the Children's Hospital at Montefiore and the National Heart, Lung, and Blood Institute Kawasaki Disease Study, coronary Z scores and the rate of coronary lesions (Z ≥ 2.0) and aneurysms (Z ≥ 2.5) were determined using four Z score systems. Agreement among Z scores and the effect on Kawasaki management were assessed. RESULTS Of 333 patients analysed, 136 were from Montefiore and 197 from the Kawasaki Disease Study. Age, sex, body surface area, and rate of coronary lesions did not differ between the samples. Among the four Z score systems, the rate of acute coronary lesions varied from 24 to 55%. The mean left anterior descending Z scores from Pediatric Heart Network and Boston had a large uniform discrepancy of 1.3. Differences in Z scores among the four systems may change anticoagulation management in up to 22% of a Kawasaki population. CONCLUSIONS Choice of Z score system alone may impact Kawasaki disease diagnosis and management. Further research is necessary to determine the ideal coronary Z score system.
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83
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Mah K, Mertens L. Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:136-157. [PMID: 37970496 PMCID: PMC10642122 DOI: 10.1016/j.cjcpc.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2023]
Abstract
As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.
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Affiliation(s)
- Kandice Mah
- Division of Cardiology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Mertens
- Department of Paediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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84
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Norrish G, Cleary A, Field E, Cervi E, Boleti O, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernandez A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PE, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Gonzales-Lopez E, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, Elliott PM, Kaski JP. Clinical Features and Natural History of Preadolescent Nonsyndromic Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2022; 79:1986-1997. [PMID: 35589160 PMCID: PMC9125690 DOI: 10.1016/j.jacc.2022.03.347] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. OBJECTIVES The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. METHODS Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. RESULTS At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. CONCLUSIONS Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom,Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Aoife Cleary
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Olga Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | | | | | | | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania “Luigi Vanvitelli,” Naples, Italy
| | | | | | - Elena Biagini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | | | | | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Chiara Marrone
- Papa Giovanni XXIII Hospital, Bergamo, Italy,Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite–Universitatsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Charite–Universitatsmedizin Berlin, Berlin, Germany,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H. Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vinay Bhole
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Ferran Gran
- Vall d’Hebron University Hospital, Barcelona, Spain
| | | | | | - Graham Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom
| | | | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca Granda – Ospedale Maggiore Policlinico Milano, Department di Medicina Interna – UOC Cardiologica, Milan, Italy
| | | | | | - Toru Kubo
- Kochi Medical School Hospital, Kochi, Japan
| | | | - Anca Popoiu
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Department of Pediatrics, Children’s Hospital “Louis Turcanu,” Timisoara, Romania
| | | | | | | | | | | | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom,St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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Weismann CG, Hlebowicz J, Åkesson A, Liuba P, Hanseus K. Comprehensive Characterization of Arterial and Cardiac Function in Marfan Syndrome-Can Biomarkers Help Improve Outcome? Front Physiol 2022; 13:873373. [PMID: 35547588 PMCID: PMC9081671 DOI: 10.3389/fphys.2022.873373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Marfan Syndrome (MFS) has been associated with increased aortic stiffness and left ventricular dysfunction. The latter may be due to the underlying genotype and/or secondary to aortic stiffening (vascular-ventricular interaction). The aim of this study was to characterize arterial and cardiac function in MFS using a multimodal approach. Methods: Prospective observational study of MFS patients and healthy controls. Methods included echocardiography, ascending aortic distensibility, common carotid intima media thickness [cIMT], parameters of wave reflection, carotid-femoral pulse wave velocity [cfPWV]), reactive hyperemia index [RHI], and biomarker analysis (Olink, CVII panel). Results: We included 20 patients with MFS and 67 controls. Ascending aortic distensibility, cIMT and RHI were decreased, while all parameters of arterial wave reflection, stiffness and BNP levels were increased in the MFS group. Both systolic and diastolic function were impaired relative to controls. Within the MFS group, no significant correlation between arterial and cardiac function was identified. However, cfPWV correlated significantly with indexed left ventricular mass and volume in MFS. Bran natriuretic peptide (BNP) was the only biomarker significantly elevated in MFS following correction for age and sex. Conclusions: MFS patients have generally increased aortic stiffness, endothelial dysfunction and BNP levels while cIMT is decreased, supporting that the mechanism of general stiffening is different from acquired vascular disease. CfPWV is associated with cardiac size, blood pressure and BNP in MFS patients. These may be early markers of disease progression that are suitable for monitoring pharmacological treatment effects in MFS patients.
