101
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Kim MJ, Cha S, Baek JS, Yu JJ, Seo GH, Kang M, Do HS, Lee SE, Lee BH. Genetic heterogeneity of cardiomyopathy and its correlation with patient care. BMC Med Genomics 2023; 16:270. [PMID: 37904158 PMCID: PMC10614404 DOI: 10.1186/s12920-023-01639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/21/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Cardiomyopathy, which is a genetically and phenotypically heterogeneous pathological condition, is associated with increased morbidity and mortality. Genetic diagnosis of cardiomyopathy enables accurate phenotypic classification and optimum patient management and counseling. This study investigated the genetic spectrum of cardiomyopathy and its correlation with the clinical course of the disease. METHODS The samples of 72 Korean patients with cardiomyopathy (43 males and 29 females) were subjected to whole-exome sequencing (WES). The familial information and clinical characteristics of the patients were reviewed and analyzed according to their genotypes. RESULTS Dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), left ventricular non-compaction cardiomyopathy, and restrictive cardiomyopathy was detected in 41 (56.9%), 25 (34.7%), 4 (5.6%), and 2 (2.8%) patients, respectively. WES analysis revealed positive results in 37 (51.4%) patients. Subsequent familial testing identified ten additional familial cases. Among DCM cases, 19 (46.3%) patients exhibited positive results, with TTN variants being the most common alteration, followed by LMNA and MYH7 variants. Meanwhile, among HCM cases, 15 (60%) patients exhibited positive results with MYH7 variants being the most common alteration. In six patients with positive results, extracardiac surveillance was warranted based on disease information. The incidence of worse outcomes, such as mortality and life-threatening arrhythmic events, in patients with DCM harboring LMNA variants, was higher than that in patients with DCM harboring TTN or MYH7 variants. CONCLUSIONS Diverse genotypes were identified in a substantial proportion of patients with cardiomyopathy. Genetic diagnosis enables personalized disease surveillance and management.
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Affiliation(s)
- Mi Jin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seulgi Cha
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Minji Kang
- Genome Research Center for Birth Defects and Genetic Diseases, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Hyo-Sang Do
- Genome Research Center for Birth Defects and Genetic Diseases, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Sang Eun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Beom Hee Lee
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicines, Seoul, Korea.
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102
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Lorenzo M, Lynch A, Ashkanase J, Fazari L, George K, Arathoon K, Minn S, Nicolson D, Jeewa A, Jean-St-Michel E. Symptomatic presentation influences outcomes in pediatric restrictive cardiomyopathy. Front Pediatr 2023; 11:1264751. [PMID: 37928350 PMCID: PMC10620919 DOI: 10.3389/fped.2023.1264751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Children with restrictive cardiomyopathy (RCM) traditionally have a poor prognosis, with most patients either dying or requiring heart transplantation within 2 years of diagnosis. The development of symptoms in RCM suggests advanced disease. However, as screening practices evolve and lead to diagnosis of early disease, identifying appropriate timing of transplant listing becomes increasingly important. In this context we compared outcomes of children with RCM presenting with clinical symptoms to those asymptomatic at initial presentation. Methods This retrospective cohort study included 25 patients with RCM presenting to a quaternary care center between 2001 and 2018. Times to transplantation, death, and a composite outcome of adverse cardiac events (CPR, cardioversion, inotropic support, mechanical ventilation, mechanical support, or heart transplant) were compared between those symptomatic and asymptomatic at presentation. Results At 2 years following diagnosis, patients asymptomatic at presentation had a significantly better transplant-free survival at 57% compared to 17% for symptomatic patients (p = 0.03). Those asymptomatic at diagnosis also had significantly improved cardiac event-free survival at 71% compared to symptomatic patients at 25% (p = 0.01). In multivariable analysis, cardiac symptoms at presentation remained an independent risk factor for heart-transplant or death [hazard ratio 5.17 (1.28-20.85), p = 0.02]. Conclusion Patients with RCM who are symptomatic at time of diagnosis have significantly worse transplant-free survival and cardiac event-free survival. Given current practice variability in timing of transplant listing, the presence of any cardiac symptoms is an important negative prognostic marker and should prompt urgent transplant listing.
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Affiliation(s)
- Melissa Lorenzo
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aine Lynch
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jenna Ashkanase
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Linda Fazari
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Kristen George
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Katelyn Arathoon
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sunghoon Minn
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Dawn Nicolson
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aamir Jeewa
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Emilie Jean-St-Michel
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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103
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Foster J, Parsons S. Histiocytoid cardiomyopathy presenting as sudden death in an 18-month-old infant. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00730-2. [PMID: 37831311 DOI: 10.1007/s12024-023-00730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Histiocytoid cardiomyopathy (HC) is an arrhythmogenic disorder, usually involving children under two years of age with a strong Caucasian and female predominance. The disease is fatal in the vast majority and diagnosis is nearly always established at autopsy, but this is only possible with adequate myocardial sampling. Meticulous gross and histological examination of the heart in collaboration with a cardiovascular-trained pathologist maximises the opportunity to make specific diagnoses (and therefore rule out the differentials of SIDS, SUDC and child abuse), guide genetic testing, and inform potentially life-saving medical interventions for blood relations. We present a typical HC case presenting as sudden death, without prodrome, in a previously healthy 18-month-old boy. The disease is characterised histologically by discrete groups of enlarged, polygonal histiocyte-like cells with distinct margins and abundant faintly eosinophilic foamy cytoplasm. Cells often contain coarse granules, microvacuoles and irregular, round nuclei. In our case, dysplastic fascicles were predominantly located immediately deep to the endocardium of the left ventricle. We report our own autopsy findings with histological images, and discuss the expected clinical, morphological and ultrastructural features of the disease.
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Affiliation(s)
- Jacob Foster
- School of Medicine, Cardiff University, Cardiff, Wales, UK.
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Melbourne, VIC, Australia
- Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
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104
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Wang Y, Jia H, Song J. Accurate Classification of Non-ischemic Cardiomyopathy. Curr Cardiol Rep 2023; 25:1299-1317. [PMID: 37721634 PMCID: PMC10651539 DOI: 10.1007/s11886-023-01944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE OF REVIEW This article aims to review the accurate classification of non-ischemic cardiomyopathy, including the methods, basis, subtype characteristics, and prognosis, especially the similarities and differences between different classifications. RECENT FINDINGS Non-ischemic cardiomyopathy refers to a myocardial disease that excludes coronary artery disease or ischemic injury and has a variety of etiologies and high incidence. Recent studies suggest that traditional classification methods based on primary/mixed/acquired or genetic/non-genetic cannot meet the precise needs of contemporary clinical management. This article systematically describes the history of classifications of cardiomyopathy and presents etiological and genetic differences between cardiomyopathies. The accurate classification is described from the perspective of morphology, function, and genomics in hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction, and partially acquired cardiomyopathy. The different clinical characteristics and treatment needs of these cardiomyopathies are elaborated. Some single-gene mutant cardiomyopathies have unique phenotypes, and some cardiomyopathies have mixed phenotypes. These special classifications require personalized precision treatment, which is worthy of independent research. This article describes recent advances in the accurate classification of non-ischemic cardiomyopathy from clinical phenotypes and causative genes, discusses the advantages and usage scenarios of each classification, compares the differences in prognosis and patient management needs of different subtypes, and summarizes common methods and new exploration directions for accurate classification.
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Affiliation(s)
- Yifan Wang
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, National Centre for Cardiovascular Disease, Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hao Jia
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, National Centre for Cardiovascular Disease, Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jiangping Song
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, National Centre for Cardiovascular Disease, Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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105
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Lasica R, Djukanovic L, Savic L, Krljanac G, Zdravkovic M, Ristic M, Lasica A, Asanin M, Ristic A. Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment. Diagnostics (Basel) 2023; 13:3073. [PMID: 37835816 PMCID: PMC10572782 DOI: 10.3390/diagnostics13193073] [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: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
| | - Lidija Savic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Medical Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Marko Ristic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | | | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Arsen Ristic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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106
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Alaei Z, Zamani N, Rabbani B, Mahdieh N. TCAP gene is not a common cause of cardiomyopathy in Iranian patients. Eur J Med Res 2023; 28:376. [PMID: 37752589 PMCID: PMC10523715 DOI: 10.1186/s40001-023-01019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are the most frequent cardiomyopathies that cause acute heart failure and sudden cardiac death. Previous genetic reports have shown that pathogenic variants of genes encoding Z-disc components such as telethonin protein (TCAP) are the primary cause of DCM and HCM. METHODS This study was the first investigation on the TCAP gene among the Iranian cardiomyopathies population wherein the TCAP gene was analyzed in 40 unrelated patients (17 females and 23 males) who were clinically diagnosed with HCM and DCM. In addition, we conducted a thorough review of all published articles and the databases that were the first to report novel pathogenic or likely pathogenic variants the in TCAP gene. RESULTS In the cohort of this study, we identified only one intronic variant c.111-42G > A in one of the HCM patients that were predicted as polymorphism by in-silico analysis. Moreover, a total of 44 variants were reported for the TCAP gene in the literature where a majority of mutations were found to be missense. Pathogenic mutations in TCAP may cause diseases including limb-girdle muscular dystrophy 2G (LGMD-2G), DCM, HCM, intestinal pseudo-obstruction, and telethonin deficiency. However, a large number of affected patients were clinically diagnosed with limb-girdle 2G compared to other presenting phenotypes. DISCUSSION These findings suggest that the TCAP gene pathogenic mutations might not be a common cause of cardiomyopathies among Iranian patients. These gene disease-causing mutations may cause various manifestations, but it has a high prevalence among LGMD-2G, HCM, and DCM patients.
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Affiliation(s)
- Zahra Alaei
- Faculty of Basic Sciences, Islamic Azad University, East Tehran Branch, Tehran, Iran
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Zamani
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Rabbani
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nejat Mahdieh
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Genetics Laboratory, Rajaie Cardiovascular Medical and Research Center, Vali-E-Asr Avenue, Tehran, 1996911151, Iran.
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Kawai A, Nagatomo Y, Yukino-Iwashita M, Nakazawa R, Taruoka A, Yumita Y, Takefuji A, Yasuda R, Toya T, Ikegami Y, Masaki N, Ido Y, Adachi T. β 1 Adrenergic Receptor Autoantibodies and IgG Subclasses: Current Status and Unsolved Issues. J Cardiovasc Dev Dis 2023; 10:390. [PMID: 37754819 PMCID: PMC10531529 DOI: 10.3390/jcdd10090390] [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: 07/26/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
A wide range of anti-myocardial autoantibodies have been reported since the 1970s. Among them, autoantibodies against the β1-adrenergic receptor (β1AR-AAb) have been the most thoroughly investigated, especially in dilated cardiomyopathy (DCM). Β1AR-Aabs have agonist effects inducing desensitization of β1AR, cardiomyocyte apoptosis, and sustained calcium influx which lead to cardiac dysfunction and arrhythmias. Β1AR-Aab has been reported to be detected in approximately 40% of patients with DCM, and the presence of the antibody has been associated with worse clinical outcomes. The removal of anti-myocardial autoantibodies including β1AR-AAb by immunoadsorption is beneficial for the improvement of cardiac function for DCM patients. However, several studies have suggested that its efficacy depended on the removal of AAbs belonging to the IgG3 subclass, not total IgG. IgG subclasses differ in the structure of the Fc region, suggesting that the mechanism of action of β1AR-AAb differs depending on the IgG subclasses. Our previous clinical research demonstrated that the patients with β1AR-AAb better responded to β-blocker therapy, but the following studies found that its response also differed among IgG subclasses. Further studies are needed to elucidate the possible pathogenic role of IgG subclasses of β1AR-AAbs in DCM, and the broad spectrum of cardiovascular diseases including HF with preserved ejection fraction.
