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Täubel J, Lorch U, Ferber G, Spencer CS, Freier A, Coates S, El Gaaloul M, Donini C, Chughlay MF, Chalon S. Concentration-QT modelling of the novel DHFR inhibitor P218 in healthy male volunteers. Br J Clin Pharmacol 2021; 88:128-137. [PMID: 34075612 PMCID: PMC9292718 DOI: 10.1111/bcp.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 11/29/2022] Open
Abstract
Aims Given the increasing emergence of drug resistance in Plasmodium, new antimalarials are urgently required. P218 is an aminopyridine that inhibits dihydrofolate reductase being developed as a malaria chemoprotective drug. Assessing the effect of new compounds on cardiac intervals is key during early drug development to determine their cardiac safety. Methods This double‐blind, randomized, placebo‐controlled, parallel group study evaluated the effect of P218 on electrocardiographic parameters following oral administration of seven single‐ascending doses up to 1000 mg in 56 healthy volunteers. Participants were randomized to treatment or placebo at a 3:1 ratio. P218 was administered in the fasted state with standardized lunch served 4 hours after dosing. 12‐lead ECGs were recorded in triplicate at regular intervals on the test day, and at 48, 72, 120, 168, 192 and 240 hours thereafter. Blood samples for pharmacokinetic evaluations were collected at similar time points. Concentration‐effect modelling was used to assess the effect of P218 and its metabolites on cardiac intervals. Results Concentration–effect analysis showed that P218 does not prolong the QTcF, J‐Tpeak or TpTe interval at all doses tested. No significant changes in QRS or PR intervals were observed. Two‐sided 90% confidence intervals of subinterval effects of P218 and its metabolites were consistently below the regulatory concern threshold for all doses. Study sensitivity was confirmed by significant shortening of QTcF after a meal. Conclusion Oral administration of P218 up to 1000 mg does not prolong QTcF and does not significantly change QRS or PR intervals, suggesting low risk for drug‐induced proarrhythmia.
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Affiliation(s)
- Jӧrg Täubel
- Richmond Pharmacology Ltd, London, UK.,Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | | | - Georg Ferber
- Statistik Georg Ferber GmbH, Riehen, Switzerland
| | | | - Anne Freier
- Richmond Research Institute, St George's University of London, London, UK
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53
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Holmström L, Pylkäs K, Tervasmäki A, Vähätalo J, Porvari K, Pakanen L, Kaikkonen KS, Perkiömäki JS, Kiviniemi AM, Kerkelä R, Ukkola O, Myerburg RJ, Huikuri HV, Junttila J. Genetic contributions to the expression of acquired causes of cardiac hypertrophy in non-ischemic sudden cardiac death victims. Sci Rep 2021; 11:11171. [PMID: 34045587 PMCID: PMC8159951 DOI: 10.1038/s41598-021-90693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
The contribution of genetic variants to non-ischemic sudden cardiac death (SCD) due to acquired myocardial diseases is unclear. We studied whether SCD victims with hypertension/obesity related hypertrophic myocardial disease harbor potentially disease associated gene variants. The Fingesture study has collected data from 5869 autopsy-verified SCD victims in Northern Finland. Among SCD victims, 740 (13%) had hypertension and/or obesity as the most likely explanation for myocardial disease with hypertrophy and fibrosis. We performed next generation sequencing using a panel of 174 cardiac genes for 151 such victims with the best quality of DNA. We used 48 patients with hypertension and hypertrophic heart as controls. Likely pathogenic variants were identified in 15 SCD victims (10%) and variants of uncertain significance (VUS) were observed in additional 43 SCD victims (28%). In controls, likely pathogenic variants were present in two subjects (4%; p = 0.21) and VUSs in 12 subjects (25%; p = 0.64). Among SCD victims, presence of potentially disease-related variants was associated with lower mean BMI and heart weight. Potentially disease related gene variants are common in non-ischemic SCD but further studies are required to determine specific contribution of rare genetic variants to the extent of acquired myocardial diseases leading to SCD.
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Affiliation(s)
- Lauri Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit and Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Anna Tervasmäki
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit and Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Katja Porvari
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Lasse Pakanen
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Forensic Medicine Unit, National Institute for Health and Welfare (THL), Oulu, Finland
| | - Kari S Kaikkonen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Risto Kerkelä
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
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54
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Ågesen FN, Lynge TH, Blanche P, Banner J, Prescott E, Jabbari R, Tfelt-Hansen J. Temporal trends and sex differences in sudden cardiac death in the Copenhagen City Heart Study. Heart 2021; 107:1303-1309. [PMID: 34021040 DOI: 10.1136/heartjnl-2020-318881] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/04/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE More knowledge about the development of sudden cardiac death (SCD) in the general population is needed to develop meaningful predictors of SCD. Our aim with this study was to estimate the incidence of SCD in the general population and examine the temporal changes, demographics and clinical characteristics. METHODS All participants in the Copenhagen City Heart Study were followed from 1993 to 2016. All death certificates, autopsy reports and national registry data were used to identify all cases of SCD. RESULTS A total of 14 562 subjects were included in this study. There were 8394 deaths with all information available, whereof 1335 were categorised as SCD. The incidence of SCD decreased during the study period by 41% for persons aged 40-90 years, and the standardised incidence rates decreased from 504 per 100 000 person-years (95% CI 447 to 569) to 237 per 100 000 person-years (95% CI 195 to 289). The incidence rate ratio of SCD between men and women ≤75 years was 1.99 (95% CI 1.62 to 2.46). The proportion of SCD of all cardiac deaths decreased during the observation period and decreased with increasing age. Men had more cardiovascular comorbidities (OR 1.34, 95% CI 1.07 to 1.68, p<0. 01), and SCD was the first registered manifestation of cardiac disease in 50% of all cases. CONCLUSION The incidence of SCD in the general population has declined significantly during the study period but should be further investigated for more recent variations as well as novel risk predictors for persons with low to medium risk of SCD.
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Affiliation(s)
- Frederik Nybye Ågesen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Paul Blanche
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, University of Copenhagen, Gentofte, Denmark.,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.,Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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55
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Vähätalo J, Holmström L, Pakanen L, Kaikkonen K, Perkiömäki J, Huikuri H, Junttila J. Coronary Artery Disease as the Cause of Sudden Cardiac Death Among Victims < 50 Years of Age. Am J Cardiol 2021; 147:33-38. [PMID: 33621522 DOI: 10.1016/j.amjcard.2021.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
Coronary artery disease (CAD) is the most common cause of sudden cardiac death (SCD). Atherosclerosis increases with age, but also many victims of SCD in young and middle-aged population have CAD at autopsy. The purpose of this study was to determine the characteristics and autopsy findings of SCD due to CAD among victims of SCD under the age of 50. Fingesture is a population-based study consisting of consecutive series of victims of autopsy verified SCD in Northern Finland between the years 1998 to 2017 (n = 5,869). Histological examinations were part of all autopsies and a toxicology investigation was performed if needed. Analyses included information accumulated from death certificates, medical records, autopsy data, standardized questionnaire to the closest family members of the victims of SCD and police reports of the conditions of the death. Overall, 10.4% of all SCDs occurred among victims under the age of 50 years (610 victims). Most common underlying cause of SCD among these younger SCD victims was CAD (43.6%). The prevalence of CAD as the cause of SCD became more common in young SCD victims after the age of 35 years. The mean age of ischemic SCD victims was 44±5 years and most were men (89.5%). Most victims (90.2%) had no clinical diagnosis of CAD, however 33.8% had an autopsy evidence of silent myocardial infarction. SCD occurred during physical activity in 24.1%. Three-vessel disease was detected in 44.4% of the study victims. Cardiac hypertrophy (58.3%) and myocardial fibrosis (82.6%) were also common. At least 1 cardiovascular risk factor was present in 64.7% of SCD victims. In conclusion, most SCDs among victims < 50 years of age are due to CAD.