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Affiliation(s)
- Constance G Weismann
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Ludwig-Maximilian University Hospital, Munich, Germany
| | - Joanna Hlebowicz
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden - Froum South, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Katarina Hanseus
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
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Kozak MF, Pessoa YC, Silva LOCE, Cabral MB, Leite BCP, Diniz JD, Saliba A, Kawahara SH. Sinais de Injúria Cardíaca em Pacientes Pediátricos com COVID-19 Gravemente Enfermos: Uma Experiência de Centro Único no Brasil. Arq Bras Cardiol 2022; 118:937-945. [PMID: 35613195 PMCID: PMC9368871 DOI: 10.36660/abc.20210200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/28/2021] [Indexed: 12/21/2022] Open
Abstract
Fundamento Alguns pacientes com COVID-19 apresentam injúria miocárdica. Objetivo Detectar a injúria miocárdica em pacientes criticamente doentes, e comparar o envolvimento cardíaco entre crianças com síndrome respiratória aguda grave (SARS) e crianças com síndrome inflamatória multissistêmica (MIS-C). Métodos Todas as crianças acometidas da COVID-19 admitidas em uma unidade de terapia intensiva de referência foram cadastradas de forma prospectiva e fizeram uma ecografia transtorácica bidimensional (ETT-2D) e um teste de troponina I cardíaca (cTnI) nas primeiras 72 horas. Para a análise estatística, um p <0,05 bilateral foi considerado significativo. Resultados 33 pacientes foram incluídos, dos quais 51,5% apresentaram cTnI elevada e/ou ETT-2D anormal e 36,4% precisaram de suporte cardiovascular, que foi mais frequente em pacientes com cTnI elevada e anormalidades em ETT-2D do que em pacientes com exames normais (83,3% e 33,3%, respectivamente; p 0,006, 95% IC = 0,15-0,73). Os achados de ETT-2D mais comuns foram efusão pericárdica (15,2%) e regurgitação tricúspide/mitral (15,2%). Sinais de envolvimento cardíaco foram mais comuns na MIS-C que na SARS. Pacientes com MIS-C também apresentaram um índice mais alto de necessidade de suporte cardiovascular (66,7% X 25%, p 0,03, 95% IC = -0,7 a -0,04) e um índice mais frequente de cTnI elevada (77,8% X 20,8%; p 0,002, 95% IC = 0,19 a 0,79). Os valores preditivos negativos de cTnI para detecção de anormalidades de ETT-2D foram 100% para pacientes com MIS-C, e 73,7% para pacientes com SARS. Conclusão Sinais de injúria cardíaca foram comuns, especialmente em pacientes com MIS-C. As anormalidades na ETT-2D foram sutis. A realização de um teste de cTnI na admissão pode ajudar os prestadores de assistência de saúde a discriminar os pacientes com uma necessidade mais urgente de uma ETT-2D.
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87
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Norrish G, Rance T, Montanes E, Field E, Brown E, Bhole V, Stuart G, Uzun O, McLeod KA, Ilina M, Adwani S, Daubeney P, Delle Donne G, Linter K, Jones CB, Bharucha T, Cervi E, Kaski JP. Friedreich's ataxia-associated childhood hypertrophic cardiomyopathy: a national cohort study. Arch Dis Child 2022; 107:450-455. [PMID: 34610949 PMCID: PMC9046745 DOI: 10.1136/archdischild-2021-322455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is an important predictor of long-term outcomes in Friedreich's ataxia (FA), but the clinical spectrum and survival in childhood is poorly described. This study aimed to describe the clinical characteristics of children with FA-HCM. DESIGN AND SETTING Retrospective, longitudinal cohort study of children with FA-HCM from the UK. PATIENTS 78 children (<18 years) with FA-HCM diagnosed over four decades. INTERVENTION Anonymised retrospective demographic and clinical data were collected from baseline evaluation and follow-up. MAIN OUTCOME MEASURES The primary study end-point was all-cause mortality (sudden cardiac death, atrial arrhythmia-related death, heart failure-related death, non-cardiac death) or cardiac transplantation. RESULTS The mean age at diagnosis of FA-HCM was 10.9 (±3.1) years. Diagnosis was within 1 year of cardiac referral in 34 (65.0%) patients, but preceded the diagnosis of FA in 4 (5.3%). At baseline, 65 (90.3%) had concentric left ventricular hypertrophy and 6 (12.5%) had systolic impairment. Over