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Affiliation(s)
- Akane Kawai
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Midori Yukino-Iwashita
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Ryota Nakazawa
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Akira Taruoka
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Yusuke Yumita
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Asako Takefuji
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Risako Yasuda
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Nobuyuki Masaki
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yasuo Ido
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (A.K.)
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Naman T, Abuduhalike R, Abudouwayiti A, Sun J, Mahemuti A. Development and Validation of a Novel Nomogram to Predict the Impact of the Polymorphisms of the Variants of ICAM-1 Gene on the Prognosis of Ischemic Cardiomyopathy. Int J Gen Med 2023; 16:4051-4066. [PMID: 37700741 PMCID: PMC10493138 DOI: 10.2147/ijgm.s425872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
Object This study investigated the correlation between polymorphisms of the ICAM-1 gene and prognosis of Ischemic cardiomyopathy (ICM), and developed a prognostic model for predicting the prognosis ICM on the basis of ICAM-1 gene variants. Methods The current study included totally 576 patients with ICM. All patients are randomly divided into training group with 399 patients and validation group with 177 patients. The prognostic model was constructed by using the data of training group. Univariable Cox-regression analysis was performed, including clinical and gene variants, then used the least absolute shrinkage and selection operator (LASSO) regression model to optimize feature selection. Furthermore, multivariate Cox-regression was applied to build the prognostic nomogram model, which included clinical and gene features chosen by the LASSO regression model. Following that, the receiver operating characteristic (ROC) curve, C-index, calibration plot analyses and decision curve analysis (DCA) were carried out to evaluate the discrimination ability, consistency, and clinical utility of the prognostic model. Results Predicting factors rs281430, ventricular arrhythmia, treating by PCI or CABG, use of β-blockers, heart rate (HR), serum sodium level, left ventricular end-diastolic diameter (LVDD) were the risk factors of the prognosis of ICM, incorporated these factors into the prognostic nomogram model. The constructed nomogram performed well in discrimination ability, as observed by the ROC and C-index. Furthermore, as shown by calibration curves, our nomogram's predicted probabilities were highly consistent with measured values. With threshold probabilities, DCA suggested that our nomogram could be useful in the clinic. Conclusion rs281430 mutation (from AA genotype to AG or GG genotype) is a risk factor for ICM patients to have a higher survival probability; the survival probability of ICM patients with the mutant genotype (AG or GG) is lower than those with the wild genotype (AA).
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Affiliation(s)
- Tuersunjiang Naman
- Department of Heart Failure, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Refukaiti Abuduhalike
- Department of Heart Failure, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Aihaidan Abudouwayiti
- Department of Heart Failure, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Juan Sun
- Department of Heart Failure, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Ailiman Mahemuti
- Department of Heart Failure, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
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López-Ponce de Leon JD, Estacio M, Giraldo N, Escalante M, Rodas Y, Largo J, Lores J, Victoria MC, Argote D, Florez N, Carrillo D, Olaya P, Mejia M, Gomez JE. Hypertrophic Cardiomyopathy in a Latin American Center: A Single Center Observational Study. J Clin Med 2023; 12:5682. [PMID: 37685749 PMCID: PMC10489055 DOI: 10.3390/jcm12175682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a complex disorder that includes various phenotypes, leading to different manifestations. It also shares different disadvantages typical of rare diseases, including limited recognition, lack of prospective studies assessing treatment, and little or delayed access to advanced treatment options. Reliable data about the prevalence and natural history of cardiomyopathies in South America are lacking. This study summarizes the features and management of patients with HCM in a university hospital in Colombia. METHODS This was an observational retrospective cohort study of patients with HCM between January 2010 and December 2021. Patient data were analyzed from an institutional cardiomyopathy registry. Demographic, paraclinical, and outcome data were collected. RESULTS A total of 82 patients during the study period were enrolled. Of these, 67.1% were male, and the mean age at diagnosis was 49 years. Approximately 83% were in NYHA functional class I and II, and the most reported symptoms were dyspnea (38%), angina (20%), syncope (15%), and palpitations (11%). In addition, 89% had preserved left ventricular ejection fraction (LVEF) with an asymmetric septal pattern in 65%. Five patients (6%) had alcohol septal ablation and four (5%) had septal myectomy. One patient required heart transplantation during follow-up. Sudden cardiovascular death was observed in 2.6%. The overall mortality during follow-up was 7.3%. CONCLUSIONS HCM is a complex and heterogeneous disorder that presents with significant morbidity and mortality. Our registry provides comprehensive data on disease courses and management in a developing country.
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Affiliation(s)
- Juan David López-Ponce de Leon
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Mayra Estacio
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Natalia Giraldo
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Manuela Escalante
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Yorlany Rodas
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Jessica Largo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juliana Lores
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | | | - Diana Argote
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Noel Florez
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Diana Carrillo
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Pastor Olaya
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Mauricio Mejia
- Departamento de Radiología, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juan Esteban Gomez
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
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110
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Li M, Huang H. Anesthetic Management of Patients with Dilated Cardiomyopathy Undergoing Noncardiac Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1567. [PMID: 37763685 PMCID: PMC10533037 DOI: 10.3390/medicina59091567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Dilated cardiomyopathy (DCM), a primary myocardial disease, is characterized by dilation of the left or both ventricles and systolic dysfunction with or without congestive heart failure. DCM per se is a well-recognized risk factor for sudden cardiac death and poor surgical outcomes following noncardiac surgery. Surgical trauma/stress represents unique challenges for DCM patient management. Unfortunately, there is a big knowledge gap in managing DCM patients undergoing non-cardiac surgery. Therefore, the aim of our review is to provide basic facts and current advances in DCM, as well as a practical guideline to perioperative care providers, for the management of surgical patients with DCM, who are quite rare compared with the general surgical population. This review summarizes recent advances in the medical management of DCM as well as perioperative assessment and management strategies for DCM patients undergoing noncardiac surgery. Optimal surgical outcomes depend on multiple-disciplinary care to minimize perioperative cardiovascular disturbances.
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Affiliation(s)
| | - Han Huang
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China;
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Yuan Y, Yang K, Liu Q, Song W, Jin D, Zhao S. Nonspecific intraventricular conduction delay predicts the prognosis of dilated cardiomyopathy. BMC Cardiovasc Disord 2023; 23:409. [PMID: 37596522 PMCID: PMC10439585 DOI: 10.1186/s12872-023-03437-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Left bundle branch block (LBBB) has been confirmed to be independently associated with adverse outcomes in dilated cardiomyopathy (DCM). However, prognostic data on nonspecific intraventricular conduction delay (NSIVCD) are still limited and conflicting. We aimed to evaluate the prognosis of DCM with NSIVCD. METHODS A total of 548 DCM patients who underwent cardiovascular magnetic resonance imaging (CMR) from January 2016 to December 2017 were consecutively enrolled. The cohort was divided into four groups: 87 with LBBB, 27 with RBBB, 61 with NSIVCD, and 373 without intraventricular conduction delay (IVCD). After a median follow-up of 58 months (interquartile range: 47-65), 123 patients reached the composite endpoints, which included cardiovascular death, heart transplantation, and malignant arrhythmias. The associations between different patterns of IVCD and the outcomes of DCM were analysed by Kaplan‒Meier analysis and Cox proportional hazards regression analysis. RESULTS Of 548 DCM patients, there were 398 males (72.6%), and the average age was 46 ± 15 years, ranging from 18 to 76 years. In Kaplan‒Meier analysis, patients with NSIVCD and LBBB showed higher event rates than patients without IVCD, while RBBB patients did not. By multivariate Cox regression analysis, LBBB, NSIVCD, NYHA class, left ventricular ejection fraction (LVEF), indexed left ventricular end-diastolic diameter (LVEDDI), percentage of late gadolinium enhancement mass (LGE%), and global longitudinal strain (GLS) were found to be independently associated with the outcomes of DCM. CONCLUSIONS In addition to LBBB, NSIVCD was an unfavourable prognostic marker in patients with DCM, independent of LVEDDI, NYHA class, LVEF, LGE%, and GLS.
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Affiliation(s)
- Yong Yuan
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Department of Diagnostic Imaging, Geriatric Hospital of Nanjing Medical University, Nanjing, 210024, China
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Qianjun Liu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Weixiang Song
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Dongsheng Jin
- Department of Diagnostic Imaging, Geriatric Hospital of Nanjing Medical University, Nanjing, 210024, China.
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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Shafaattalab S, Li AY, Jayousi F, Maaref Y, Dababneh S, Hamledari H, Baygi DH, Barszczewski T, Ruprai B, Jannati S, Nagalingam R, Cool AM, Langa P, Chiao M, Roston T, Solaro RJ, Sanatani S, Toepfer C, Lindert S, Lange P, Tibbits GF. Mechanisms of Pathogenicity of Hypertrophic Cardiomyopathy-Associated Troponin T (TNNT2) Variant R278C +/- During Development. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.06.542948. [PMID: 37609317 PMCID: PMC10441323 DOI: 10.1101/2023.06.06.542948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the most common heritable cardiovascular diseases and variants of TNNT2 (cardiac troponin T) are linked to increased risk of sudden cardiac arrest despite causing limited hypertrophy. In this study, a TNNT2 variant, R278C+/-, was generated in both human cardiac recombinant/reconstituted thin filaments (hcRTF) and human- induced pluripotent stem cells (hiPSCs) to investigate the mechanisms by which the R278C+/- variant affects cardiomyocytes at the proteomic and functional levels. The results of proteomics analysis showed a significant upregulation of markers of cardiac hypertrophy and remodeling in R278C+/- vs. the isogenic control. Functional measurements showed that R278C+/- variant enhances the myofilament sensitivity to Ca2+, increases the kinetics of contraction, and causes arrhythmia at frequencies >75 bpm. This study uniquely shows the profound impact of the TNNT2 R278C+/- variant on the cardiomyocyte proteomic profile, cardiac electrical and contractile function in the early stages of cardiac development.