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Patel R, Kemp CL, Hafejee M, Peckham N, Jain V, McCann GP, Pallikadavath S. The Underrepresentation of Females in Studies Assessing the Impact of High-Dose Exercise on Cardiovascular Outcomes: a Scoping Review. SPORTS MEDICINE-OPEN 2021; 7:30. [PMID: 33914201 PMCID: PMC8085142 DOI: 10.1186/s40798-021-00320-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/18/2021] [Indexed: 11/24/2022]
Abstract
High-dose exercise-induced cardiac outcomes may vary between sexes. However, many studies investigating the cardiovascular effects of high-dose exercise have excluded or under-recruited females. This scoping review aimed to describe the recruitment of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and describe how this has changed over time. This scoping review followed the protocol outlined by Arksey and O’Malley and is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. The OVID and EMBASE databases were searched for studies that assessed the effects of high-dose exercise on cardiovascular outcomes. Both professional and nonprofessional groups were included. The review found 2973 studies, and 250 met the inclusion criteria including cumulatively 17,548,843 subjects. Over half the studies (n = 127) excluded females entirely, and only 8 (3.2%) studies recruited all-female participants. The overall mean percentage of females recruited was 18.2%. The mean percentage was 14.5% in studies conducted before 2011 and 21.8% in studies conducted after 2011. Females are an underrepresented group in studies assessing the cardiovascular outcomes related to high-dose exercise. As cardiovascular outcomes vary between sexes, translating findings from a largely male-based evidence may not be appropriate. Future investigators should aim to establish and overcome barriers to female recruitment.
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Affiliation(s)
- Roshan Patel
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Caitlin L Kemp
- College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Nicholas Peckham
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Vageesh Jain
- Institute for Global Health, University College London, London, UK
| | - Gerry P McCann
- NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Susil Pallikadavath
- NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, Glenfield Hospital, University of Leicester, Leicester, UK.
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57
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Tseng ZH, Ramakrishna S, Salazar JW, Vittinghoff E, Olgin JE, Moffatt E. Sex and Racial Differences in Autopsy-Defined Causes of Presumed Sudden Cardiac Death. Circ Arrhythm Electrophysiol 2021; 14:e009393. [PMID: 33835824 DOI: 10.1161/circep.120.009393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., S.R., J.E.O.), University of California, San Francisco
| | - Satvik Ramakrishna
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., S.R., J.E.O.), University of California, San Francisco
| | - James W Salazar
- Department of Medicine (J.W.S.), University of California, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics (E.V.), University of California, San Francisco
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., S.R., J.E.O.), University of California, San Francisco
| | - Ellen Moffatt
- Office of the Chief Medical Examiner, San Francisco, CA (E.M.)
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58
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Pérez-Villacastín J. Muerte súbita en el deporte, ¿lo que cura a uno mata a otro? Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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60
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3047] [Impact Index Per Article: 1015.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Haukilahti MAE, Kenttä TV, Tikkanen JT, Anttonen O, Aro AL, Kerola T, Eranti A, Holkeri A, Rissanen H, Heliövaara M, Knekt P, Junttila MJ, Huikuri HV. Electrocardiographic Risk Markers of Cardiac Death: Gender Differences in the General Population. Front Physiol 2021; 11:578059. [PMID: 33613298 PMCID: PMC7894046 DOI: 10.3389/fphys.2020.578059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
Background Cardiac death is one of the leading causes of death and sudden cardiac death (SCD) is estimated to cause approximately 50% of cardiac deaths. Men have a higher cardiac mortality than women. Consequently, the mechanisms and risk markers of cardiac mortality are not as well defined in women as they are in men. Aim The aim of the study was to assess the prognostic value and possible gender differences of SCD risk markers of standard 12-lead electrocardiogram in three large general population samples. Methods The standard 12-lead electrocardiographic (ECG) markers were analyzed from three different Finnish general population samples including total of 20,310 subjects (49.9% women, mean age 44.8 ± 8.7 years). The primary endpoint was cardiac death, and SCD and all-cause mortality were secondary endpoints. The interaction effect between women and men was assessed for each ECG variable. Results During the follow-up (7.7 ± 1.2 years), a total of 883 deaths occurred (24.5% women, p < 0.001). There were 296 cardiac deaths (13.9% women, p < 0.001) and 149 SCDs (14.8% women, p < 0.001). Among those who had died due to cardiac cause, women had more often a normal electrocardiogram compared to men (39.0 vs. 27.5%, p = 0.132). After adjustments with common cardiovascular risk factors and the population sample, the following ECG variables predicted the primary endpoint in men: left ventricular hypertrophy (LVH) with strain pattern (p < 0.001), QRS duration > 110 ms (p < 0.001), inferior or lateral T-wave inversion (p < 0.001) and inferolateral early repolarization (p = 0.033). In women none of the variables remained significant predictors of cardiac death in multivariable analysis, but LVH, QTc ≥ 490 ms and T-wave inversions predicted SCD (p < 0.047 and 0.033, respectively). In the interaction analysis, LVH (HR: 2.4; 95% CI: 1.2–4.9; p = 0.014) was stronger predictor of primary endpoint in women than in men. Conclusion Several standard ECG variables provide independent information on the risk of cardiac mortality in men but not in women. LVH and T-wave inversions predict SCD also in women.
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Affiliation(s)
- Mira Anette E Haukilahti
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland
| | - Jani T Tikkanen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland
| | - Olli Anttonen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Aapo L Aro
- Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Antti Eranti
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Arttu Holkeri
- Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Rissanen
- Department of Public Health Solutions, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Markku Heliövaara
- Department of Public Health Solutions, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Paul Knekt
- Department of Public Health Solutions, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland
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Weizman O, Sharifzadehgan A, Bougouin W, Narayanan K, Tence N, Dumas F, Waldmann V, Lamhaut L, Jost D, Wahbi K, Varenne O, Garcia R, Karam N, Cariou A, Jouven X, Marijon E. Sudden Cardiac Arrest in Young Women. Circulation 2021; 143:758-760. [PMID: 33587656 DOI: 10.1161/circulationaha.120.052219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orianne Weizman
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Nancy University Hospital, Cardiology Department, France (O.W.)
| | - Ardalan Sharifzadehgan
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Jacques Cartier Hospital, Intensive Care Unit, Massy, France (W.B.)
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Medicover Hospitals, Cardiology Department, Hyderabad, India (K.N.)
| | - Noémie Tence
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Florence Dumas
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Emergency Department, Paris, France (F.D.)
| | - Victor Waldmann
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Lionel Lamhaut
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Emergency Medical Services 75, Necker University Hospital, APHP, Paris, France (L.L.)
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Paris Firefighters Brigade, France (D.J.)
| | - Karim Wahbi
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France
| | - Olivier Varenne
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France
| | - Rodrigue Garcia
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cardiovascular Center, University Hospital La Milétrie, Poitiers, France (R.G.)