a median follow-up of 5.1 years (IQR 2.4-7.3), 8 (10.5%) had documented supraventricular arrhythmias and 8 (10.5%) died (atrial arrhythmia-related n=2; heart failure-related n=1; non-cardiac n=2; or unknown cause n=3), but there were no sudden cardiac deaths. Freedom from death or transplantation at 10 years was 80.8% (95% CI 62.5 to 90.8). CONCLUSIONS This is the largest cohort of childhood FA-HCM reported to date and describes a high prevalence of atrial arrhythmias and impaired systolic function in childhood, suggesting early progression to end-stage disease. Overall mortality is similar to that reported in non-syndromic childhood HCM, but no patients died suddenly.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK,Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas Rance
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elena Montanes
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elspeth Brown
- Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
| | - Vinay Bhole
- Paediatric Cardiology, Birmingham Women and Children’s NHS Foundation Trust, Birmingham, UK
| | - Graham Stuart
- Bristol Congenital Heart Centre, Bristol Heart Institute, Bristol, UK
| | - Orhan Uzun
- Paediatric cardiology, University Hospital of Wales, Cardiff, UK
| | - Karen A McLeod
- Paediatric cardiology, Royal Hospital for Sick Children, Glasgow, UK
| | - Maria Ilina
- Paediatric cardiology, Royal Hospital for Children, Glasgow, UK
| | - Satish Adwani
- Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Piers Daubeney
- Paediatric cardiology, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London, UK
| | - Grazia Delle Donne
- Paediatric cardiology, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London, UK
| | - Katie Linter
- Paediatric cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline B Jones
- Paediatric cardiology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,Institute of Cardiovascular Science, University College London, London, UK
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88
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Norrish G, Ding T, Field E, Cervi E, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Vignati G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, O'Mahony C, Omar RZ, Elliott PM, Kaski JP. Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e010075. [PMID: 35491873 PMCID: PMC7612749 DOI: 10.1161/circep.121.010075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. METHODS The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). RESULTS MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. CONCLUSIONS In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
| | - Tao Ding
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | | | | | | | | | | | | | - Elena Biagini
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | - Luca Ragni
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | | | - Sophie Duignan
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Adrián Fernández
- Fundación Favaloro University Hospital, Buenos Aires, Argentina (A.F.)
| | | | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic (P.K.)
| | - Piers E F Daubeney
- Royal Brompton and Harefield NHS Trust, London, United Kingdom (P.E.F.D.)
| | | | - Sergi Cesar
- Sant Joan de Deu, Barcelona, Spain (G.S.-B., S.C.)
| | - Sabine Klaassen
- Department of Pediatric Cardiology (S.K.), Charite-Universitatsmedizin Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine (S.K.), Charite-Universitatsmedizin Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (S.K.)
| | - Tiina H Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Finland (T.H.O.)
| | - Vinay Bhole
- Birmingham Children's Hospital, United Kingdom (V.B.)
| | - Constancio Medrano
- Fondazione Toscana G. Monasterio, Massa-Pisa, Italy (C.M.).,Hospital General Universitario Gregorio Marañón, Madrid, Spain (C.M.)
| | - Orhan Uzun
- University Hospital of Wales, Cardiff (O.U.)
| | | | - Ferran Gran
- Val d'Hebron University Hospital, Barcelona, Spain (F.G.)
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Italy (G.S.)
| | | | - Graham Stuart
- Bristol Royal Hospital for Children, United Kingdom (G.S.)
| | | | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan (H.Y.)
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom (T.B.)