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Affiliation(s)
- Sanam Shafaattalab
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Alison Y Li
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Farah Jayousi
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Yasaman Maaref
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Saif Dababneh
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Homa Hamledari
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Dina Hosseini Baygi
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Tiffany Barszczewski
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Balwinder Ruprai
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Shayan Jannati
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Mechanical Engineering, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Raghu Nagalingam
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Austin M Cool
- Department of Chemistry and Biochemistry, Ohio State University, Columbus, OH, USA
| | - Paulina Langa
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Mu Chiao
- Mechanical Engineering, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Thomas Roston
- Division of Cardiology and Centre for Cardiovascular Innovation, The University of British Columbia 1081 Burrard Street, Level 4 Cardiology Vancouver, BC, V6Z 1Y6, Canada
| | - R John Solaro
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Shubhayan Sanatani
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
| | | | - Steffen Lindert
- Mechanical Engineering, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Philipp Lange
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
- Michael Cuccione Childhood Cancer Research Program, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
| | - Glen F Tibbits
- Cellular and Regenerative Medicine Centre, BC Children’s Hospital Research Institute, Vancouver, BC, V5Z 4H4, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
- Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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Migliore F, Biffi M, Viani S, Pittorru R, Francia P, Pieragnoli P, De Filippo P, Bisignani G, Nigro G, Dello Russo A, Pisanò E, Palmisano P, Rapacciuolo A, Silvetti MS, Lavalle C, Curcio A, Rordorf R, Lovecchio M, Valsecchi S, D’Onofrio A, Botto GL. Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry. Europace 2023; 25:euad239. [PMID: 37536671 PMCID: PMC10438213 DOI: 10.1093/europace/euad239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation. METHODS AND RESULTS We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8-6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1-3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45-1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1-4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6-5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3-2.3) and 3.2% (95% CI: 1.2-6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients. CONCLUSION Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Paolo Pieragnoli
- Arrhythmic Disease Unit, University of Florence, Florence, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Ennio Pisanò
- Cardiology Unit, ‘Vito Fazzi’ Hospital, Lecce, Italy
| | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carlo Lavalle
- Cardiology Department, Policlinico Umberto I - La Sapienza University, Rome, Italy
| | - Antonio Curcio
- Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi Magna Graecia, Campus di Germaneto, Catanzaro, Italy
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | | | - Sergio Valsecchi
- Cardiac Rhythm Management Division, Boston Scientific, Milan, Italy
| | - Antonio D’Onofrio
- ‘Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie’, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- Department of Clinical cardiology and Electrophysiology ASST Rhodense, Rho and Garbagnate M.se, Milan, Italy
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Ikoma T, Narumi T, Akita K, Sato R, Masuda T, Kaneko H, Toda M, Mogi S, Sano M, Suwa K, Naruse Y, Ohtani H, Saotome M, Maekawa Y. Association of an Increased Abnormal Mitochondria Ratio in Cardiomyocytes with a Prolonged Oxygen Uptake Time Constant during Cardiopulmonary Exercise Testing of Patients with Non-ischemic Cardiomyopathy. Intern Med 2023; 62:2163-2170. [PMID: 36450468 PMCID: PMC10465282 DOI: 10.2169/internalmedicine.0697-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The cardiac function, blood distribution, and oxygen extraction in the muscles as well as the pulmonary function determine the oxygen uptake (VO2) kinetics at the onset of exercise. This factor is called the VO2 time constant, and its prolongation is associated with an unfavorable prognosis for heart failure (HF). The mitochondrial function of skeletal muscle is known to reflect exercise tolerance. Morphological changes and dysfunction in cardiac mitochondria are closely related to HF severity and its prognosis. Although mitochondria play an important role in generating energy in cardiomyocytes, the relationship between cardiac mitochondria and the VO2 time constant has not been elucidated. Methods We calculated the ratio of abnormal cardiac mitochondria in human myocardial biopsy samples using an electron microscope and measured the VO2 time constant during cardiopulmonary exercise testing. The VO2 time constant was normalized by the fat-free mass index (FFMI). Patients Fifteen patients with non-ischemic cardiomyopathy (NICM) were included. Patients were divided into two groups according to their median VO2 time constant/FFMI value. Results Patients with a low VO2 time constant/FFMI value had a lower abnormal mitochondria ratio than those with a high VO2 time constant/FFMI value. A multiple linear regression analysis revealed that the ratio of abnormal cardiac mitochondria was independently associated with a high VO2 time constant/FFMI. Conclusion An increased abnormal cardiac mitochondria ratio might be associated with a high VO2 time constant/FFMI value in patients with NICM.
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Affiliation(s)
- Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Taro Narumi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Keitaro Akita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Ryota Sato
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Takayuki Masuda
- Department of Rehabilitation, Hamamatsu University Hospital, Japan
| | - Hanami Kaneko
- Department of Rehabilitation, Hamamatsu University Hospital, Japan
| | - Masahiro Toda
- Department of Rehabilitation, Hamamatsu University Hospital, Japan
| | - Satoshi Mogi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
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Saha S, Singh P, Dutta A, Vaidya H, Negi PC, Sengupta S, Seth S, Basak T. A Comprehensive Insight and Mechanistic Understanding of the Lipidomic Alterations Associated With DCM. JACC. ASIA 2023; 3:539-555. [PMID: 37614533 PMCID: PMC10442885 DOI: 10.1016/j.jacasi.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/17/2023] [Accepted: 06/03/2023] [Indexed: 08/25/2023]
Abstract
Dilated cardiomyopathy (DCM) is one of the major causes of heart failure characterized by the enlargement of the left ventricular cavity and contractile dysfunction of the myocardium. Lipids are the major sources of energy for the myocardium. Impairment of lipid homeostasis has a potential role in the pathogenesis of DCM. In this review, we have summarized the role of different lipids in the progression of DCM that can be considered as potential biomarkers. Further, we have also explained the mechanistic pathways followed by the lipid molecules in disease progression along with the cardioprotective role of certain lipids. As the global epidemiological status of DCM is alarming, it is high time to define some disease-specific biomarkers with greater prognostic value. We are proposing an adaptation of a system lipidomics-based approach to profile DCM patients in order to achieve a better diagnosis and prognosis of the disease.
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Affiliation(s)
- Shubham Saha
- School of Biosciences and Bioengineering. IIT-Mandi, Mandi, India
- BioX Center, Indian Institute of Technology-Mandi, Mandi, India
| | - Praveen Singh
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abhi Dutta
- School of Biosciences and Bioengineering. IIT-Mandi, Mandi, India
- BioX Center, Indian Institute of Technology-Mandi, Mandi, India
| | - Hiteshi Vaidya
- Department of Cardiology, Indira Gandhi Medical College & Hospital, Shimla, India
| | - Prakash Chand Negi
- Department of Cardiology, Indira Gandhi Medical College & Hospital, Shimla, India
| | - Shantanu Sengupta
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Trayambak Basak
- School of Biosciences and Bioengineering. IIT-Mandi, Mandi, India
- BioX Center, Indian Institute of Technology-Mandi, Mandi, India
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Zuin M, Rigatelli G, Porcari A, Merlo M, Bilato C, Roncon L, Sinagra G. Trends in age and sex-specific dilated cardiomyopathy mortality in Italy, 2005-2017. J Cardiovasc Med (Hagerstown) 2023; 24:530-536. [PMID: 37409598 DOI: 10.2459/jcm.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIMS Data regarding the dilated cardiomyopathy (DCM)-related mortality and relative time trends in the Italian population remain scant. We sought to assess the DCM mortality rates and relative trends among the Italian population between 2005 and 2017. METHODS Annual death rates by sex and 5-year age group were extracted from the WHO global mortality database. The age-standardized mortality rates, with relative 95% confidence intervals (95% CIs), also stratified by sex, were calculated using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in DCM-related death rates. To calculate nationwide annual trends in DCM-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. RESULTS In Italy, the DCM age-standardized annual mortality rate decreased from 4.99 (95% CI: 4.97-5.02) deaths per 100 000 to 2.51 (95% CI: 2.49-2.52) deaths per 100 000 population. Over the entire period, men had a higher DCM-related mortality rates than women. Moreover, the mortality rate increased with age, with a seemingly exponential distribution and showing a similar trend among men and women. Joinpoint regression analysis revealed a linear decrease in age-standardized DCM-related mortality from 2005 to 2017 [AAPC: -5.1% (95% CI: -5.9 to -4.3, P < 0.001)] in the entire Italian population. However, the decline was more pronounced among women [AAPC: -5.6 (95% CI: -6.4 to -4.8, P < 0.001)] compared with men [AAPC: -4.9 (95% CI: -5.8 to -4.1, P < 0.001)]. CONCLUSION In Italy, the DCM-related mortality rates linearly declined from 2005 to 2017.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERNGUARD-Heart
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERNGUARD-Heart
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERNGUARD-Heart
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Gil KE, Truong VT, Zareba KM, Varghese J, Simonetti OP, Rajpal S. Parametric mapping by cardiovascular magnetic resonance imaging in sudden cardiac arrest survivors. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1547-1555. [PMID: 37147450 DOI: 10.1007/s10554-023-02864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
Etiology of sudden cardiac arrest (SCA) is identified in less than 30% of survivors without coronary artery disease. We sought to assess the diagnostic role of myocardial parametric mapping using cardiovascular magnetic resonance (CMR) in identifying SCA etiology. Consecutive SCA survivors undergoing CMR with myocardial parametric mapping were included in the study. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Parametric mapping was considered essential for establishing probable SCA etiology by CMR if the SCA cause could not have been determined without its utilization. If the CMR diagnosis could have been potentially based on the combination of cine and LGE imaging, parametric mapping was considered contributory. Of the 35 patients (mean age 46.9 ± 14.1 years; 57% males) included, SCA diagnosis was based on CMR in 23 (66%) patients. Of those, parametric mapping was essential for the diagnosis of myocarditis and tako-tsubo cardiomyopathy (11/48%) and contributed to the diagnosis in 10 (43%) additional cases. Inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis.
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Affiliation(s)
- Katarzyna E Gil
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA.
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
| | - Vien T Truong
- Department of Internal Medicine, Nazareth Hospital, Pennsylvania, PA, USA
| | - Karolina M Zareba
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Juliet Varghese
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rajpal
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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Moscatelli S, Leo I, Bianco F, Borrelli N, Beltrami M, Garofalo M, Milano EG, Bisaccia G, Iellamo F, Bassareo PP, Pradhan A, Cimini A, Perrone MA. The Role of Multimodality Imaging in Pediatric Cardiomyopathies. J Clin Med 2023; 12:4866. [PMID: 37510983 PMCID: PMC10381492 DOI: 10.3390/jcm12144866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Cardiomyopathies are a heterogeneous group of myocardial diseases representing the first cause of heart transplantation in children. Diagnosing and classifying the different phenotypes can be challenging, particularly in this age group, where cardiomyopathies are often overlooked until the onset of severe symptoms. Cardiovascular imaging is crucial in the diagnostic pathway, from screening to classification and follow-up assessment. Several imaging modalities have been proven to be helpful in this field, with echocardiography undoubtedly representing the first imaging approach due to its low cost, lack of radiation, and wide availability. However, particularly in this clinical context, echocardiography may not be able to differentiate from cardiomyopathies with similar phenotypes and is often complemented with cardiovascular magnetic resonance. The latter allows a radiation-free differentiation between different phenotypes with unique myocardial tissue characterization, thus identifying the presence and extent of myocardial fibrosis. Nuclear imaging and computed tomography have a complementary role, although they are less used in daily clinical practice due to the concern related to the use of radiation in pediatric patients. However, these modalities may have some advantages in evaluating children with cardiomyopathies. This paper aims to review the strengths and limitations of each imaging modality in evaluating pediatric patients with suspected or known cardiomyopathies.
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Affiliation(s)
- Sara Moscatelli
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK;
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- Cardiology Department, CMR Unit, Royal Brompton and Harefield Hospitals, Guys’ and St. Thomas’ NHS Trust, London SW3 5NP, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department—AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy;
| | | | - Manuel Garofalo
- Department of Clinical and Experimental Medicine, Careggi University Hospital, 50134 Florence, Italy;
| | - Elena Giulia Milano
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK;
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Ferdinando Iellamo
- Division of Cardiology and Cardio Lab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Mater Misericordiae University Hospital and Children’s Health Ireland Crumlin, D07 R2WY Dublin, Ireland;
| | - Akshyaya Pradhan
- Department of Cardiology, King George’s Medical University, Lucknow 226003, India;
| | - Andrea Cimini
- Nuclear Medicine Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Marco Alfonso Perrone
- Division of Cardiology and Cardio Lab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
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119
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Couto JF, Martins E. Recommendations for the Management of Cardiomyopathy Mutation Carriers: Evidence, Doubts, and Intentions. J Clin Med 2023; 12:4706. [PMID: 37510821 PMCID: PMC10380898 DOI: 10.3390/jcm12144706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Cardiomyopathies may be hereditary and associated with a familial predilection. Morbidity and mortality can be caused by heart failure, sudden death, or arrhythmias. Sometimes these events are the first manifestations of cardiovascular disease. Hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy are perhaps most thoroughly studied in that context. Dilated cardiomyopathy, although most frequently of secondary etiology, has a significant familial cluster. Noncompaction of the left ventricle can sometimes be seen in healthy individuals and, in other instances, is associated with severe LV dysfunction. Genetic testing is of utmost importance, since it might allow for the identification of individuals carrying mutations predisposing them to these diseases. In addition, certain variants may benefit from tailored therapeutic regimens, and thus searching for a causal mutation can impact clinical practice and is recommended for all patients with HCM or ACM. Patients with DCM and positive family history should be included as well. Regular follow-ups are advised, even in those with negative phenotypes, because these disorders are often age dependent. During pregnancy and in the case of athletes, special consideration should be made as well. We intend to summarize the most current evidence regarding their management.