- University of Poitiers, France (R.G.)
| | - Nicole Karam
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Alain Cariou
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Intensive Care Unit (A.C.), Paris, France
| | - Xavier Jouven
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Eloi Marijon
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
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Monteiro FR, Rabelo Evangelista AB, Nearing BD, Medeiros SA, Tessarolo Silva F, Pedreira GC, Ullman E, Gervino EV, Verrier RL. T-wave heterogeneity in standard resting 12-lead ECGs is associated with 90-day cardiac mortality in women following emergency department admission: A nested case-control study. Ann Noninvasive Electrocardiol 2021; 26:e12826. [PMID: 33543816 PMCID: PMC8164148 DOI: 10.1111/anec.12826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/06/2023] Open
Abstract
Background We investigated whether T‐wave heterogeneity (TWH) can identify patients who are at risk for near‐term cardiac mortality. Methods A nested case–control analysis was performed in the 888 patients admitted to the Emergency Department (ED) of our medical center in July through September 2018 who had ≥2 serial troponin measurement tests within 6 hr for acute coronary syndrome evaluation to rule‐in or rule‐out the presence of acute myocardial infarction. Patients who died from cardiac causes during 90 days after ED admission were considered cases (n = 20; 10 women) and were matched 1:4 on sex and age with patients who survived during this period (n = 80, 40 women). TWH, that is, interlead splay of T waves, was automatically assessed from precordial leads by second central moment analysis. Results TWHV4‐6 was significantly elevated at ED admission in 12‐lead resting ECGs of female patients who died of cardiac causes during the following 90 days compared to female survivors (100 ± 14.9 vs. 40 ± 3.6 µV, p < .0001). TWHV4‐6 generated areas under the receiver‐operating characteristic (ROC) curve (AUC) of 0.933 in women (p < .0001) and 0.573 in men (p = .4). In women, the ROC‐guided 48‐µV TWHV4‐6 cut point for near‐term cardiac mortality produced an adjusted odds ratio of 121.37 (95% CI: 2.89–6,699.84; p = .02) with 100% sensitivity and 82.5% specificity. In Kaplan–Meier survival analysis, TWHV4‐6 ≥ 48 µV predicted cardiac mortality in women during 90‐day follow‐up with a hazard ratio of 27.84 (95% CI: 7.29–106.36, p < .0001). Conclusion Elevated TWHV4‐6 is associated with near‐term cardiac mortality among women evaluated for acute coronary syndrome.
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Affiliation(s)
- Felipe R Monteiro
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana B Rabelo Evangelista
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruce D Nearing
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sofia A Medeiros
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Tessarolo Silva
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Giovanna C Pedreira
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Edward Ullman
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ernest V Gervino
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Richard L Verrier
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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64
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Ramireddy A, Chugh HS, Reinier K, Uy-Evanado A, Stecker EC, Jui J, Chugh SS. Sudden cardiac death during nighttime hours. Heart Rhythm 2021; 18:778-784. [PMID: 33482388 DOI: 10.1016/j.hrthm.2020.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND In the absence of apparent triggers, sudden cardiac death (SCD) during nighttime hours is a perplexing and devastating phenomenon. There are few published reports in the general population, with insufficient numbers to perform sex-specific analyses. Smaller studies of rare nocturnal SCD syndromes suggest a male predominance and implicate sleep-disordered breathing. OBJECTIVE The purpose of this study was to identify mechanisms of nighttime SCD in the general population. METHODS From the population-based Oregon Sudden Unexpected Death Study, we evaluated SCD cases that occurred in the community between 10 PM and 6 AM (nighttime) and compared them with daytime cases. Univariate comparisons were evaluated using Pearson χ2 tests and independent samples t tests. Logistic regression was used to further assess independent SCD risk. RESULTS A total of 4126 SCD cases (66.2% male, 33.8% female) met criteria for analysis and 22.3% (n = 918) occurred during nighttime hours. Women were more likely to present with nighttime SCD than men (25.4% vs 20.6%; P < .001). In a multivariate regression model, female sex (odds ratio [OR] 1.3 [confidence interval (CI) 1.1-1.5]; P = .001), medications associated with somnolence/respiratory depression (OR 1.2 [CI 1.1-1.4]; P = .008) and chronic obstructive pulmonary disease/asthma (OR 1.4 [CI 1.1-1.6]; P < .001) were independently associated with nighttime SCD. Women were taking more central nervous system-affecting medications than men (1.9 ± 1.7 vs 1.4 ± 1.4; P = .001). CONCLUSION In the general population, women were more likely than men to suffer SCD during nighttime hours and female sex was an independent predictor of nighttime events. Respiratory suppression is a concern, and caution is advisable when prescribing central nervous system-affecting medications to patients at an increased risk of SCD, especially women.
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Affiliation(s)
- Archana Ramireddy
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Harpriya S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
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65
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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66
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Sudden death in the young adult: a Tunisian autopsy-based series. BMC Public Health 2020; 20:1915. [PMID: 33334328 PMCID: PMC7745477 DOI: 10.1186/s12889-020-10012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background We aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention. Methods We performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done (August 1990 to December 2018). In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 and 35 years. Results We collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%. Conclusion In this series, sudden death in young adults occurs mainly in a smoking male, aged between 18 and 24 years old, occurring at rest, in the morning, and early in the week. It is more common, especially in summer. Sudden death is most often the first manifestation of pathologies, especially unsuspected heart diseases. The predominance of cardiovascular causes is the common denominator of almost all studies reported in the literature. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.
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67
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Sudden cardiac death during sports practice. Is one man's meat another man's poison? ACTA ACUST UNITED AC 2020; 74:210-212. [PMID: 33317960 DOI: 10.1016/j.rec.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022]
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68
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Mody P, Pandey A, Slutsky AS, Segar MW, Kiss A, Dorian P, Parsons J, Scales DC, Rac VE, Cheskes S, Bierman AS, Abramson BL, Gray S, Fowler RA, Dainty KN, Idris AH, Morrison L. Gender-Based Differences in Outcomes Among Resuscitated Patients With Out-of-Hospital Cardiac Arrest. Circulation 2020; 143:641-649. [PMID: 33317326 DOI: 10.1161/circulationaha.120.050427] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Studies examining gender-based differences in outcomes of patients experiencing out-of-hospital cardiac arrest have demonstrated that, despite a higher likelihood of return of spontaneous circulation, women do not have higher survival. METHODS Patients successfully resuscitated from out-of-hospital cardiac arrest enrolled in the CCC trial (Trial of Continuous or Interrupted Chest Compressions during CPR) were included. Hierarchical multivariable logistic regression models were constructed to evaluate the association between gender and survival after adjustment for age, gender, cardiac arrest rhythm, witnessed status, bystander cardiopulmonary resuscitation, episode location, epinephrine dose, emergency medical services response time, and duration of resuscitation. Do not resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) order status were used to assess whether differences in postresuscitation outcomes were modified by baseline prognosis. The analysis was replicated among ALPS trial (Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest) participants. RESULTS Among 4875 successfully resuscitated patients, 1825 (37.4%) were women and 3050 (62.6%) were men. Women were older (67.5 versus 65.3 years), received less bystander cardiopulmonary resuscitation (49.1% versus 54.9%), and had a lower proportion of cardiac arrests that were witnessed (55.1% versus 64.5%) or had shockable rhythm (24.3% versus 44.6%, P<0.001 for all). A significantly higher proportion of women received DNR orders (35.7% versus 32.1%, P=0.009) and had WLST (32.8% versus 29.8%, P=0.03). Discharge survival was significantly lower in women (22.5% versus 36.3%, P<0.001; adjusted odds ratio, 0.78 [95% CI, 0.66-0.93]; P=0.005). The association between gender and survival to discharge was modified by DNR and WLST order status such that women had significantly reduced survival to discharge among patients who were not designated DNR (31.3% versus 49.9%, P=0.005; adjusted odds ratio, 0.74 [95% CI, 0.60-0.91]) or did not have WLST (32.3% versus 50.7%, P=0.002; adjusted odds ratio, 0.73 [95% CI, 0.60-0.89]). In contrast, no gender difference in survival was noted among patients receiving a DNR order (6.7% versus 7.4%, P=0.90) or had WLST (2.8% versus 2.4%, P=0.93). Consistent patterns of association between gender and postresuscitation outcomes were observed in the secondary cohort. CONCLUSIONS Among patients resuscitated after experiencing out-of-hospital cardiac arrest, discharge survival was significantly lower in women than in men, especially among patients considered to have a favorable prognosis.