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Dept di Medicina Interna, UOC Cardiologica, Milano, Italy (M.C.)
| | - Caroline B Jones
- Alder Hey Children's Hospital, Liverpool, United Kingdom (C.B.J.)
| | | | - Toru Kubo
- Kochi Medical School Hospital, Japan (T.K.)
| | | | - Anca Popoiu
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes" Timisoara, Children's Hospital 'Louis Turcanu,' Romania (A.P.)
| | | | - Sujeev Mathur
- Evelina Children's Hospital, London, United Kingdom (S.M.)
| | | | | | | | - Costas O'Mahony
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Rumana Z Omar
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Perry M Elliott
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
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89
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Olander RFW, Litwin L, Sundholm JKM, Sarkola T. Childhood cardiovascular morphology and function following abnormal fetal growth. Heart Vessels 2022; 37:1618-1627. [PMID: 35426503 PMCID: PMC9349157 DOI: 10.1007/s00380-022-02064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/25/2022] [Indexed: 12/01/2022]
Abstract
Studies examining the link between abnormal fetal growth and cardiac changes in childhood have presented conflicting results. We studied the effect of abnormal fetal growth on cardiac morphology and function during childhood, while controlling for body size, composition and postnatal factors. We report on the follow-up of 90 children (median age 5.81 years, IQR 5.67; 5.95) born appropriate for gestational age (AGA, N = 48), small for gestational age (SGA, N = 23), or large for gestational age (LGA, N = 19); SGA and LGA defined as birth weight Z-score < − 2 and > + 2, respectively. We examined the heart using echocardiography, including Doppler and strain imaging, in relation to anthropometrics, body composition, blood pressure, physical activity, and diet. Although groupwise differences in body size decreased during the first year after birth, LGA remained larger at follow-up, with higher lean body mass and BMI, while SGA were smaller. Slight changes in left ventricular diastolic function were present in SGA and LGA, with SGA showing increased mitral diastolic E- and A-wave peak flow velocities, and increased septal E/E′ ratio, and LGA showing larger left atrial volume adjusted for sex and lean body mass. In univariate analyses, lean body mass at follow-up was the strongest predictor of cardiac morphology. We found no groupwise differences at follow-up for ventricular sphericity, cardiac morphology adjusted for lean body mass and sex, or blood pressure, diet, or physical activity. Cardiac morphology is predicted by lean body mass during childhood, even in the setting of abnormal fetal growth. Our results are consistent with a limited effect of fetal programming on cardiac dimensions during childhood. Minor changes in diastolic function are present in both SGA and LGA children, however, the clinical significance of these changes at this stage is likely small.
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Affiliation(s)
- Rasmus F W Olander
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, 00029, Helsinki, Finland.
- Minerva Foundation Institute for Medical Research, Helsinki, Finland.
| | - Linda Litwin
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, FMS, Medical University of Silesia, Katowice, Poland
| | - Johnny K M Sundholm
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, 00029, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, 00029, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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90
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van Stijn D, Korbee JM, Netea SA, de Winter VC, Zwinderman KAH, Kuipers IM, Kuijpers TW. Treatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis. J Pediatr 2022; 243:167-172.e1. [PMID: 34968497 DOI: 10.1016/j.jpeds.2021.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess whether 'treatment day' is a significant predicting factor in Kawasaki disease and imposes a risk for coronary artery aneurysms (CAAs) in a per-day analysis. CAA formation can be reduced from 25% to 10% when treated with intravenous immunoglobulin (IVIG). STUDY DESIGN Patient data from (n = 1016) a single center were collected for an observational cohort study. After exclusions, we retrospectively analyzed 776 patients in total. A multivariate analysis was performed with treatment day as a continuous variable (n = 691). Patients were categorized as no enlargement, small CAA, medium CAA, and giant CAA. RESULTS Late treatment per-day was a significant predicting factor for the development of larger CAAs. ORs for medium and giant CAAs per delayed day were 1.1 (95% CI 1.1-1.2) P < .05 and 1.2 (95% CI 1.1-1.2) P < .05, respectively. CONCLUSION We showed that every day of delay in treatment of patients with Kawasaki disease inherently carries a risk of medium and giant aneurysm formation. There was no cut-off point for treatment day that could mark a safe zone.