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Affiliation(s)
- José F Couto
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Elisabete Martins
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Centro Hospitalar Universitário São João, Member of the European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), 4200-319 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
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120
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Burrowes KS, Ruppage M, Lowry A, Zhao D. Sex matters: the frequently overlooked importance of considering sex in computational models. Front Physiol 2023; 14:1186646. [PMID: 37520817 PMCID: PMC10374267 DOI: 10.3389/fphys.2023.1186646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Personalised medicine and the development of a virtual human or a digital twin comprises visions of the future of medicine. To realise these innovations, an understanding of the biology and physiology of all people are required if we wish to apply these technologies at a population level. Sex differences in health and biology is one aspect that has frequently been overlooked, with young white males being seen as the "average" human being. This has not been helped by the lack of inclusion of female cells and animals in biomedical research and preclinical studies or the historic exclusion, and still low in proportion, of women in clinical trials. However, there are many known differences in health between the sexes across all scales of biology which can manifest in differences in susceptibility to diseases, symptoms in a given disease, and outcomes to a given treatment. Neglecting these important differences in the development of any health technologies could lead to adverse outcomes for both males and females. Here we highlight just some of the sex differences in the cardio-respiratory systems with the goal of raising awareness that these differences exist. We discuss modelling studies that have considered sex differences and touch on how and when to create sex-specific models. Scientific studies should ensure sex differences are included right from the study planning phase and results reported using sex as a biological variable. Computational models must have sex-specific versions to ensure a movement towards personalised medicine is realised.
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Affiliation(s)
- K. S. Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - M. Ruppage
- Department of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. Lowry
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - D. Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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121
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Wang YY, Tian Y, Li YZ, Liu YF, Zhao YY, Chen LH, Zhang C. The role of m5C methyltransferases in cardiovascular diseases. Front Cardiovasc Med 2023; 10:1225014. [PMID: 37476573 PMCID: PMC10354557 DOI: 10.3389/fcvm.2023.1225014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
The global leading cause of death is cardiovascular disease (CVD). Although advances in prevention and treatment have been made, the role of RNA epigenetics in CVD is not fully understood. Studies have found that RNA modifications regulate gene expression in mammalian cells, and m5C (5-methylcytosine) is a recently discovered RNA modification that plays a role in gene regulation. As a result of these developments, there has been renewed interest in elucidating the nature and function of RNA "epitranscriptomic" modifications. Recent studies on m5C RNA methylomes, their functions, and the proteins that initiate, translate and manipulate this modification are discussed in this review. This review improves the understanding of m5C modifications and their properties, functions, and implications in cardiac pathologies, including cardiomyopathy, heart failure, and atherosclerosis.
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Affiliation(s)
- Yan-Yue Wang
- Key Lab for Arteriosclerology of Hunan Province, Institute of Cardiovascular Disease, Hengyang Medical School, University of South China, Hengyang, China
| | - Yuan Tian
- Key Lab for Arteriosclerology of Hunan Province, Institute of Cardiovascular Disease, Hengyang Medical School, University of South China, Hengyang, China
| | - Yong-Zhen Li
- Key Lab for Arteriosclerology of Hunan Province, Institute of Cardiovascular Disease, Hengyang Medical School, University of South China, Hengyang, China
| | - Yi-Fan Liu
- ResearchLaboratory of Translational Medicine, Hengyang Medical School, University of South China, Hengyang, China
| | - Yu-Yan Zhao
- Key Lab for Arteriosclerology of Hunan Province, Institute of Cardiovascular Disease, Hengyang Medical School, University of South China, Hengyang, China
| | - Lin-Hui Chen
- Key Lab for Arteriosclerology of Hunan Province, Institute of Cardiovascular Disease, Hengyang Medical School, University of South China, Hengyang, China
| | - Chi Zhang
- Key Lab for Arteriosclerology of Hunan Province, Institute of Cardiovascular Disease, Hengyang Medical School, University of South China, Hengyang, China
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Hu J, Xu J, Tan X, Li D, Yao D, Xu B, Lei Y. Dapagliflozin protects against dilated cardiomyopathy progression by targeting NLRP3 inflammasome activation. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:1461-1470. [PMID: 36749400 PMCID: PMC10244283 DOI: 10.1007/s00210-023-02409-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
Dilated cardiomyopathy (DCM) is the major cause of heart failure and has a poor prognosis. The accumulating evidence points to an essential role of the inflammatory component in the process of DCM. Inhibitors of sodium-glucose cotransporter 2 (SGLT2) are widely used to treat heart failure patients due to their cardiac benefits. However, their role in DCM remains unclear. We used the doxorubicin (Dox)-induced DCM model for our study. The SGLT2 inhibitor dapagliflozin (Dapa) improved cardiac function in mice treated with doxorubicin and attenuated the activation of the nucleotide-binding oligomerization domain-like receptor family protein 3 (NLRP3) inflammasome pathway and the expression of inflammatory factors. In addition, dapagliflozin suppresses NLRP3 activation by decreasing p38-dependent toll-like receptor 4 (TLR4) expression. In our study, dagliflozin improves cardiac function in DCM by inhibiting the activity of the NLRP3 inflammasome.
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Affiliation(s)
- Jiaxin Hu
- Cardiovascular Disease Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, No.158 Wuyang Avenue, Enshi, 445000, Hubei, China
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiamin Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xi Tan
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China
| | - Dong Li
- Department of Medical Oncology, Enshi Tujia and Miao Autonomous Prefecture Central Hospital, Enshi, Hubei, China
| | - Dejiang Yao
- Surgical Division IIIThe Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, Hubei, China
| | - Biao Xu
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.
| | - Yuhua Lei
- Cardiovascular Disease Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, No.158 Wuyang Avenue, Enshi, 445000, Hubei, China.
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123
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Milaras N, Dourvas P, Doundoulakis I, Sotiriou Z, Nevras V, Xintarakou A, Laina A, Soulaidopoulos S, Zachos P, Kordalis A, Arsenos P, Archontakis S, Antoniou CK, Tsiachris D, Dilaveris P, Tsioufis K, Sideris S, Gatzoulis K. Noninvasive electrocardiographic risk factors for sudden cardiac death in dilated ca rdiomyopathy: is ambulatory electrocardiography still relevant? Heart Fail Rev 2023; 28:865-878. [PMID: 36872393 PMCID: PMC10289982 DOI: 10.1007/s10741-023-10300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
Risk stratification for sudden cardiac death in dilated cardiomyopathy is a field of constant debate, and the currently proposed criteria have been widely questioned due to their low positive and negative predictive value. In this study, we conducted a systematic review of the literature utilizing the PubMed and Cochrane library platforms, in order to gain insight about dilated cardiomyopathy and its arrhythmic risk stratification utilizing noninvasive risk markers derived mainly from 24 h electrocardiographic monitoring. The obtained articles were reviewed in order to register the various electrocardiographic noninvasive risk factors used, their prevalence, and their prognostic significance in dilated cardiomyopathy. Premature ventricular complexes, nonsustained ventricular tachycardia, late potentials on Signal averaged electrocardiography, T wave alternans, heart rate variability and deceleration capacity of the heart rate, all have both some positive and negative predictive value to identify patients in higher likelihood for ventricular arrhythmias and sudden cardiac death. Corrected QT, QT dispersion, and turbulence slope-turbulence onset of heart rate have yet to establish a predictive correlation in the literature. Although ambulatory electrocardiographic monitoring is frequently used in clinical practice in DCM patients, no single risk marker can be used for the selection of patients at high-risk for malignant ventricular arrhythmic events and sudden cardiac death who could benefit from the implantation of a defibrillator. More studies are needed in order to establish a risk score or a combination of risk factors with the purpose of selecting high-risk patients for ICD implantation in the context of primary prevention.
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Affiliation(s)
- Nikias Milaras
- National and Kapodistrian University of Athens, Athens, Greece.
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece.
| | - Panagiotis Dourvas
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Zoi Sotiriou
- Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece
| | - Vasileios Nevras
- Department of Cardiology, General Hospital of Thessaloniki Gennimatas, Thessaloniki, Greece
| | - Anastasia Xintarakou
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Aggeliki Laina
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Panagiotis Zachos
- Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Stefanos Archontakis
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
| | | | | | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Skevos Sideris
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
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124
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Walter A, Calite E, Geipel A, Strizek B, Recker F, Herberg U, Berg C, Gembruch U. Spectrum and Outcome of Prenatally Diagnosed Fetal Primary Cardiomyopathies-A Twenty-Year Overview. J Clin Med 2023; 12:4366. [PMID: 37445401 DOI: 10.3390/jcm12134366] [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: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE to assess the course and outcome of fetuses affected by primary cardiomyopathy (CM). METHODS Retrospective study of 21 cases with prenatal diagnosis of a primary CM in one tertiary center over a period of 20 years. Charts were reviewed for echocardiographic findings, pregnancy outcome, and postnatal course. The utility of prenatal evaluation was discussed. RESULTS The mean gestational age (GA) at diagnosis was 26.7 (±5.1) weeks. A total of 33.3% (7/21) had associated anomalies. Genetic etiology was confirmed in 50.0% (10/20, with one case lost to follow up). The overall survival rate of the entire study population was 40% (8/20) including termination of pregnancy in 20% (4/20) and an intrauterine mortality rate of 5% (1/20). Of the initial survivors (n = 15), a neonatal and early infant mortality rate of 46.7% (7/15) was calculated. Prenatal isolated right ventricular involvement was the only identified significant parameter for survival (p = 0.035). Four phenotypical groups were identified: 42.9% (9/21) hypertrophic (HCM), 38.1% (8/21) dilated (DCM), 14.3% (3/21) isolated noncompaction (NCCM), and 4.8% (1/21) restrictive CM (RCM). Fetuses assigned to isolated NCCM revealed a 100% survival rate. CONCLUSION Prenatal detection is feasible but needs to a introduce classification method for better consulting and management practices. A poor outcome is still observed in many cases, but an increase in examiners' awareness may influence optimal multispecialized care.
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Affiliation(s)
- Adeline Walter
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Elina Calite
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
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Wray J, Layton S, Vaccarella M, Bucciarelli-Ducci C, Biglino G. "Please keep on beating"-Participation in a Creative Workshop Offers Unexpected Benefits to Women With Takotsubo Cardiomyopathy. J Patient Exp 2023; 10:23743735231151765. [PMID: 37441276 PMCID: PMC10334024 DOI: 10.1177/23743735231151765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM) or "broken heart syndrome" is a rare condition that is more common in women than men, particularly those who are postmenopausal. It mimics a myocardial infarction and psychological factors have been implicated in its etiology as well as being consequences of its presentation. As part of a public engagement project we brought together 8 women (of 12 invited) previously diagnosed with TCM to facilitate a discussion, through participation in a creative workshop-based process, about their illness experience, how they made sense of it, and the meaning it had for them in their lives, and to identify areas of unmet need. Through a range of creative activities we identified that participants had high levels of unmet need in terms of information and psychosocial support. All participants enjoyed the creative process and meeting other people with a diagnosis of TCM. The workshop overall was perceived as empowering. Exploring patient narratives during artist-facilitated workshops is one approach for providing the first steps to addressing unmet need, although the importance of ensuring psychological safety cannot be over-stated.