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Affiliation(s)
- Purav Mody
- Division of Cardiology, Department of Internal Medicine (P.M., A.P., M.W.S.), University of Texas Southwestern Medical Center, Dallas.,VA North Texas Health System, Dallas (P.M.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (P.M., A.P., M.W.S.), University of Texas Southwestern Medical Center, Dallas
| | - Arthur S Slutsky
- Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Departments of Medicine, Surgery, and Biomedical Engineering, Interdepartmental Division of Critical Care (A.S.S.), University of Toronto, Ontario, Canada
| | - Matthew W Segar
- Division of Cardiology, Department of Internal Medicine (P.M., A.P., M.W.S.), University of Texas Southwestern Medical Center, Dallas
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Institute for Health Policy and Management (A.K.), University of Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, St Michael's Hospital, Division of Cardiology, Department of Medicine, Faculty of Medicine, Institute of Medical Sciences (P.D.), University of Toronto, Ontario, Canada
| | - Janet Parsons
- Applied Health Research Centre at the Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Physical Therapy and the Rehabilitation Sciences Institute (J.P.), University of Toronto, Ontario, Canada
| | - Damon C Scales
- Sunnybrook Health Sciences Center, Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, Institute for Health Policy and Management (D.C.S.), University of Toronto, Ontario, Canada
| | - Valeria E Rac
- Ted Rogers Centre for Heart Research and Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Institute of Health Policy, Management and Evaluation (V.E.R.), University of Toronto, Ontario, Canada
| | - Sheldon Cheskes
- Sunnybrook Centre for Prehospital Medicine, Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), University of Toronto, Ontario, Canada
| | - Arlene S Bierman
- Centre for Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD (A.S.B.)
| | - Beth L Abramson
- Division of Cardiology, St Michael's Hospital, Division of Cardiology, Department of Medicine, Faculty of Medicine (B.L.A.), University of Toronto, Ontario, Canada
| | - Sara Gray
- Emergency Medicine and Critical Care, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, Interdepartmental Division of Critical Care, Faculty of Medicine (S.G.), University of Toronto, Ontario, Canada
| | - Rob A Fowler
- Sunnybrook Health Sciences Center, Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, Institute for Health Policy and Management (R.A.F.), University of Toronto, Ontario, Canada
| | - Katie N Dainty
- North York General Hospital, Institute for Health Policy and Management (K.N.D.), University of Toronto, Ontario, Canada
| | - Ahamed H Idris
- Department of Emergency Medicine (A.H.I.), University of Texas Southwestern Medical Center, Dallas
| | - Laurie Morrison
- Rescu at the Li Ka Shing Knowledge Institute, Emergency Medicine, St. Michael's Hospital, Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, Institute for Health Policy and Management (L.M.), University of Toronto, Ontario, Canada
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Spoormans EM, Lemkes JS, Janssens GN, van der Hoeven NW, Jewbali LSD, Dubois EA, van de Ven PM, Meuwissen M, Rijpstra TA, Bosker HA, Blans MJ, Bleeker GB, Baak R, Vlachojannis GJ, Eikemans BJW, der Harst PV, van der Horst ICC, Voskuil M, van der Heijden JJ, Beishuizen A, Stoel M, Camaro C, van der Hoeven H, Henriques JP, Vlaar APJ, Vink MA, van den Bogaard B, Heestermans TACM, de Ruijter W, Delnoij TSR, Crijns HJGM, Jessurun GAJ, Oemrawsingh PV, Gosselink MTM, Plomp K, Magro M, Elbers PWG, Appelman Y, van Royen N. Sex differences in patients with out-of-hospital cardiac arrest without ST-segment elevation: A COACT trial substudy. Resuscitation 2020; 158:14-22. [PMID: 33189807 DOI: 10.1016/j.resuscitation.2020.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether sex is associated with outcomes of out-of-hospital cardiac arrest (OHCA) is unclear. OBJECTIVES This study examined sex differences in survival in patients with OHCA without ST-segment elevation myocardial infarction (STEMI). METHODS Using data from the randomized controlled Coronary Angiography after Cardiac Arrest (COACT) trial, the primary point of interest was sex differences in OHCA-related one-year survival. Secondary points of interest included the benefit of immediate coronary angiography compared to delayed angiography until after neurologic recovery, angiographic and clinical outcomes. RESULTS In total, 522 patients (79.1% men) were included. Overall one-year survival was 59.6% in women and 63.4% in men (HR 1.18; 95% CI: 0.76-1.81;p = 0.47). No cardiovascular risk factors were found that modified survival. Women less often had significant coronary artery disease (CAD) (37.0% vs. 71.3%;p < 0.001), but when present, they had a worse prognosis than women without CAD (HR 3.06; 95% CI 1.31-7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67-1.65;p = 0.83). In both sexes, immediate coronary angiography did not improve one-year survival compared to delayed angiography (women, odds ratio (OR) 0.87; 95% CI 0.58-1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45-2.09;p = 0.93). CONCLUSION In OHCA patients without STEMI, we found no sex differences in overall one-year survival. Women less often had significant CAD, but when CAD was present they had worse survival than women without CAD. This was not the case for men. Both sexes did not benefit from a strategy of immediate coronary angiography as compared to delayed strategy with respect to one-year survival. CLINICAL TRIAL REGISTRATION NUMBER Netherlands trial register (NTR) 4973.
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Affiliation(s)
- Eva M Spoormans
- Department of Cardiology, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - Jorrit S Lemkes
- Department of Cardiology, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands.
| | - Gladys N Janssens
- Department of Cardiology, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - Nina W van der Hoeven
- Department of Cardiology, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | | | - Eric A Dubois
- Thorax Centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | | | - Tom A Rijpstra
- Department of Intensive care medicine, Amphia Hospital, Breda, the Netherlands
| | - Hans A Bosker
- Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michiel J Blans
- Department of Intensive care medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Gabe B Bleeker
- Department of Cardiology, HAGA Hospital, Den Haag, the Netherlands
| | - Remon Baak
- Department of Intensive care medicine, HAGA Hospital, Den Haag, the Netherlands
| | - Georgios J Vlachojannis
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands; Department of Cardiology, University Medical Centre Utrecht, the Netherlands
| | - Bob J W Eikemans
- Department of Intensive care medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Centre Groningen, Department of Cardiology, Groningen, the Netherlands; Department of Cardiology, University Medical Centre Utrecht, the Netherlands
| | - Iwan C C van der Horst
- University of Groningen, University Medical Centre Groningen, Department of Intensive care medicine, Groningen, the Netherlands; Department of Intensive care medicine, Maastricht University Medical Centre, University Maastricht, Maastricht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, the Netherlands
| | | | - Albertus Beishuizen
- Department of Intensive care medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Martin Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Cyril Camaro
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hans van der Hoeven
- Department of Intensive care medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - José P Henriques
- Department of Cardiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive care medicine, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Maarten A Vink
- Department of Cardiology, OLVG, Amsterdam, the Netherlands
| | | | | | - Wouter de Ruijter
- Department of Intensive care medicine, Noord West Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Thijs S R Delnoij
- Department of Intensive care medicine, Maastricht University Medical Centre, University Maastricht, Maastricht, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | | | | | - Koos Plomp
- Department of Cardiology, Tergooi Hospital, Blaricum, the Netherlands
| | - Michael Magro
- Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Paul W G Elbers
- Department of Intensive care medicine, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Cardiac arrest: An interdisciplinary scoping review of the literature from 2019. Resusc Plus 2020; 4:100037. [PMID: 34223314 PMCID: PMC8244427 DOI: 10.1016/j.resplu.2020.100037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 01/09/2023] Open
Abstract
Objectives The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct a systematic annual search of peer-reviewed literature relevant to cardiac arrest. Now in its second year, the goals of the review are to illustrate best practices in research and help reduce compartmentalization of knowledge by disseminating clinically relevant advances in the field of cardiac arrest across disciplines. Methods An electronic search of PubMed using keywords related to cardiac arrest was conducted. Title and abstracts retrieved by these searches were screened for relevance, classified by article type (original research or review), and sorted into 7 categories. Screened manuscripts underwent standardized scoring of overall methodological quality and impact on the categorized fields of study by reviewer teams lead by a subject-matter expert editor. Articles scoring higher than 99 percentiles by category-type were selected for full critique. Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. Results A total of 3348 articles were identified on initial search; of these, 1364 were scored after screening for relevance and deduplication, and forty-five underwent full critique. Epidemiology & Public Health represented 24% of fully reviewed articles with Prehospital Resuscitation, Technology & Care, and In-Hospital Resuscitation & Post-Arrest Care Categories both representing 20% of fully reviewed articles. There were no significant differences between editor and reviewer scoring. Conclusions The sheer number of articles screened is a testament to the need for an accessible source calling attention to high-quality and impactful research and serving as a high-yield reference for clinicians and scientists seeking to follow the ever-growing body of cardiac arrest-related literature. This will promote further development of the unique and interdisciplinary field of cardiac arrest medicine.