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Affiliation(s)
- Diana van Stijn
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Justin M Korbee
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stejara A Netea
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vera C de Winter
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Department of Public Health and Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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91
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Norrish G, Qu C, Field E, Cervi E, Khraiche D, Klaassen S, Ojala TH, Sinagra G, Yamazawa H, Marrone C, Popoiu A, Centeno F, Schouvey S, Olivotto I, Day SM, Colan S, Rossano J, Wittekind SG, Saberi S, Russell M, Helms A, Ingles J, Semsarian C, Elliott PM, Ho CY, Omar RZ, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2022; 29:678-686. [PMID: 34718528 PMCID: PMC8967478 DOI: 10.1093/eurjpc/zwab181] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Indexed: 11/24/2022]
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort. METHODS AND RESULTS A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1-16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48-2.78]. Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52-0.97) and Uno's C-index 0.714 (95% 0.58-0.85) with a calibration slope of 1.15 (95% 0.51-1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60-0.81). CONCLUSIONS This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | | | - Sabine Klaassen
- Department of Paediatric Cardiology, Charite – Universitatsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Centre (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Centre for Molecular Medicine (MDC), Charite – Universitatsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H Ojala
- Department of Paediatric Cardiology, New Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Trieste, Italy
| | - Hirokuni Yamazawa
- Department of Paediatrics, Faculty of Medicine and Graduate school of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Anca Popoiu
- Department of Paediatrics, Children’s Hospital ‘Louis Turcanu’, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
| | | | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve Colan
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Rossano
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Russell
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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92
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Abumehdi M, Mehta C, Afifi ARSA, Yong SF, Chaudhari M, Bhole V, Dhillon R, Stumper O. Supravalvular pulmonary stenosis: A risk factor for reintervention in Noonan syndrome with pulmonary valve stenosis. Catheter Cardiovasc Interv 2022; 99:1538-1544. [PMID: 35266270 DOI: 10.1002/ccd.30148] [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: 08/10/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/11/2022]
Abstract
To assess the short- and long-term outcomes of balloon pulmonary valvuloplasty (BPV) in children with Noonan syndrome (NS). Pulmonary stenosis (PS) is the most common congenital heart lesion in NS. BPV is the accepted first line treatment in PS. However, BPV in NS patients has been reported to be less effective, without specific factors for the need for reintervention being identified. Retrospective case-note review of all patients with NS who underwent BPV between 1985 and 2020. Patients were divided into 2 groups: those with supravalvular pulmonary stenosis (SPS) in addition to valvar PS, and those with isolated valvar PS. A cohort of 54 patients with NS underwent BPV at a median of 275 (interquartile range [IQR]: 108-575) days of age. SPS was present in 32 (59%) patients whereas 22 had (41) isolated PS. The preprocedural invasive gradient was 47 (IQR: 35-69) mmHg, and 44 (IQR: 35-48) mmHg in those with SPS and those without respectively (p = 0.88). Reintervention was required in 22 patients (41%): 17 (77%) -with SPS and 5 (23%) without (p = 0.017). Fourteen patients (11 with SPS) required surgical reintervention and 8 (6 with SPS) required further BPV. There was no significant difference in the age at initial BPV, pre- and postprocedural gradients and interval until reintervention between groups. This is the largest reported cohort of patients with NS undergoing BPV. Although BPV is often successful, the reintervention rates are high. SPS was a risk factor for reintervention.
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Affiliation(s)
- Mohammad Abumehdi
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Chetan Mehta
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Ahmed Reda Sanad Arafa Afifi
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - San-Fui Yong
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Milind Chaudhari
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Vinay Bhole
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Rami Dhillon
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Oliver Stumper
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
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93
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Common things are common… or the elephant in the room. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2021.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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94