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Affiliation(s)
- Jo Wray
- Centre for Outcomes and Experience Research
in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS
Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical
Research Centre, London, UK
| | | | | | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield
Hospitals, Guys’ and St Thomas’ NHS Trust, London, UK
- School of Biomedical Engineering and Imaging
Sciences, Faculty of Life Sciences and Medicine, King's College University, London, UK
| | - Giovanni Biglino
- Bristol Medical School, University of
Bristol, Bristol, UK
- National Heart and Lung Institute, Imperial
College London, London, UK
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Dziewięcka E, Winiarczyk M, Wiśniowska-Śmiałek S, Karabinowska-Małocha A, Robak J, Kaciczak M, Baranowski F, Rubiś P. Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy. Cardiology 2023; 148:395-401. [PMID: 37311443 DOI: 10.1159/000531534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND By definition, dilated cardiomyopathy (DCM) is characterized by enlargement of the left ventricular (LV) cavity, and systolic dysfunction. However, in 2016 ESC introduced a new clinical entity - hypokinetic non-dilated cardiomyopathy (HNDC). HNDC is defined as LV systolic dysfunction without LV dilatation. However, the diagnosis of HNDC has so far rarely been made by a cardiologist, and it is unknown whether "classic" DCM differs from HNDC in terms of clinical course and outcomes. OBJECTIVES Comparison of heart failure profiles and outcomes between patients with "classic" dilated (DCM) and HNDCs. METHOD We retrospectively analysed 785 DCM patients, defined as impaired left ventricle (LV) systolic function (ejection fraction [LVEF] <45%) in the absence of coronary artery disease, valve disease, congenital heart disease, and severe arterial hypertension. "Classic" DCM was diagnosed when LV dilatation was present (LV end-diastolic diameter >52 mm/58 mm in women/men); otherwise, HNDC was diagnosed. After 47 ± 31 months, the all-cause mortality and composite endpoint (all-cause mortality, heart transplant - HTX, left ventricle assist device implantation - LVAD) were assessed. RESULTS There were 617 (79%) patients with LV dilatation. Patients with "classic" DCM differed from HNDC in terms of clinically relevant parameters [hypertension (47% vs. 64%, p = 0.008), ventricular tachyarrhythmias (29% vs. 15%, p = 0.007), NYHA class (2.5 ± 0.9 vs. 2.2 ± 0.8, p = 0.003)], had lower cholesterol (LDL: 2.9 ± 1.0 vs. 3.2 ± 1.1 mmol/L, p = 0.049), and higher N-terminal pro-brain natriuretic peptide (3,351 ± 5,415 vs. 2,563 ± 8584 pg/mL, p = 0.0001) and required higher diuretics dosages (57.8 ± 89.5 vs. 33.7 ± 48.7 mg/day, p ≤ 0.0001). All of their chambers were larger (LVEDd: 68.3 ± 4.5 vs. 52.7 ± 3.5 mm, p < 0.0001) and they had lower LVEF (25.2 ± 9.4 vs. 36.6 ± 11.7%, p < 0.0001). During the follow-up, there were 145 (18%) composite endpoints ("classic" DCM vs. HNDC: 122 [20%] vs. 26 [18%], p = 0.22): deaths (97 [16%] vs. 24 [14%], p = 0.67), HTX (17 [4%] vs. 4 [4%], p = 0.97) and LVAD (19 [5%] vs. 0 [0%], p = 0.03). Both groups did not differ in terms of all-cause mortality (p = 0.70), cardiovascular (CV) mortality (p = 0.37) and composite endpoint (p = 0.26). CONCLUSIONS LV dilatation was absent in more than one-fifth of DCM patients. HNDC patients had less severe heart failure symptoms, less advanced cardiac remodelling, and required lower diuretics dosages. On the other hand, "classic" DCM and HNDC patients did not differ in terms of all-cause mortality, CV mortality, and composite endpoint.
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Affiliation(s)
- Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Mateusz Winiarczyk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Aleksandra Karabinowska-Małocha
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Jan Robak
- Students' Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Monika Kaciczak
- Students' Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Filip Baranowski
- Students' Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
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Bustea C, Bungau AF, Tit DM, Iovanovici DC, Toma MM, Bungau SG, Radu AF, Behl T, Cote A, Babes EE. The Rare Condition of Left Ventricular Non-Compaction and Reverse Remodeling. Life (Basel) 2023; 13:1318. [PMID: 37374101 PMCID: PMC10305066 DOI: 10.3390/life13061318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Left ventricular non-compaction (LVNC) is a rare disease defined by morphological criteria, consisting of a two-layered ventricular wall, a thin compacted epicardial layer, and a thick hyper-trabeculated myocardium layer with deep recesses. Controversies still exist regarding whether it is a distinct cardiomyopathy (CM) or a morphological trait of different conditions. This review analyzes data from the literature regarding diagnosis, treatment, and prognosis in LVNC and the current knowledge regarding reverse remodeling in this form of CM. Furthermore, for clear exemplification, we report a case of a 41-year-old male who presented symptoms of heart failure (HF). LVNC CM was suspected at the time of transthoracic echocardiography and was subsequently confirmed upon cardiac magnetic resonance imaging. A favorable remodeling and clinical outcome were registered after including an angiotensin receptor neprilysin inhibitor in the HF treatment. LVNC remains a heterogenous CM, and although a favorable outcome is not commonly encountered, some patients respond well to therapy.
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Affiliation(s)
- Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Diana Carina Iovanovici
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Mirela Marioara Toma
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Andrei-Flavius Radu
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Tapan Behl
- School of Health Sciences & Technology, University of Petroleum and Energy Studies, Bidholi, Dehradun 248007, India;
| | - Adrian Cote
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Elena Emilia Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
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Tang S, Guan L, Tayier B, Mu Y. ECHO provides layer-specific insight of both myocardial deformation and microcirculation dysfunction in dilated cardiomyopathy patients: Clinical value of combined application of left ventricular layer-specific strain and myocardial contrast echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:753-761. [PMID: 36578173 DOI: 10.1002/jcu.23419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 06/02/2023]
Abstract
AIM To investigate the pattern of left ventricular (LV) function and myocardial perfusion and their relationship in dilated cardiomyopathy (DCM) patients using layer-specific speckle tracking imaging (STI) and layer-specific myocardial contrast echocardiography (MCE). MATERIAL AND METHODS Thirty DCM patients and 30 controls were recruited and underwent STI and MCE examination. The peak values of longitudinal strain (LS), circumferential strain (CS) of each layer of LV were recorded and compared between groups. Additionally, cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) of each layer were measured, myocardial blood flow (MBF) was estimated using A × β, above parameters were compared between two groups. RESULTS The LS of endo- (LSendo ), mid- (LSmid ) and epicardium (LSepi ), as well as CS of endo- (RSendo ), mid- (RSmid ), (LSepi ) epicardium and LS endo/epi, CS endo/epi were significantly decreased in DCM patients. More importantly, DCM patients demonstrated decreased A, β and A × β in all three myocardium layers and A endo/epi, β endo/epi, A × β endo/epi compared to the controls. The time to peak and the cardiac cycle required to reach the peak were prolonged in DCM patients (p < 0.05). Longitudinal strain parameters of each layer had a negative relationship with perfusion parameter A and this relationship was strongest between LSendo and Aendo (r = 0.690, p < 0.01). CONCLUSIONS The cardiac strain and, more importantly, coronary microcirculation perfusion was impaired in each layer in DCM patients. The longitudinal function of the LV myocardium was closely related to changes in myocardial microcirculation perfusion.
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Affiliation(s)
- Sha Tang
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
| | - Lina Guan
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
| | - Baihetiya Tayier
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
| | - Yuming Mu
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
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Reuter MC, Massera D, Axel L, Latson LA, Goldstein JM, Stepanovic A, Sherrid MV. Weight loss in hypertrophic cardiomyopathy: A clinical case series. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200179. [PMID: 36923366 PMCID: PMC10009201 DOI: 10.1016/j.ijcrp.2023.200179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/02/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
Background Obesity is prevalent among patients with hypertrophic cardiomyopathy (HCM). Obese HCM patients have greater wall thickness, LV mass, worse hemodynamic function and NYHA class. Weight loss may favorably influence the HCM phenotype. Case summary We describe six patients with hypertrophic cardiomyopathy who lost weight through diet and lifestyle changes (n = 4) or bariatric surgery (n = 2). Radiographic imaging, with cardiac MRI or CT scan, was performed before and after their weight loss. There was a mean decrease in LV mass and indexed LV mass, and a mean numerical decrease in mean wall thickness in up to 14 out of 18 LV segments. There was also NYHA class reduction in symptoms. Discussion In this case series, we have shown that substantial weight loss in HCM patients can be associated with a decrease in LV mass, wall thickness and improvement in symptoms. These observations indicate the potential for positive remodeling of the heart by weight loss. Prospective studies of the benefits of weight loss in HCM are needed.
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Affiliation(s)
- Maria C. Reuter
- Hypertrophic Cardiomyopathy Program, The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Leon Axel
- NYU Radiology Associates, NYU Langone Health, New York, NY, USA
| | - Larry A. Latson
- NYU Radiology Associates, NYU Langone Health, New York, NY, USA
| | | | - Alexandra Stepanovic
- Hypertrophic Cardiomyopathy Program, The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Mark V. Sherrid
- Hypertrophic Cardiomyopathy Program, The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
- Corresponding author. 530 1st AveHCC 4HNew YorkNY 10016, USA
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130
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Chauhan PK, Sowdhamini R. Transcriptome data analysis of primary cardiomyopathies reveals perturbations in arachidonic acid metabolism. Front Cardiovasc Med 2023; 10:1110119. [PMID: 37288265 PMCID: PMC10242083 DOI: 10.3389/fcvm.2023.1110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Cardiomyopathies are complex heart diseases with significant prevalence around the world. Among these, primary forms are the major contributors to heart failure and sudden cardiac death. As a high-energy demanding engine, the heart utilizes fatty acids, glucose, amino acid, lactate and ketone bodies for energy to meet its requirement. However, continuous myocardial stress and cardiomyopathies drive towards metabolic impairment that advances heart failure (HF) pathogenesis. So far, metabolic profile correlation across different cardiomyopathies remains poorly understood. Methods In this study, we systematically explore metabolic differences amongst primary cardiomyopathies. By assessing the metabolic gene expression of all primary cardiomyopathies, we highlight the significantly shared and distinct metabolic pathways that may represent specialized adaptations to unique cellular demands. We utilized publicly available RNA-seq datasets to profile global changes in the above diseases (|log2FC| ≥ 0.28 and BH adjusted p-val 0.1) and performed gene set analysis (GSA) using the PAGE statistics on KEGG pathways. Results Our analysis demonstrates that genes in arachidonic acid metabolism (AA) are significantly perturbed across cardiomyopathies. In particular, the arachidonic acid metabolism gene PLA2G2A interacts with fibroblast marker genes and can potentially influence fibrosis during cardiomyopathy. Conclusion The profound significance of AA metabolism within the cardiovascular system renders it a key player in modulating the phenotypes of cardiomyopathies.