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71
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Ben Ahmed H, Ben Khelil M, Bellali M, Shimi M, Belhaj A, Allouche M, Allouche E, Razghallah R, Banasr A, Benzarti A, Hamdoun M. [Sudden cardiac death in women, data from the northern Tunisian sudden cardiac-death registry]. Ann Cardiol Angeiol (Paris) 2020; 70:1-6. [PMID: 33109353 DOI: 10.1016/j.ancard.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sudden cardiac death is a major public health problem. Epidemiological and clinical differences according to gender have been described in sudden cardiac death. The aim of this study was to examine the gender differences between autopsy findings and circumstance of occurrence associated with sudden cardiac death. METHODS We prospectively collected epidemiological and autopsy data of victims of sudden cardiac death occurring in the northern governorates of Tunisia between January 2013 and December 2019. Symptoms preceding death, circadian, weekly and seasonal variations of sudden death were also analyzed. RESULTS The study population included 1834 men and 468 women with a mean age of 56.5±14.2 years. All cardiovascular risk factors except smoking were significantly more frequent among women but ischemic heart disease was the most common cause of death in men (51.3 %, versus 28 %, P<0.001). Women were more likely to have a negative macroscopic autopsy than men (34 % versus 23.6 %, P<0.001). Chest pain preceding sudden death was more frequent in male (24 % versus 13.2 %, P<0.001). In contrast, women were more likely to have dyspnea (8.1 % versus 15.6 %, P<0.001). Sudden death in women occurred indoors more often than in men (63.9 % versus 54.5 %, P<0.001) and also more often during night (midnight to 6 am). We also recorded an excess cardiac mortality in winter in both sexes. CONCLUSIONS Women had considerably more cardiovascular risk factors and more commonly negative macroscopic autopsy. Death occurred indoors and during night more often than in men.
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Affiliation(s)
- H Ben Ahmed
- Service de cardiologie, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie.
| | - M Ben Khelil
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Bellali
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Shimi
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - A Belhaj
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Allouche
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - E Allouche
- Service de cardiologie, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - R Razghallah
- Service de cardiologie, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - A Banasr
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - A Benzarti
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Hamdoun
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
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Howell SJ, German D, Bender A, Phan F, Mukundan SV, Perez-Alday EA, Rogovoy NM, Haq KT, Yang K, Wirth A, Jensen K, Tereshchenko LG. Does Sex Modify an Association of Electrophysiological Substrate with Sudden Cardiac Death? The Atherosclerosis Risk in Communities (ARIC) Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 1:80-88. [PMID: 34308405 PMCID: PMC8301262 DOI: 10.1016/j.cvdhj.2020.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Sex is a well-recognized risk factor for sudden cardiac death (SCD). We hypothesized that sex modifies the association of electrophysiological (EP) substrate with SCD. Objective The purpose of this study was to determine whether there are sex differences in electrocardiographic (ECG) measures and whether sex modifies the association of ECG measures of EP substrate with SCD. Methods Participants from the Atherosclerosis Risk in Communities study with analyzable ECGs (n = 14,725; age 54.2 ± 5.8 years; 55% female; 74% white) were included. EP substrate was characterized by heart rate, QRS, QTc, Cornell voltage, spatial ventricular gradient (SVG), and sum absolute QRST integral (SAI QRST) ECG metrics. Two competing outcomes were adjudicated: SCD and non-SCD. Interaction of ECG metrics with sex was studied in Cox proportional hazards and Fine-Gray competing risk models. Model 1 was adjusted for prevalent cardiovascular disease (CVD) and risk factors. Time-updated model 2 was additionally adjusted for incident nonfatal CVD. Relative hazard ratio (RHR) and relative subhazard ratio with 95% confidence interval (CI) for SCD and non-SCD risk for women relative to men were calculated. Model 1 was adjusted for prevalent CVD and risk factors. Time-updated model 2 was additionally adjusted for incident nonfatal CVD. Results Over median follow-up of 24.4 years, there were 530 SCDs (incidence 1.72; 95% CI 1.58–1.88 per 1000 person-years). Women compared to men experienced a greater risk of SCD associated with Cornell voltage (RHR 1.18; 95% CI 1.06–1.32; P = .003), SAI QRST (RHR 1.16; 95% CI 1.04–1.30; P = .007), and SVG magnitude (RHR 1.24; 95% CI 1.05–1.45; P = .009), independently from incident CVD. Conclusion In women, the global EP substrate is associated with up to 24% greater risk of SCD than in men, suggesting differences in underlying mechanisms and the need for sex-specific SCD risk stratification.
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Affiliation(s)
- Stacey J. Howell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - David German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Aron Bender
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Francis Phan
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Srini V. Mukundan
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- Rush University Medical Center, Chicago, Illinois
| | - Erick A. Perez-Alday
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Nichole M. Rogovoy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Kazi T. Haq
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Katherine Yang
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Ashley Wirth
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Kelly Jensen
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Larisa G. Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- Cardiovascular Division, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Address reprint requests and correspondence: Dr Larisa G. Tereshchenko, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239.
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Abstract
PURPOSE OF REVIEW To summarize gender- and sex-specific differences in the presentation, diagnosis, management, and pathophysiology of women presenting with acute coronary syndrome (ACS). RECENT FINDINGS Sex differences exist in many aspects of ACS that impact the identification, treatment, and outcomes in women. There are delays in the initiation of care, under recognized diagnostic differences based on sex, and inconsistencies in the management of ACS in women compared with men, that ultimately impact outcomes. Additionally, women with ACS are more likely than men to present with non-obstructive coronary artery disease (CAD), which appears to be due to diverse underlying pathophysiology. Women with ACS face diagnostic and treatment dilemmas from time of symptom onset to hospital discharge. Under-recognition, under-diagnosis, and under-treatment ultimately result in poorer outcomes in women. Underlying pathophysiologic differences in women require additional testing to elucidate underlying etiologies.