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Sukhavasi A, McHugh-Grant S, Glatz AC, Mondal A, Griffis H, Burnham N, Chen JM, Mascio CE, Gaynor JW, Spray TL, Fuller SM. Pulmonary Atresia with Intact Ventricular Septum: Intended Strategies. J Thorac Cardiovasc Surg 2022; 164:1277-1288. [DOI: 10.1016/j.jtcvs.2021.11.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/06/2021] [Accepted: 11/24/2021] [Indexed: 10/31/2022]
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95
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Leal GN, Astley C, Lima MS, de Fátima Rodrigues Diniz M, Lianza AC, Sawamura KSS, Menezes CRB, da Silva CLMR, Bain V, Imada R, Chalela W, Pereira MFB, de Sousa Marques HH, Buchpiguel CA, Gualano B, Silva CA. Segmental cardiac strain assessment by two-dimensional speckle-tracking echocardiography in surviving MIS-c patients: correlations with myocardial flow reserve (MFR) by 13 N-ammonia PET-CT. Microcirculation 2022; 29:e12750. [PMID: 35146846 DOI: 10.1111/micc.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
MIS-c is associated with severe cardiovascular impairment and eventually death. Pathophysiological mechanisms involved in myocardial injury were scarcely investigated and cardiovascular outcomes are uncertain. Autopsy studies suggested that microvascular dysfunction may be relevant to LV impairment. we aimed to evaluate segmental LV longitudinal strain by 2DST echocardiography, as well as myocardial flow reserve (MFR) by 13 N-ammonia PET-CT, in surviving MIS-c patients. each patient generated 34 LV segments for combined 2DST and MRF analysis. MFR was considered abnormal when < 2, borderline when between 2 and 2.5 and normal when > 2.5. From July 2020 to February 2021, six patients were admitted with MIS-c: three males, aged 9.3 (6.6-15.7) years. Time from admission to the follow-up visit was 6.05 (2-10.3) months. Although all patients were asymptomatic and LV EF was ≥ 55%, 43/102 (42.1%) LV segments showed MFR < 2.5. There was a modest positive correlation between segmental peak systolic longitudinal strain and MFR: r = 0.36, p = 0.03 for basal segments; r = 0.41, p = 0.022 for mid segments; r = 0.42, p = 0.021 for apical segments. Median peak systolic longitudinal strain was different among MRF categories: 18% (12%-24%) for abnormal, 18.5% (11%-35%) for borderline and 21% (12%-32%) for normal MFR (p = 0.006). We provided preliminary evidence that surviving MIS-c patients may present subclinical impairment of myocardial microcirculation. Segmental cardiac strain assessment 2DST seems useful for MIS-c cardiovascular follow-up, given its good correlation with 13 N-ammonia PET-CT derived MFR.
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Affiliation(s)
- Gabriela Nunes Leal
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Camila Astley
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Marcos Santos Lima
- Departamento de Radiologia e Oncologia da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Maria de Fátima Rodrigues Diniz
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Alessandro Cavalcanti Lianza
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Karen Saori Shiraishi Sawamura
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Carolina Rocha Brito Menezes
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Camila Lino Martins Rodrigues da Silva
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Vera Bain
- Departamento de Pediatria da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Rodrigo Imada
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - William Chalela
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | | | | | - Carlos Alberto Buchpiguel
- Departamento de Radiologia e Oncologia da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Bruno Gualano
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Clovis Artur Silva
- Departamento de Pediatria da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
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96
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Singh TP, Colan SD, Gauvreau K. Matching Donor and Recipient Size in Pediatric Heart Transplantation. Transpl Int 2022; 35:10226. [PMID: 35185381 PMCID: PMC8842272 DOI: 10.3389/ti.2022.10226] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022]
Abstract
Previous analyses in pediatric heart transplant (HT) recipients using weight or height have not found donor-recipient size-mismatch to be associated with post-transplant mortality. A recent study in 3,215 normal US children developed an equation for left ventricular (LV) mass using body surface area (BSA). We assessed whether donor-recipient size match using predicted LV mass (PLM) is associated with post-transplant in-hospital mortality or 1-year graft survival. We identified 4,717 children <18 yrs old who received primary HT in the US during 01/2000 to 03/2015 and divided them into five groups [10%, 10%, 60% (reference group), 10% and 10%, respectively] with increasing donor-recipient PLM ratio. In adjusted analysis, group 1 children (PLM ratio ≤.90) were at higher risk of post-transplant in-hospital mortality [Odds Ratio (OR) 1.55, 95% CI 1.04, 2.31]. This association of the most undersized donors with recipient in-hospital mortality was similar when donor-recipient weight ratio<.88 or BSA ratio<.92 (lowest decile) were used instead. There was no difference in 1-year graft survival among groups. Utilizing donors with donor-recipient PLM ratio ≤.90 is associated with higher risk of early post-transplant mortality in pediatric HT recipients. However, this metric is not superior to donor-recipient weight ratio or BSA ratio for assessing size match.