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Affiliation(s)
- Pankaj Kumar Chauhan
- National Centre for Biological Sciences (Tata Institute of Fundamental Research), Bangalore, India
| | - Ramanathan Sowdhamini
- National Centre for Biological Sciences (Tata Institute of Fundamental Research), Bangalore, India
- Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India
- Institute of Bioinformatics and Applied Biotechnology, Bangalore, India
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Miles C, Boukens BJ, Scrocco C, Wilde AA, Nademanee K, Haissaguerre M, Coronel R, Behr ER. Subepicardial Cardiomyopathy: A Disease Underlying J-Wave Syndromes and Idiopathic Ventricular Fibrillation. Circulation 2023; 147:1622-1633. [PMID: 37216437 PMCID: PMC11073566 DOI: 10.1161/circulationaha.122.061924] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/27/2023] [Indexed: 05/24/2023]
Abstract
Brugada syndrome (BrS), early repolarization syndrome (ERS), and idiopathic ventricular fibrillation (iVF) have long been considered primary electrical disorders associated with malignant ventricular arrhythmia and sudden cardiac death. However, recent studies have revealed the presence of subtle microstructural abnormalities of the extracellular matrix in some cases of BrS, ERS, and iVF, particularly within right ventricular subepicardial myocardium. Substrate-based ablation within this region has been shown to ameliorate the electrocardiographic phenotype and to reduce arrhythmia frequency in BrS. Patients with ERS and iVF may also exhibit low-voltage and fractionated electrograms in the ventricular subepicardial myocardium, which can be treated with ablation. A significant proportion of patients with BrS and ERS, as well as some iVF survivors, harbor pathogenic variants in the voltage-gated sodium channel gene, SCN5A, but the majority of genetic susceptibility of these disorders is likely to be polygenic. Here, we postulate that BrS, ERS, and iVF may form part of a spectrum of subtle subepicardial cardiomyopathy. We propose that impaired sodium current, along with genetic and environmental susceptibility, precipitates a reduction in epicardial conduction reserve, facilitating current-to-load mismatch at sites of structural discontinuity, giving rise to electrocardiographic changes and the arrhythmogenic substrate.
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Affiliation(s)
- Chris Miles
- Cardiovascular Clinical Academic Group, St. George’s University Hospitals’ NHS Foundation Trust and Molecular and Clinical Sciences Institute, St. George’s, University of London, UK (C.M., C.S., E.R.B.)
| | - Bastiaan J. Boukens
- Department of Medical Biology, University of Amsterdam, the Netherlands (B.J.B.)
- University of Maastricht, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (B.J.B.)
| | - Chiara Scrocco
- Cardiovascular Clinical Academic Group, St. George’s University Hospitals’ NHS Foundation Trust and Molecular and Clinical Sciences Institute, St. George’s, University of London, UK (C.M., C.S., E.R.B.)
| | - Arthur A.M. Wilde
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, the Netherlands (A.A.M.W.)
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, the Netherlands (A.A.M.W.)
- European Reference Network for rare, low-prevalence, and complex diseases of the heart: ERN GUARD-Heart (A.A.M.W., M.H.)
| | - Koonlawee Nademanee
- Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Chulalongkorn University, Thailand (K.N.)
- Pacific Rim Electrophysiology Research Institute, Bumrungrad Hospital, Bangkok, Thailand (K.N.)
| | - Michel Haissaguerre
- European Reference Network for rare, low-prevalence, and complex diseases of the heart: ERN GUARD-Heart (A.A.M.W., M.H.)
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France (M.H.)
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, France (M.H.)
| | - Ruben Coronel
- Department of Experimental Cardiology, Amsterdam University Medical Centers, Cardiovascular Science, the Netherlands (R.C.)
| | - Elijah R. Behr
- Cardiovascular Clinical Academic Group, St. George’s University Hospitals’ NHS Foundation Trust and Molecular and Clinical Sciences Institute, St. George’s, University of London, UK (C.M., C.S., E.R.B.)
- Mayo Clinic Healthcare, London, UK (E.R.B.)
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Visoiu IS, Rimbas RC, Nicula AI, Mihaila-Baldea S, Magda SL, Mihalcea DJ, Hayat M, Luchian ML, Chitroceanu AM, Vinereanu D. Multimodality Imaging and Biomarker Approach to Characterize the Pathophysiology of Heart Failure in Left Ventricular Non-Compaction with Preserved Ejection Fraction. J Clin Med 2023; 12:3632. [PMID: 37297827 PMCID: PMC10253280 DOI: 10.3390/jcm12113632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Left ventricular non-compaction (LVNC) with preserved ejection fraction (EF) is still a controverted entity. We aimed to characterize structural and functional changes in LVNC with heart failure with preserved EF (HFpEF). METHODS We enrolled 21 patients with LVNC and HFpEF and 21 HFpEF controls. For all patients, we performed CMR, speckle tracking echocardiography (STE), and biomarker assessment for HFpEF (NT-proBNP), for myocardial fibrosis (Galectin-3), and for endothelial dysfunction [ADAMTS13, von Willebrand factor, and their ratio]. By CMR, we assessed native T1 and extracellular volume (ECV) for each LV level (basal, mid, and apical). By STE, we assessed longitudinal strain (LS), globally and at each LV level, base-to-apex gradient, LS layer by layer, from epicardium to endocardium, and transmural deformation gradient. RESULTS In the LVNC group, mean NC/C ratio was 2.9 ± 0.4 and the percentage of NC myocardium mass was 24.4 ± 8.7%. LVNC patients, by comparison with controls, had higher apical native T1 (1061 ± 72 vs. 1008 ± 40 ms), diffusely increased ECV (27.2 ± 2.9 vs. 24.4 ± 2.5%), with higher values at the apical level (29.6 ± 3.8 vs. 25.2 ± 2.8%) (all p < 0.01); they had a lower LS only at the apical level (-21.4 ± 4.4 vs. -24.3 ± 3.2%), with decreased base-to-apex gradient (3.8 ± 4.7 vs. 6.9 ± 3.4%) and transmural deformation gradient (3.9 ± 0.8 vs. 4.8 ± 1.0%). LVNC patients had higher NT-proBNP [237 (156-489) vs. 156 (139-257) pg/mL] and Galectin-3 [7.3 (6.0-11.5) vs. 5.6 (4.8-8.3) ng/mL], and lower ADAMTS13 (767.3 ± 335.5 vs. 962.3 ± 253.7 ng/mL) and ADAMTS13/vWF ratio (all p < 0.05). CONCLUSION LVNC patients with HFpEF have diffuse fibrosis, which is more extensive at the apical level, explaining the decrease in apical deformation and overexpression of Galectin-3. Lower transmural and base-to-apex deformation gradients underpin the sequence of myocardial maturation failure. Endothelial dysfunction, expressed by the lower ADAMTS13 and ADAMTS13/vWF ratio, may play an important role in the mechanism of HFpEF in patients with LVNC.
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Affiliation(s)
- Ionela-Simona Visoiu
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
| | - Roxana Cristina Rimbas
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
| | - Alina Ioana Nicula
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
- Department of Radiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania
| | - Sorina Mihaila-Baldea
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
| | - Stefania Lucia Magda
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
| | - Diana Janina Mihalcea
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
| | - Memis Hayat
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
| | - Maria Luiza Luchian
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
| | - Alexandra Maria Chitroceanu
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
| | - Dragos Vinereanu
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, 37 Dionisie Lupu, 020021 Bucharest, Romania; (I.-S.V.); (R.C.R.); (A.I.N.); (S.M.-B.); (S.L.M.); (D.J.M.); (M.H.)
- Department of Cardiology, University and Emergency Hospital, 169 Splaiul Independentei, 050098 Bucharest, Romania; (M.L.L.); (A.M.C.)
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Lazzeroni D, Crocamo A, Ziveri V, Notarangelo MF, Rizzello D, Spoladori M, Donelli D, Cacciola G, Ardissino D, Niccoli G, Peretto G. Personalized Management of Sudden Death Risk in Primary Cardiomyopathies: From Clinical Evaluation and Multimodality Imaging to Ablation and Cardioverter-Defibrillator Implant. J Pers Med 2023; 13:jpm13050877. [PMID: 37241047 DOI: 10.3390/jpm13050877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Sudden cardiac death represents the leading cause of death worldwide; although the majority of sudden deaths occur in an elderly population with coronary artery disease, some occur in young and otherwise healthy individuals, as is the case of cardiomyopathies. The aim of the present review is to provide a stepwise hierarchical approach for the global sudden death risk estimation in primary cardiomyopathies. Each individual risk factor is analyzed for its contribution to the overall risk of sudden death for each specific cardiomyopathy as well as across all primary myocardial diseases. This stepwise hierarchical and personalized approach starts from the clinical evaluation, subsequently passes through the role of electrocardiographic monitoring and multimodality imaging, and finally concludes with genetic evaluation and electro-anatomical mapping. In fact, the sudden cardiac death risk assessment in cardiomyopathies depends on a multiparametric approach. Moreover, current indications for ventricular arrhythmia ablation and defibrillator implantation are discussed.
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Affiliation(s)
- Davide Lazzeroni
- Prevention and Rehabilitation Unit of Parma, IRCCS Fondazione Don Gnocchi, 43100 Parma, Italy
| | - Antonio Crocamo
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Valentina Ziveri
- Prevention and Rehabilitation Unit of Parma, IRCCS Fondazione Don Gnocchi, 43100 Parma, Italy
| | | | - Davide Rizzello
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Matteo Spoladori
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Davide Donelli
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Giovanna Cacciola
- Prevention and Rehabilitation Unit of Parma, IRCCS Fondazione Don Gnocchi, 43100 Parma, Italy
| | - Diego Ardissino
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Giampaolo Niccoli
- U.O.C. di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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134
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Monda E, Lioncino M, Caiazza M, Simonelli V, Nesti C, Rubino M, Perna A, Mauriello A, Budillon A, Pota V, Bruno G, Varone A, Nigro V, Santorelli FM, Pacileo G, Russo MG, Frisso G, Sampaolo S, Limongelli G. Clinical, Genetic, and Histological Characterization of Patients with Rare Neuromuscular and Mitochondrial Diseases Presenting with Different Cardiomyopathy Phenotypes. Int J Mol Sci 2023; 24:ijms24109108. [PMID: 37240454 DOI: 10.3390/ijms24109108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiomyopathies are mostly determined by genetic mutations affecting either cardiac muscle cell structure or function. Nevertheless, cardiomyopathies may also be part of complex clinical phenotypes in the spectrum of neuromuscular (NMD) or mitochondrial diseases (MD). The aim of this study is to describe the clinical, molecular, and histological characteristics of a consecutive cohort of patients with cardiomyopathy associated with NMDs or MDs referred to a tertiary cardiomyopathy clinic. Consecutive patients with a definitive diagnosis of NMDs and MDs presenting with a cardiomyopathy phenotype were described. Seven patients were identified: two patients with ACAD9 deficiency (Patient 1 carried the c.1240C>T (p.Arg414Cys) homozygous variant in ACAD9; Patient 2 carried the c.1240C>T (p.Arg414Cys) and the c.1646G>A (p.Ar549Gln) variants in ACAD9); two patients with MYH7-related myopathy (Patient 3 carried the c.1325G>A (p.Arg442His) variant in MYH7; Patient 4 carried the c.1357C>T (p.Arg453Cys) variant in MYH7); one patient with desminopathy (Patient 5 carried the c.46C>T (p.Arg16Cys) variant in DES); two patients with mitochondrial myopathy (Patient 6 carried the m.3243A>G variant in MT-TL1; Patient 7 carried the c.253G>A (p.Gly85Arg) and the c.1055C>T (p.Thr352Met) variants in MTO1). All patients underwent a comprehensive cardiovascular and neuromuscular evaluation, including muscle biopsy and genetic testing. This study described the clinical phenotype of rare NMDs and MDs presenting as cardiomyopathies. A multidisciplinary evaluation, combined with genetic testing, plays a main role in the diagnosis of these rare diseases, and provides information about clinical expectations, and guides management.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
| | | | - Claudia Nesti
- Molecular Medicine, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
| | - Alessia Perna
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
| | - Alberta Budillon
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Vincenzo Pota
- NeuroMuscular Omnicentre (NEMO), AORN dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Giorgia Bruno
- Pediatric Neurology Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Naples, Italy
| | - Antonio Varone
- Pediatric Neurology Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via Luigi De Crecchio 7, 80138 Naples, Italy
- Telethon Institute of Genetics and Medicine, Via Campi Flegrei 34, 80078 Pozzuoli, Italy
| | | | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology Unit, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81100 Caserta, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", 80138 Naples, Italy
| | - Simone Sampaolo
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, AORN dei Colli, Monaldi Hospital, 81031 Naples, Italy
- NeuroMuscular Omnicentre (NEMO), AORN dei Colli, Monaldi Hospital, 80131 Naples, Italy
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Gower St, London WC1E 6DD, UK
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Wang J, Huo L, Lin X, Fang L, Hacker M, Niu N, Li X. Molecular imaging of fibroblast activation in multiple non-ischemic cardiomyopathies. EJNMMI Res 2023; 13:39. [PMID: 37155002 PMCID: PMC10167070 DOI: 10.1186/s13550-023-00986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND This pilot study is aimed to perform a pilot visualization study to investigate in vivo fibroblast activation in non-ischemic cardiomyopathies by 68Ga-FAPI-04 PET/CT. METHODS Twenty-nine consecutive patients with symptomatic non-ischemic cardiomyopathies who underwent 68Ga-FAPI-04 PET/CT were prospectively recruited. Clinical characteristics and echocardiographic parameters were recorded. Cardiac uptake was quantified by standardized uptake values (SUVmax, SUVmean, SUVR) and left ventricular metabolism volume. The relationship between 68Ga-FAPI-04 uptake with clinical and echocardiography parameters was investigated. RESULTS Heterogeneous 68Ga-FAPI-04 uptake was observed in different subtypes of non-ischemic cardiomyopathies. Twenty-two (75.9%) patients showed elevated 68Ga-FAPI-04 uptake in the left ventricle, and 10 (34.5%) patients also showed slightly diffuse elevated uptake in the right ventricle. Cardiac uptake values were significantly correlated with enlarged ventricular volume evaluated by echocardiography. CONCLUSION FAPI PET/CT presents a potential value for in vivo visualization and quantification of fibroblast activation on the molecular level. Further study is warranted for investigating the theranostic and prognostic value of elevated FAP signal.