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74
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Hekkanen JJ, Kenttä TV, Haukilahti MAE, Rahola JT, Holmström L, Vähätalo J, Tulppo MP, Kiviniemi AM, Pakanen L, Ukkola OH, Junttila MJ, Huikuri HV, Perkiömäki JS. Increased Beat-to-Beat Variability of T-Wave Heterogeneity Measured From Standard 12-Lead Electrocardiogram Is Associated With Sudden Cardiac Death: A Case-Control Study. Front Physiol 2020; 11:1045. [PMID: 32982784 PMCID: PMC7477294 DOI: 10.3389/fphys.2020.01045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarization measured from standard 12-lead ECG is not well-understood. Methods We measured the short-term variability of repolarization parameters, such as T-wave heterogeneity in leads V4–V6 (TWH) and QT interval (QT), from five consecutive beats of previously recorded standard 12-lead ECG in 200 victims of unexpected sudden cardiac death (SCD) confirmed to be due to complicated atherosclerotic coronary artery disease (CAD) in medico-legal autopsy and 200 age- and sex-matched controls with angiographically confirmed CAD. The short-term variability of repolarization heterogeneity was defined as the standard deviation (SD) of the measured repolarization parameters. All ECGs were in sinus rhythm, and no premature ventricular contractions were included in the measured segment. Results TWH-SD and QT-SD were significantly higher in SCD victims than in subjects with CAD (6.9 ± 5.6 μV vs. 3.8 ± 2.6 μV, p = 1.8E-11; 8.3 ± 13.1 ms vs. 3.8 ± 7.1 ms, p = 0.00003, respectively). After adjusting in the multivariate clinical model with factors, such as diabetes, RR interval, and beta blocker medication, TWH-SD and QT-SD retained their significant power in discriminating between the victims of SCD and the patients with CAD (p = 0.00003, p = 0.006, respectively). TWH-SD outperformed QT-SD in identifying the SCD victims among the study subjects (area under the curve in the receiver operating characteristics curve 0.730 vs. 0.679, respectively). Conclusion Increased short-term variability of repolarization heterogeneity measured from standard 12-lead ECG is associated with SCD.
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Affiliation(s)
- Jenni J Hekkanen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mira Anette E Haukilahti
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Janne T Rahola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Lauri Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland.,Research Unit of Internal Medicine, Department of Forensic Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Yang Z, Ma H, Liu W. In silico identification of common and specific signatures in coronary heart diseases. Exp Ther Med 2020; 20:3595-3614. [PMID: 32905032 PMCID: PMC7464937 DOI: 10.3892/etm.2020.9121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/15/2020] [Indexed: 12/03/2022] Open
Abstract
Coronary heart disease (CHD) is on the increase in developing countries, where lifestyle choices such as smoking, bad diet, and no exercise contribute and increase the incidence of high blood pressure and high cholesterol levels to cause CHD. Through utilization of a biomarker-based approach for developing interventions, the aim of the study was to identify differentially expressed genes (DEGs) and their association and impact on various bio-targets. The microarray datasets of both healthy and CHD patients were analyzed to identify the DEGs and their interactions using Gene Ontology, PANTHER, Reactome, and STRING (for the possible associated genes with multiple targets). Our data mining approach suggests that the DEGs were associated with molecular functions, including protein binding (75%) and catalytic activity (56%); biological processes such as cellular process (83%), biological regulation (57%), and metabolic process (44%); and cellular components such as cell (65%) and organelle (58%); as well as other associations including apoptosis, inflammatory, cell development and metabolic pathways. The molecular functions were further analyzed, and protein binding in particular was analyzed using network analysis to determine whether there was a clear association with CHD and disease. The ingenuity pathway analysis revealed pathways related to cell cholesterol biosynthesis, the immune system including cytokinin signaling, in which, the understanding of DEGs is crucial to predict the advancement of preventive strategies. Results of the present study showed that, there is a need to validate the top DEGs to rule out their molecular mechanism in heart failure caused by CHD.
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Affiliation(s)
- Zhijia Yang
- The Third Department of Cardiovascular Medicine, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Haifang Ma
- The First Department of Cardiovascular Medicine, Affiliated Hospital of Hebei University of Technology, Handan, Hebei 056002, P.R. China
| | - Wei Liu
- The First Department of Cardiovascular Medicine, Handan Central Hospital, Handan, Hebei 056001, P.R. China
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Abstract
PURPOSE OF REVIEW Persons with diabetes mellitus (DM) have increased morbidity and mortality rates compared with persons without DM. Sudden cardiac death (SCD) is a leading cause of death, and multiple studies have found an increased risk of SCD among individuals with DM. This review sought to collect the latest knowledge of the epidemiological and pathophysiological interplay between DM and SCD. RECENT FINDINGS Persons with DM have a two- to tenfold increased risk of SCD compared with persons without DM. The underlying mechanisms for the increased risk of SCD are complex and multifactorial. The main pathophysiological contributors are DM-induced cardiac autonomic neuropathy (CAN), metabolic changes, silent ischemia, and polypharmacy. Persons with DM have an increased risk of SCD. Future studies should focus on CAN and the combined risk of QT prolongation from the interplay between CAN, hypoglycemia, and polypharmacy. Genes and pathways involved in control of the autonomic nervous system and cardiac ion channels could be a future focal point.
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Everett BM, Moorthy MV, Tikkanen JT, Cook NR, Albert CM. Markers of Myocardial Stress, Myocardial Injury, and Subclinical Inflammation and the Risk of Sudden Death. Circulation 2020; 142:1148-1158. [PMID: 32700639 DOI: 10.1161/circulationaha.120.046947] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The majority of sudden cardiac deaths (SCDs) occur in low-risk populations often as the first manifestation of cardiovascular disease (CVD). Biomarkers are screening tools that may identify subclinical cardiovascular disease and those at elevated risk for SCD. We aimed to determine whether the total to high-density lipoprotein cholesterol ratio, high-sensitivity cardiac troponin I, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or high-sensitivity C-reactive protein individually or in combination could identify individuals at higher SCD risk in large, free-living populations with and without cardiovascular disease. METHODS We performed a nested case-control study within 6 prospective cohort studies using 565 SCD cases matched to 1090 controls (1:2) by age, sex, ethnicity, smoking status, and presence of cardiovascular disease. RESULTS The median study follow-up time until SCD was 11.3 years. When examined as quartiles or continuous variables in conditional logistic regression models, each of the biomarkers was significantly and independently associated with SCD risk after mutually controlling for cardiac risk factors and other biomarkers. The mutually adjusted odds ratios for the top compared with the bottom quartile were 1.90 (95% CI, 1.30-2.76) for total to high-density lipoprotein cholesterol ratio, 2.59 (95% CI, 1.76-3.83) for high-sensitivity cardiac troponin I, 1.65 (95% CI, 1.12-2.44) for NT-proBNP, and 1.65 (95% CI, 1.13-2.41) for high-sensitivity C-reactive protein. A biomarker score that awarded 1 point when the concentration of any of those 4 biomarkers was in the top quartile (score range, 0-4) was strongly associated with SCD, with an adjusted odds ratio of 1.56 (95% CI, 1.37-1.77) per 1-unit increase in the score. CONCLUSIONS Widely available measures of lipids, subclinical myocardial injury, myocardial strain, and vascular inflammation show significant independent associations with SCD risk in apparently low-risk populations. In combination, these measures may have utility to identify individuals at risk for SCD.
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Affiliation(s)
- Brendan M Everett
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Cardiovascular Medicine (B.M.E.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - M V Moorthy
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jani T Tikkanen
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Nancy R Cook
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Christine M Albert
- Divisions of Preventive Medicine (B.M.E., M.V.M., J.T.T., N.R.C., C.M.A.), Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (C.M.A.)