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Affiliation(s)
- Tajinder P. Singh
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- *Correspondence: Tajinder P. Singh,
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
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97
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Poswar FDO, Santos HS, Santos ABS, Berger SV, de Souza CFM, Giugliani R, Baldo G. Progression of Cardiovascular Manifestations in Adults and Children With Mucopolysaccharidoses With and Without Enzyme Replacement Therapy. Front Cardiovasc Med 2022; 8:801147. [PMID: 35097020 PMCID: PMC8790121 DOI: 10.3389/fcvm.2021.801147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Cardiovascular involvement is among the main features of MPS disorders and it is also a significant cause of morbidity and mortality. The range of manifestations includes cardiac valve disease, conduction abnormalities, left ventricular hypertrophy, and coronary artery disease. Here, we assessed the cardiovascular manifestations in a cohort of children and adults with MPS I, II, IV, and VI, as well as the impact of enzyme replacement therapy (ERT) on those manifestations. Methods: We performed a chart review of 53 children and 23 adults with different types of MPS that had performed echocardiograms from January 2000 until October 2018. Standardized Z scores were obtained for heart chamber sizes according to the body surface area. When available, echocardiographic measurements that were performed before ERT and at least 18 months after that date were used for the assessment of pre- and post-treatment parameters. Results: Left side valvular disease was a frequent finding, with mitral and aortic thickening being reported in most patients in all four MPS types. Left atrium dilatation was present in 26% of the patients; 25% had increased relative wall thickness; 28% had pulmonary hypertension. The cardiovascular involvement was, in general, more prevalent and more severe in adults than in children, including conduction disorders (40 vs. 16%), mitral stenosis (26 vs. 6%), aortic stenosis (13 vs. 4%), and systolic dysfunction (observed in only one adult patient). ERT promoted a significant reduction of the left ventricular hypertrophy parameters, but failed to improve valve abnormalities, pulmonary hypertension, and left atrial dilatation. Conclusions: Adult patients with MPS may develop severe cardiovascular involvement, not commonly observed in children, and clinicians should be aware of the need for careful monitoring and timely management of those potentially life-threatening complications. Our results also confirm the impact of long-term ERT on left ventricular hypertrophy and its limitations in reversing other prevalent cardiovascular manifestations.
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Affiliation(s)
- Fabiano de Oliveira Poswar
- Postgraduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Hallana Souza Santos
- Postgraduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Angela Barreto Santiago Santos
- Cardiology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Cardiology and Cardiovascular Sciences, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Roberto Giugliani
- Postgraduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Baldo
- Postgraduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Physiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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98
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Nasef MA, Sullivan DO, Ng LY, Walsh KP, Oslizlok P, McCrossan B, Kenny D, Sathanandam S. Use of the Medtronic Microvascular Plug 7Q for transcatheter closure of large patent ductus arteriosus in infants weighing less than 2.5 kg. Catheter Cardiovasc Interv 2022; 99:1545-1550. [PMID: 35094486 PMCID: PMC9543682 DOI: 10.1002/ccd.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 12/03/2022]
Abstract
Background The sole Food and Drug Administration‐approved device for transcatheter closure of the patent arterial duct in premature infants is indicated for patent ductus arteriosus (PDAs) ≤ 4 mm in diameter. We report a two‐center experience with transcatheter closure of large PDAs (>4 mm) in infants weighing <2.5 kg using the Microvascular Plug 7Q (MVP‐7Q) device. Methods This is a retrospective review of departmental databases and medical charts to define patient cohort and report demographic, procedural, and follow‐up data. Results Twenty‐two patients (12 male) with a median gestational age and birthweight of 25.5 weeks (interquartile range [IQR] = 24–28) and 800 g (572–1075), respectively, underwent attempted PDA occlusion with the MVP‐7Q using a transvenous approach. The median age and weight at the time of PDA occlusion was 32 days (IQR = 24–28) and 1100 g (IQR = 960–1700), respectively. The median PDA length was 12 mm (IQR = 11–12.65). The median PDA diameters at the aortic and pulmonary ends were 5.1 (IQR = 4.9–5.5) and 4.8 mm (IQR = 4.6–5.3), respectively. Successful device occlusion was achieved in 20 patients (91%). There were two failed attempts: One due to inappropriate sizing, and the other secondary to left pulmonary artery stenosis. There were no procedural complications and no residual shunting on follow‐up. Conclusions The MVP‐7Q is safe and effective for transcatheter closure of large (>4 mm) PDAs in infants <2.5 kg. The lack of retention disks may help with avoiding impingement on surrounding vessels.