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Affiliation(s)
- Jingnan Wang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Na Niu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China.
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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136
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Sun QC, Liu J, Meng R, Zhang N, Yao J, Yang F, Zhu DL. Association of the triglyceride-glucose index with subclinical left ventricular dysfunction in type 2 diabetes mellitus patients: A retrospective cross-sectional study. J Diabetes Investig 2023. [PMID: 37151188 PMCID: PMC10360383 DOI: 10.1111/jdi.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
AIMS/INTRODUCTION The triglyceride-glucose (TyG) index is a simple and reliable indicator of insulin resistance, and is associated with the development and poor outcomes of cardiovascular disease. Subclinical left ventricular dysfunction (SLVD) is frequently detected in approximately one-third of diabetes patients, but it has not been established whether the TyG index correlates with SLVD. We carried out this research to evaluate the relationship between the TyG index and SLVD in type 2 diabetes mellitus patients. MATERIALS AND METHODS This was a cross-sectional and observational study of 183 type 2 diabetes mellitus inpatients at Nanjing Drum Tower Hospital, Nanjing, China. The TyG index and homeostasis model assessment 2 estimates for insulin resistance (HOMA2-IR) were calculated from biochemical measurements, and speckle-tracking echocardiography was carried out. According to global longitudinal strain (GLS) by echocardiography, participants were categorized into the SLVD (GLS <18%) group or the non-SLVD (GLS ≥18%) group. RESULTS In comparison with non-SLVD participants, SLVD participants had higher insulin resistance, as reflected by elevated TyG and HOMA2-IR indices, as well as a higher body mass index, waist circumference and triglyceride level (P < 0.05 for each). When grouped by TyG index tertiles, an elevated TyG index was correlated with other cardiometabolic risk factors, as well as a decrease in GLS. In the multivariate logistic regression analyses, the TyG index was an independent risk factor for SLVD in type 2 diabetes mellitus patients (odds ratio 2.047, 95% confidence interval 1.07-3.914, P = 0.03), whereas HOMA2-IR was not. CONCLUSIONS The TyG index is independently associated with SLVD in type 2 diabetes mellitus patients and is a more reliable indicator of SLVD than HOMA2-IR.
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Affiliation(s)
- Qi-Chao Sun
- Department of Endocrinology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Jie Liu
- Department of Endocrinology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Ran Meng
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Ning Zhang
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Yao
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Fan Yang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Da-Long Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
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Pio Loco detto Gava C, Merlo M, Paldino A, Korcova R, Massa L, Porcari A, Zecchin M, Perotto M, Rossi M, Sinagra G. New perspectives in diagnosis and risk stratification of non-ischaemic dilated cardiomyopathy. Eur Heart J Suppl 2023; 25:C137-C143. [PMID: 37125318 PMCID: PMC10132605 DOI: 10.1093/eurheartjsupp/suad016] [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] [Indexed: 05/02/2023]
Abstract
Dilated cardiomyopathy is a primitive heart muscle condition, characterized by structural and functional abnormalities, in the absence of a specific cause sufficient to determine the disease. It is, though, an 'umbrella' term that describes the final common pathway of different pathogenic processes and gene-environment interactions. Performing an accurate diagnostic workup and appropriate characterization of the patient has a direct impact on the patient's outcome. The physician should adapt a multiparametric approach, including a careful anamnesis and physical examination and integrating imaging data and genetic testing. Aetiological characterization should be pursued, and appropriate arrhythmic risk stratification should be performed. Evaluations should be repeated thoroughly at follow-up, as the disease is dynamical over time and individual risk might evolve. The goal is an all-around characterization of the patient, a personalized medicine approach, in order to establish a diagnosis and therapy tailored for the individual patient.
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Affiliation(s)
| | - Marco Merlo
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Alessia Paldino
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Renata Korcova
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Laura Massa
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Aldostefano Porcari
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Massimo Zecchin
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Maria Perotto
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
| | - Maddalena Rossi
- Cardiothoracovascular Department, Cardiology, Giuliano Isontina University Health Authority (ASUGI), European Reference Network for rare, low-prevalence, or complex diseases of the Heart (ERN GUARD-Heart), University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste (TS), Italy
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138
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Masri A, Reza N. Genetic Testing for Cardiomyopathies in Japan: Embarking on a Journey of Discovery. J Card Fail 2023; 29:815-817. [PMID: 37169423 DOI: 10.1016/j.cardfail.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Ahmad Masri
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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139
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Autore C, Bariani R, Bauce B, Biagini E, Canepa M, Castelletti S, Crotti L, Limongelli G, Merlo M, Monda E, Pio Loco Detto Gava C, Parisi V, Tini G, Imazio M. From the phenotype to precision medicine: an update on the cardiomyopathies diagnostic workflow. J Cardiovasc Med (Hagerstown) 2023; 24:e178-e186. [PMID: 37186568 DOI: 10.2459/jcm.0000000000001424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Cardiomyopathies are disease of the cardiac muscle largely due to genetic alterations of proteins with 'structural' or 'functional' roles within the cardiomyocyte, going from the regulation of contraction-relaxation, metabolic and energetic processes to ionic fluxes. Modifications occurring to these proteins are responsible, in the vast majority of cases, for the phenotypic manifestations of the disease, including hypertrophic, dilated, arrhythmogenic and restrictive cardiomyopathies. Secondary nonhereditary causes to be excluded include infections, toxicity from drugs or alcohol or medications, hormonal imbalance and so on. Obtaining a phenotypic definition and an etiological diagnosis is becoming increasingly relevant and feasible, thanks to the availability of new tailored treatments and the diagnostic advancements made particularly in the field of genetics. This is, for example, the case for transthyretin cardiac amyloidosis, Fabry disease or dilated cardiomyopathies due to laminopathies. For these diseases, specific medications have been developed, and a more tailored arrhythmic risk stratification guides the implantation of a defibrillator. In addition, new medications directly targeting the altered protein responsible for the phenotype are becoming available (including the myosin inhibitors mavacantem and aficamten, monoclonal antibodies against Ras-MAPK, genetic therapies for sarcoglycanopathies), thus making a precision medicine approach less unrealistic even in the field of cardiomyopathies. For these reasons, a contemporary approach to cardiomyopathies must consider diagnostic algorithms founded on the clinical suspicion of the disease and developed towards a more precise phenotypic definition and etiological diagnosis, based on a multidisciplinary methodology putting together specialists from different disciplines, facilities for advanced imaging testing and genetic and anatomopathological competencies.
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Affiliation(s)
- Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome
| | - Riccardo Bariani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua
| | - Elena Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Marco Canepa
- Department of Internal Medicine, Università degli Studi di Genova
- Cardiovascular Unit, IRCCS Ospedale Policlinico San Martino, Genova
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS San Luca Hospital, Cardiology Department Milan
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS San Luca Hospital, Cardiology Department Milan
- University of Milano-Bicocca, Department of Medicine and Surgery, Milan
| | - Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali -Università della Campania 'Luigi Vanvitelli' - Osp. Monaldi, AORN Colli, Ospedale Monaldi, Napoli
| | - Marco Merlo
- Centre for Diagnosis and Management of Cardiomyopathy, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste
| | - Emanuele Monda
- Dipartimento di Scienze Mediche Traslazionali -Università della Campania 'Luigi Vanvitelli' - Osp. Monaldi, AORN Colli, Ospedale Monaldi, Napoli
| | - Carola Pio Loco Detto Gava
- Centre for Diagnosis and Management of Cardiomyopathy, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste
| | - Vanda Parisi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Giacomo Tini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome
| | - Massimo Imazio
- Dipartimento Cardiotoracico, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
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140
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Kyriakopoulou E, Monnikhof T, van Rooij E. Gene editing innovations and their applications in cardiomyopathy research. Dis Model Mech 2023; 16:dmm050088. [PMID: 37222281 PMCID: PMC10233723 DOI: 10.1242/dmm.050088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Cardiomyopathies are among the major triggers of heart failure, but their clinical and genetic complexity have hampered our understanding of these disorders and delayed the development of effective treatments. Alongside the recent identification of multiple cardiomyopathy-associated genetic variants, advances in genome editing are providing new opportunities for cardiac disease modeling and therapeutic intervention, both in vitro and in vivo. Two recent innovations in this field, prime and base editors, have improved editing precision and efficiency, and are opening up new possibilities for gene editing of postmitotic tissues, such as the heart. Here, we review recent advances in prime and base editors, the methods to optimize their delivery and targeting efficiency, their strengths and limitations, and the challenges that remain to be addressed to improve the application of these tools to the heart and their translation to the clinic.
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Affiliation(s)
- Eirini Kyriakopoulou
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center, 3584CT Utrecht, The Netherlands
| | - Thomas Monnikhof
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center, 3584CT Utrecht, The Netherlands
| | - Eva van Rooij
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center, 3584CT Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands
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141
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Kubo T, Kitaoka H. Genetic Testing for Cardiomyopathy in Japan 2022: Current Status and Issues of Precision Medicine. J Card Fail 2023; 29:805-814. [PMID: 37169422 DOI: 10.1016/j.cardfail.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 05/13/2023]
Abstract
Although many causative genes for primary cardiomyopathy have been identified, the use of genetic testing in routine practice is limited in Japan presently. Genetic diagnosis has been reported to be useful for early diagnosis through cascade genetic screening in the family, differentiating secondary cardiomyopathies, and predicting prognosis in some patients; nonetheless, the acquisition of genetic information for cardiomyopathy is stagnating in actual clinical practice. There seem to be a number of reasons for this phenomenon, and although the use of next-generation sequencers has resolved some of the past issues, the importance of pathogenicity studies of variants that are identified is growing. To ensure that patients with cardiomyopathy and their relatives can receive precision medicine, the results of genetic analysis linked to clinical information need to be collected, and a database of variants in Japanese people needs to be established.