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Gender differences in prevalence and prognostic value of fragmented QRS complex. J Electrocardiol 2020; 61:1-9. [PMID: 32460128 DOI: 10.1016/j.jelectrocard.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fragmented QRS (fQRS) on 12-lead electrocardiogram (ECG) is associated with scarred myocardium and adverse outcome. However, the data on gender differences in terms of its prevalence and prognostic value is sparse. The aim of this study was to evaluate whether gender differences in fQRS exist among subjects drawn from populations with different risk profiles. METHODS We analyzed fQRS from 12-lead ECG in 953 autopsy-confirmed victims of sudden cardiac death (SCD) (78% men; 67.0 ± 11.4 yrs), 1900 coronary artery disease (CAD) patients with angiographically confirmed stenosis of ≥50% (70% men; 66.6 ± 9.0 yrs, 43% with previous myocardial infarction [MI]), and in 10,904 adults drawn from the Finnish adult general population (52% men; 44.0 ± 8.5 yrs). RESULTS Prevalence of fQRS was associated with older age, male sex and the history and severity of prior cardiac disease of subjects. Among the general population fQRS was more commonly found among men in comparison to women (20.5% vs. 14.8%, p < 0.001). The prevalence of fQRS rose gradually along with the severity of prior cardiac disease in both genders, yet remained significantly higher in the male population: subjects with suspected or known cardiac disease (25.4% vs. 15.8% p < 0.001), CAD patients without prior MI (39.9% vs. 26.4%, p < 0.001), CAD patients with prior MI (42.9% vs. 31.2%, p < 0.001), and victims of SCD (56.4% vs. 44.4%, p < 0.001). CONCLUSIONS The prevalence of QRS fragmentation varies in different populations. The fragmentation is clearly related to the underlying cardiac disease in both genders, however women seem to have significantly lower prevalence of fQRS in each patient population in comparison to men.
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79
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miR-1468-3p Promotes Aging-Related Cardiac Fibrosis. MOLECULAR THERAPY-NUCLEIC ACIDS 2020; 20:589-605. [PMID: 32348937 PMCID: PMC7191129 DOI: 10.1016/j.omtn.2020.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
Non-coding microRNAs (miRNAs) are powerful regulators of gene expression and critically involved in cardiovascular pathophysiology. The aim of the current study was to identify miRNAs regulating cardiac fibrosis. Cardiac samples of age-matched control subjects and sudden cardiac death (SCD) victims with primary myocardial fibrosis (PMF) were subjected to miRNA profiling. Old SCD victims with PMF and healthy aged human hearts showed increased expression of miR-1468-3p. In vitro studies in human cardiac fibroblasts showed that augmenting miR-1468-3p levels induces collagen deposition and cell metabolic activity and enhances collagen 1, connective tissue growth factor, and periostin expression. In addition, miR-1468-3p promotes cellular senescence with increased senescence-associated β-galactosidase activity and increased expression of p53 and p16. AntimiR-1468-3p antagonized transforming growth factor β1 (TGF-β1)-induced collagen deposition and metabolic activity. Mechanistically, mimic-1468-3p enhanced p38 phosphorylation, while antimiR-1468-3p decreased TGF-β1-induced p38 activation and abolished p38-induced collagen deposition. RNA sequencing analysis, a computational prediction model, and qPCR analysis identified dual-specificity phosphatases (DUSPs) as miR-1468-3p target genes, and regulation of DUSP1 by miR-1468-3p was confirmed with a dual-luciferase reporter assay. In conclusion, miR-1468-3p promotes cardiac fibrosis by enhancing TGF-β1-p38 signaling. Targeting miR-1468-3p in the older population may be of therapeutic interest to reduce cardiac fibrosis.
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80
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May T, Skinner K, Unger B, Mooney M, Patel N, Dupont A, McPherson J, McMullan P, Nielsen N, Seder DB, Kern KB. Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death. J Am Heart Assoc 2020; 9:e015629. [PMID: 32208830 PMCID: PMC7428608 DOI: 10.1161/jaha.119.015629] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Coronary artery disease is the primary etiology for sudden cardiac arrest in adults, but potential differences in the incidence and utility of invasive coronary testing between resuscitated men and women have not been extensively evaluated. Our aim was to characterize angiographic similarities and differences between men and women after cardiac arrest. Methods and Results Data from the International Cardiac Arrest Registry–Cardiology database included patients resuscitated from out‐of‐hospital cardiac arrest of presumed cardiac origin, admitted to 7 academic cardiology/resuscitation centers during 2006 to 2017. Demographics, clinical factors, and angiographic findings of subjects were evaluated in relationship to sex and multivariable logistic regression models created to predict both angiography and outcome. Among 966 subjects, including 277 (29%) women and 689 (71%) men, fewer women had prior coronary artery disease and more had prior congestive heart failure (P=0.05). Women were less likely to have ST‐segment–elevation myocardial infarction (32% versus 39%, P=0.04). Among those with ST‐segment–elevation myocardial infarctions, identification and distribution of culprit arteries was similar between women and men, and there were no differences in treatment or outcome. In patients without ST‐segment elevation post‐arrest, women were overall less likely to undergo coronary angiography (51% versus 61%, P<0.02), have a culprit vessel identified (29% versus 45%, P=0.03), and had fewer culprits acutely occluded (17% versus 28%, P=0.03). Women were also less often re‐vascularized (44% versus 52%, P<0.03). Conclusions Among cardiac arrest survivors, women are less likely to undergo angiography or percutaneous coronary intervention than men. Sex disparities for invasive therapies in post‐cardiac arrest care need continued attention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Karl B Kern
- Sarver Heart Center University of Arizona Tucson AZ
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81
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Huikuri HV, Junttila MJ. Editorial commentary: Paradigm shift in the circadian and septadian patterns of sudden cardiac death: Fact or fiction? Trends Cardiovasc Med 2020; 31:177-178. [PMID: 32146016 DOI: 10.1016/j.tcm.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, University Hospital of Oulu, and University of Oulu, Finland.
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center, University Hospital of Oulu, and University of Oulu, Finland
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82
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Regulatory Mechanisms of Mitochondrial Function and Cardiac Aging. Int J Mol Sci 2020; 21:ijms21041359. [PMID: 32085438 PMCID: PMC7072955 DOI: 10.3390/ijms21041359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 01/10/2023] Open
Abstract
Aging is a major risk factor for cardiovascular diseases (CVDs), the major cause of death worldwide. Cardiac myocytes, which hold the most abundant mitochondrial population, are terminally differentiated cells with diminished regenerative capacity in the adult. Cardiomyocyte mitochondrial dysfunction is a characteristic feature of the aging heart and one out of the nine features of cellular aging. Aging and cardiac pathologies are also associated with increased senescence in the heart. However, the cause and consequences of cardiac senescence during aging or in cardiac pathologies are mostly unrecognized. Further, despite recent advancement in anti-senescence therapy, the targeted cell type and the effect on cardiac structure and function have been largely overlooked. The unique cellular composition of the heart, and especially the functional properties of cardiomyocytes, need to be considered when designing therapeutics to target cardiac aging. Here we review recent findings regarding key factors regulating cell senescence, mitochondrial health as well as cardiomyocyte rejuvenation.
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83
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Reinier K, Stecker EC, Uy-Evanado A, Chugh HS, Binz A, Nakamura K, Sargsyan A, Jui J, Chugh SS. Sudden Cardiac Death as First Manifestation of Heart Disease in Women: The Oregon Sudden Unexpected Death Study, 2004-2016. Circulation 2020; 141:606-608. [PMID: 32065764 DOI: 10.1161/circulationaha.119.044169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kyndaron Reinier
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
| | - Eric C Stecker
- Knight Cardiovascular Institute (E.C.S.), Oregon Health and Science University, Portland, OR
| | - Audrey Uy-Evanado
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
| | - Harpriya S Chugh
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
| | - Andrea Binz
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
| | - Kotoka Nakamura
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
| | - Arayik Sargsyan
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
| | - Jonathan Jui
- Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland, OR
| | - Sumeet S Chugh
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (K.R., A.U.-E., H.S.C., A.B., K.N., A.S., S.S.C.)