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Affiliation(s)
- Mohamed Al Nasef
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Donnchadh O. Sullivan
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Li Yen Ng
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Kevin P. Walsh
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Paul Oslizlok
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Brian McCrossan
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Damien Kenny
- Department of Paediatric Cardiology Children's Health Ireland at Crumlin Dublin Ireland
| | - Shyam Sathanandam
- Department of Pediatric Cardiology Le Bonheur Children's Hospital, Memphis Tennessee USA
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99
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Landis BJ, Lai D, Guo DC, Corvera JS, Idrees MT, Stadler HW, Cuevas C, Needler GU, Vujakovich CE, Milewicz DM, Hinton RB, Ware SM. Identification of a common polymorphism in COQ8B acting as a modifier of thoracic aortic aneurysm severity. HGG ADVANCES 2022; 3. [PMID: 34917985 PMCID: PMC8670066 DOI: 10.1016/j.xhgg.2021.100057] [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] [Indexed: 11/24/2022] Open
Abstract
Thoracic aortic aneurysm (TAA) predisposes to sudden, life-threatening aortic dissection. The factors that regulate interindividual variability in TAA severity are not well understood. Identifying a molecular basis for this variability has the potential to improve clinical risk stratification and advance mechanistic insight. We previously identified COQ8B, a gene important for biosynthesis of coenzyme Q, as a candidate genetic modifier of TAA severity. Here, we investigated the physiological role of COQ8B in human aortic smooth muscle cells (SMCs) and further tested its genetic association with TAA severity. We find COQ8B protein localizes to mitochondria in SMCs, and loss of mitochondrial COQ8B leads to increased oxidative stress, decreased mitochondrial respiration, and altered expression of SMC contractile genes. Oxidative stress and mitochondrial cristae defects were prevalent in the medial layer of human proximal aortic tissues in individuals with TAA, and COQ8B expression was decreased in TAA SMCs compared with controls. A common single nucleotide polymorphism (SNP) rs3865452 in COQ8B (c.521A>G [p.His174Arg]) was associated with decreased rate of aortic root dilation in young individuals with TAA. In addition, the SNP was less frequent in a second cohort of early-onset thoracic aortic dissection (TAD) cases compared with controls. COQ8B protein levels in aortic SMCs were increased in TAA individuals homozygous for rs3865452 compared with those homozygous for the reference allele. Thus, COQ8B is important for aortic SMC metabolism, which is dysregulated in TAA, and rs3865452 may decrease TAA severity by increasing the COQ8B level. Genotyping rs3865452 may be useful for clinical risk stratification and tailored aortopathy management.
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Affiliation(s)
- Benjamin J Landis
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Dong-Chuan Guo
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Joel S Corvera
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Muhammad T Idrees
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Henry W Stadler
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Christian Cuevas
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Gavin U Needler
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Courtney E Vujakovich
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030, United States of America
| | - Robert B Hinton
- Divison of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States of America
| | - Stephanie M Ware
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
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100
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Impact of Sex and Obesity on Echocardiographic Parameters in Children and Adolescents. Pediatr Cardiol 2022; 43:1502-1516. [PMID: 35394150 PMCID: PMC9489563 DOI: 10.1007/s00246-022-02876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 12/04/2022]
Abstract
Subclinical alterations in left ventricular structure and function are detectable in adolescents with hypertension or obesity. However, data on early echocardiographic abnormalities in seemingly healthy children are lacking. Sex differences in cardiac structure and function have been previously reported, but sex-specific reference values are not available. Specifically, the potential interaction of sex and overweight has not been addressed at all. Anthropometric data, blood pressure and exercise tests were obtained in 356 healthy children. Echocardiographic parameters comprised peak early (E) and late (A) mitral inflow Doppler velocities, E/A ratio, tissue Doppler peak velocities of early (e') and late diastolic (a') excursion of mitral/septal annulus and isovolumetric relaxation time (IVRT). Left ventricular mass index (LVMI) and LVMI z-score were calculated. Interaction terms between BMI and sex and stratification by sex were used for analysis. We provide values for echocardiographic parameters for children of two age groups separated by BMI. Overweight/obese children had a significant higher LVMI, lower E/A ratio, higher E/e' ratios and a longer IVRT. For a given BMI in the upper ranges we demonstrated a higher LVMI in girls than in boys, the IVRT extended significantly more in girls than in boys with increasing BMI. There are sex differences in structural and functional echocardiographic parameters in children and adolescents. Our data not only confirms the importance of overweight and obesity, but demonstrates important interactions between sex and overweight. The greater susceptibility of overweight girls toward echocardiographic changes associated with potential long-term functional impairment needs further exploration and follow-up.Trial registration number DRKS00012371; Date 18.08.2017.
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