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84
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Affiliation(s)
- Sumeet S Chugh
- SmidtHeart Institute, Cedars-Sinai Health System, Los Angeles, CA
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85
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Mitchell RN, Ashar FN, Jarvelin MR, Froguel P, Sotoodehnia N, Brody JA, Sebert S, Huikuri H, Rioux J, Goyette P, Newcomb CE, Junttila MJ, Arking DE. Effect of Sex and Underlying Disease on the Genetic Association of QT Interval and Sudden Cardiac Death. J Am Heart Assoc 2019; 8:e013751. [PMID: 31747862 PMCID: PMC6912973 DOI: 10.1161/jaha.119.013751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Sudden cardiac death (SCD) accounts for ≈300 000 deaths annually in the United States. Men have a higher risk of SCD and are more likely to have underlying coronary artery disease, while women are more likely to have arrhythmic events in the setting of inherited or acquired QT prolongation. Moreover, there is evidence of sex differences in the genetics of QT interval duration. Using sex- and coronary artery disease-stratified analyses, we assess differences in genetic association between longer QT interval and SCD risk. Methods and Results We examined 2282 SCD subjects and 3561 Finnish controls. The SCD subjects were stratified by underlying disease (ischemic versus nonischemic) and by sex. We used logistic regression to test for association between the top QT interval-associated single-nucleotide polymorphism, rs12143842 (in the NOS1AP locus), and SCD risk. We also performed Mendelian randomization to test for causal association of QT interval in the various subgroups. No statistically significant differences were observed between the sexes for associations with rs12143842, despite the odds ratio being higher in females across all subgroup analyses. Consistent with our hypothesis, female non-ischemics had the highest odds ratio point estimate for association between rs12143842 and SCD risk and male ischemics the lowest odds ratio point estimate (P=0.036 for difference). Similar trends were observed for the Mendelian randomization analysis. Conclusions While individual subgroup comparisons did not achieve traditional criteria for statistical significance, this study is consistent with the hypothesis that the causal association of longer QT interval on SCD risk is stronger in women and nonischemic individuals.
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Affiliation(s)
- Rebecca N Mitchell
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
| | - Foram N Ashar
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
| | - Marjo-Riitta Jarvelin
- Center for Life Course Health Research Faculty of Medicine University of Oulu Finland.,Biocenter Oulu University of Oulu Finland.,Unit of Primary Health Care Oulu University Hospital Oulu Finland.,Department of Epidemiology and Biostatistics MRC-PHE Centre for Environment and Health School of Public Health Imperial College London London United Kingdom.,Department of Life Sciences College of Health and Life Sciences Brunel University London London United Kingdom
| | - Philippe Froguel
- Department of Epidemiology and Biostatistics MRC-PHE Centre for Environment and Health School of Public Health Imperial College London London United Kingdom
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit Division of Cardiology Departments of Medicine and Epidemiology University of Washington Seattle WA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit University of Washington Seattle WA
| | - Sylvain Sebert
- Center for Life Course Health Research Faculty of Medicine University of Oulu Finland.,Biocenter Oulu University of Oulu Finland.,Department of Epidemiology and Biostatistics MRC-PHE Centre for Environment and Health School of Public Health Imperial College London London United Kingdom
| | - Heikki Huikuri
- Research Unit of Internal Medicine Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
| | - John Rioux
- Montreal Heart Institute University of Montreal Canada
| | | | - Charles E Newcomb
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
| | - M Juhani Junttila
- Research Unit of Internal Medicine Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
| | - Dan E Arking
- Department of Genetic Medicine McKusick-Nathans Institute Johns Hopkins Baltimore MD
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86
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van den Berg ME, Kors JA, van Herpen G, Bots ML, Hillege H, Swenne CA, Stricker BH, Rijnbeek PR. Normal Values of QT Variability in 10-s Electrocardiograms for all Ages. Front Physiol 2019; 10:1272. [PMID: 31636572 PMCID: PMC6788348 DOI: 10.3389/fphys.2019.01272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2019] [Indexed: 12/02/2022] Open
Abstract
Aims: QT variability is a promising electrocardiographic marker. It has been studied as a screening tool for coronary artery disease and left ventricular hypertrophy, and increased QT variability is a known risk factor for sudden cardiac death. Considering that comprehensive normal values for QT variability were lacking, we set out to establish these in standard 10-s electrocardiograms (ECGs) covering both sexes and all ages. Methods: Ten-second, 12-lead ECGs were provided by five Dutch population studies (Pediatric Normal ECG Study, Leiden University Einthoven Science Project, Prevention of Renal and Vascular End-stage Disease Study, Utrecht Health Project, Rotterdam Study). ECGs were recorded digitally and processed by well-validated analysis software. We selected cardiologically healthy participants, 46% being women. Ages ranged from 11 days to 91 years. After quality control, 13,828 ECGs were available. We assessed three markers: standard deviation of QT intervals (SDqt), short-term QT variability (STVqt), and QT variability index (QTVI). Results: For SDqt and STVqt, the median and the lower limit of normal remained stable with age. The upper limit of normal declined until around age 45, and increased strongly in the elderly, notably so in women. This implies that a subset of the population, small enough not to have appreciable effect on the median, shows a high degree of QT variability with a possible risk of arrhythmias or worse, especially in women. Otherwise, sex differences were negligible in all three measurements. For QTVI, median, and normal limits decreased until age 20, and steadily went up afterwards except for the lower limit of normal, which flattens off after age 65. Conclusion: We report the first set of normal values for QT variability based on 10-s ECGs, for all ages and both sexes.
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Affiliation(s)
- Marten E van den Berg
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerard van Herpen
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Hans Hillege
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.,Inspectorate of Health Care, Utrecht, Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
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87
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Hietanen S, Herajärvi J, Junttila J, Pakanen L, Huikuri HV, Liisanantti J. Characteristics of subjects with alcoholic cardiomyopathy and sudden cardiac death. Heart 2019; 106:686-690. [PMID: 31551291 DOI: 10.1136/heartjnl-2019-315534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/31/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To study social and clinical characteristics of victims of sudden cardiac death (SCD) due to alcoholic cardiomyopathy (ACM). METHODS The study population comprised a subset of Fingesture cohort. All subjects were verified SCD victims determined to have ACM as cause of death in medico-legal autopsy between 1998 and 2017 in Northern Finland. The Finnish Population Register Centre provided SCD victims' last place of residence. Population data of residential area were obtained from Statistics Finland. RESULTS From a total of 5869 SCD victims in Fingesture cohort, in 290 victims the cause of SCD was ACM (4.9%; median age 56 (50-62) years; 83% males). In 64 (22.1%) victims, the diagnosis of cardiac disease was made prior to death and in 226 (77.9%) at autopsy. There were no significant differences in autopsy findings between victims with or without known cardiac diagnosis, but steatohepatitis (94.5%) and liver cirrhosis (64,5%) were common in both groups. Alcoholism was more often recorded in the known cardiac disease group (64.1% vs 47.3%, p=0.023). Majority were included in the working age population (ie, under 65 years) (54.8% and 53.1%, p=0.810). In high-income communities, 28.8% of ACM SCD victims had previously diagnosed cardiac disease, the proportion in the middle-income and low-income communities was 18.6% (p=0.05). CONCLUSIONS Majority of SCD victims due to ACM did not have previously diagnosed cardiac disease, but documented risk consumption of alcohol was common. This emphasises the importance of routine screening of alcohol consumption and signs of cardiomyopathy in heavy alcohol users in primary healthcare.
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Affiliation(s)
- Siiri Hietanen
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland .,Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Johanna Herajärvi
- Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
| | - Juhani Junttila
- Oulu University Medical Research Center, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, National Institute for Health and Welfare, Oulu, Finland.,Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Oulu University Medical Research Center, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Janne Liisanantti
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.,Oulu University Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland
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