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Affiliation(s)
- Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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142
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Wu Z, Wang X, Liang H, Liu F, Li Y, Zhang H, Wang C, Wang Q. Identification of Signature Genes of Dilated Cardiomyopathy Using Integrated Bioinformatics Analysis. Int J Mol Sci 2023; 24:ijms24087339. [PMID: 37108502 PMCID: PMC10139023 DOI: 10.3390/ijms24087339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular or biventricular enlargement with systolic dysfunction. To date, the underlying molecular mechanisms of dilated cardiomyopathy pathogenesis have not been fully elucidated, although some insights have been presented. In this study, we combined public database resources and a doxorubicin-induced DCM mouse model to explore the significant genes of DCM in full depth. We first retrieved six DCM-related microarray datasets from the GEO database using several keywords. Then we used the "LIMMA" (linear model for microarray data) R package to filter each microarray for differentially expressed genes (DEGs). Robust rank aggregation (RRA), an extremely robust rank aggregation method based on sequential statistics, was then used to integrate the results of the six microarray datasets to filter out the reliable differential genes. To further improve the reliability of our results, we established a doxorubicin-induced DCM model in C57BL/6N mice, using the "DESeq2" software package to identify DEGs in the sequencing data. We cross-validated the results of RRA analysis with those of animal experiments by taking intersections and identified three key differential genes (including BEX1, RGCC and VSIG4) associated with DCM as well as many important biological processes (extracellular matrix organisation, extracellular structural organisation, sulphur compound binding, and extracellular matrix structural components) and a signalling pathway (HIF-1 signalling pathway). In addition, we confirmed the significant effect of these three genes in DCM using binary logistic regression analysis. These findings will help us to better understand the pathogenesis of DCM and may be key targets for future clinical management.
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Affiliation(s)
- Zhimin Wu
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
| | - Xu Wang
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
| | - Hao Liang
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
| | - Fangfang Liu
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
| | - Yingxuan Li
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
| | - Huaxing Zhang
- Core Facilities and Centers, Hebei Medical University, Shijiazhuang 050017, China
| | - Chunying Wang
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
| | - Qiao Wang
- Department of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
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143
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Moustafa A, Hashemi S, Brar G, Grigull J, Ng SHS, Williams D, Schmitt-Ulms G, McDermott JC. The MEF2A transcription factor interactome in cardiomyocytes. Cell Death Dis 2023; 14:240. [PMID: 37019881 PMCID: PMC10076289 DOI: 10.1038/s41419-023-05665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/02/2022] [Accepted: 02/08/2023] [Indexed: 04/07/2023]
Abstract
Transcriptional regulators encoded by the Myocyte Enhancer Factor 2 (MEF2) gene family play a fundamental role in cardiac development, homeostasis and pathology. Previous studies indicate that MEF2A protein-protein interactions serve as a network hub in several cardiomyocyte cellular processes. Based on the idea that interactions with regulatory protein partners underly the diverse roles of MEF2A in cardiomyocyte gene expression, we undertook a systematic unbiased screen of the MEF2A protein interactome in primary cardiomyocytes using an affinity purification-based quantitative mass spectrometry approach. Bioinformatic processing of the MEF2A interactome revealed protein networks involved in the regulation of programmed cell death, inflammatory responses, actin dynamics and stress signaling in primary cardiomyocytes. Further biochemical and functional confirmation of specific protein-protein interactions documented a dynamic interaction between MEF2A and STAT3 proteins. Integration of transcriptome level data from MEF2A and STAT3-depleted cardiomyocytes reveals that the balance between MEF2A and STAT3 activity exerts a level of executive control over the inflammatory response and cardiomyocyte cell survival and experimentally ameliorates Phenylephrine induced cardiomyocyte hypertrophy. Lastly, we identified several MEF2A/STAT3 co-regulated genes, including the MMP9 gene. Herein, we document the cardiomyocyte MEF2A interactome, which furthers our understanding of protein networks involved in the hierarchical control of normal and pathophysiological cardiomyocyte gene expression in the mammalian heart.
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Affiliation(s)
- Amira Moustafa
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
- Muscle Health Research Centre (MHRC), York University, Toronto, ON, M3J 1P3, Canada
- Centre for Research in Biomolecular Interactions (CRBI), York University, Toronto, ON, M3J 1P3, Canada
| | - Sara Hashemi
- Analytical Sciences, Sanofi, Toronto, ON, M2R 3T4, Canada
- Seneca College, School of Health Sciences, King City, ON, L7B 1B3, Canada
| | - Gurnoor Brar
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
- Muscle Health Research Centre (MHRC), York University, Toronto, ON, M3J 1P3, Canada
- Centre for Research in Biomolecular Interactions (CRBI), York University, Toronto, ON, M3J 1P3, Canada
| | - Jörg Grigull
- Department of Mathematics and Statistics, York University, Toronto, ON, M3J1P3, Canada
| | - Siemon H S Ng
- Analytical Sciences, Sanofi, Toronto, ON, M2R 3T4, Canada
- Analytical Development, Notch Therapeutics, Toronto, ON, M5G 1M1, Canada
| | - Declan Williams
- Tanz Centre for Research in Neurodegenerative Diseases, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5T 0S8, Canada
| | - Gerold Schmitt-Ulms
- Tanz Centre for Research in Neurodegenerative Diseases, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5T 0S8, Canada
| | - John C McDermott
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada.
- Muscle Health Research Centre (MHRC), York University, Toronto, ON, M3J 1P3, Canada.
- Centre for Research in Biomolecular Interactions (CRBI), York University, Toronto, ON, M3J 1P3, Canada.
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Bunch TA, Guhathakurta P, Thompson AR, Lepak VC, Carter AL, Thomas JJ, Thomas DD, Colson BA. Drug discovery for heart failure targeting myosin-binding protein C. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.03.535496. [PMID: 37066417 PMCID: PMC10104056 DOI: 10.1101/2023.04.03.535496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Cardiac MyBP-C (cMyBP-C) interacts with actin-myosin to fine-tune cardiac muscle contractility. Phosphorylation of cMyBP-C, which reduces binding of cMyBP-C to actin or myosin, is often decreased in heart failure (HF) patients, and is cardioprotective in model systems for HF. Therefore, cMyBP-C is a potential target for HF drugs that mimic phosphorylation and/or perturb its interactions with actin or myosin. We labeled actin with fluorescein-5-maleimide (FMAL), and the C0-C2 fragment of cMyBP-C (cC0-C2) with tetramethyl rhodamine (TMR). We performed two complementary high-throughput screens (HTS) on an FDA-approved drug library, to discover small molecules that specifically bind to cMyBP-C and affect its interactions with actin or myosin, using fluorescence lifetime (FLT) detection. We first excited FMAL and detected its FLT, to measure changes in fluorescence resonance energy transfer (FRET) from FMAL (donor) to TMR (acceptor), indicating binding and/or structural changes in the protein complex. Using the same samples, we then excited TMR directly, using a longer wavelength laser, to detect the effects of compounds on the environmentally sensitive FLT of TMR, to identify compounds that bind directly to cC0-C2. Secondary assays, performed on selected modulators with the most promising effects in the primary HTS assays, characterized specificity of these compounds for phosphorylated versus unphosphorylated cC0-C2 and for cC0-C2 versus C1-C2 of fast skeletal muscle (fskC1-C2). A subset of identified compounds modulated ATPase activity in cardiac and/or skeletal myofibrils. These assays establish feasibility for discovery of small-molecule modulators of the cMyBP-C-actin/myosin interaction, with the ultimate goal of developing therapies for HF.
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Flach H, Geiß K, Lohse KA, Feickert M, Dietmann P, Pfeffer S, Kühl M, Kühl SJ. The neonicotinoid thiacloprid leads to multiple defects during early embryogenesis of the South African clawed frog (Xenopuslaevis). Food Chem Toxicol 2023; 176:113761. [PMID: 37028742 DOI: 10.1016/j.fct.2023.113761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
There is increasing concern about the health effects of pesticides that pollute natural waters. In particular, the use of neonicotinoids, such as thiacloprid (THD), is causing unease. THD is considered non-toxic to non-target vertebrates. Studies classify THD as carcinogenic, toxic to reproduction, and therefore harmful to the environment. A detailed study of possible THD effects during the amphibian embryogenesis is needed because leaching can introduce THD into aquatic environments. We incubated stage 2 embryos of the South African clawed frog in various THD concentrations (0.1-100 mg/L) at 14 °C to study the potential effects of a one-time THD contamination of waters on the early embryogenesis. We showed that THD has, indeed, negative effects on the embryonic development of the X. laevis. A treatment with THD led to a reduced embryonic body length and mobility. Furthermore, a treatment with THD resulted in smaller cranial cartilages, eyes and brains, and the embryos had shorter cranial nerves and an impaired cardiogenesis. On a molecular basis, THD led to a reduced expression of the brain marker emx1 and the heart marker mhcα. Our results underly the importance of a strict and efficient monitoring of the regulatory levels and application areas of THD.
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Affiliation(s)
- Hannah Flach
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Kristina Geiß
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Kim-André Lohse
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Manuel Feickert
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Petra Dietmann
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Sarah Pfeffer
- Institute of Neurobiology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Michael Kühl
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Susanne J Kühl
- Institute of Biochemistry and Molecular Biology, Ulm University, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
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Peretto G, Sommariva E, Di Resta C, Rabino M, Villatore A, Lazzeroni D, Sala S, Pompilio G, Cooper LT. Myocardial Inflammation as a Manifestation of Genetic Cardiomyopathies: From Bedside to the Bench. Biomolecules 2023; 13:646. [PMID: 37189393 PMCID: PMC10136351 DOI: 10.3390/biom13040646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Over recent years, preclinical and clinical evidence has implicated myocardial inflammation (M-Infl) in the pathophysiology and phenotypes of traditionally genetic cardiomyopathies. M-Infl resembling myocarditis on imaging and histology occurs frequently as a clinical manifestation of classically genetic cardiac diseases, including dilated and arrhythmogenic cardiomyopathy. The emerging role of M-Infl in disease pathophysiology is leading to the identification of druggable targets for molecular treatment of the inflammatory process and a new paradigm in the field of cardiomyopathies. Cardiomyopathies constitute a leading cause of heart failure and arrhythmic sudden death in the young population. The aim of this review is to present, from bedside to bench, the current state of the art about the genetic basis of M-Infl in nonischemic cardiomyopathies of the dilated and arrhythmogenic spectrum in order to prompt future research towards the identification of novel mechanisms and treatment targets, with the ultimate goal of lowering disease morbidity and mortality.
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Affiliation(s)
- Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20139 Milan, Italy
| | - Chiara Di Resta
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Genomic Unit for the Diagnosis of Human Pathologies, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Martina Rabino
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20139 Milan, Italy
| | - Andrea Villatore
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20139 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
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147
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Okan T, Lodeen H, Abawkaw M, Stetsiv T, Semeniv V. Left Ventricular Noncompaction Cardiomyopathy in an Elderly Patient: A Case Report and Literature Review. Cureus 2023; 15:e38305. [PMID: 37261174 PMCID: PMC10226827 DOI: 10.7759/cureus.38305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/29/2023] [Indexed: 06/02/2023] Open
Abstract
Isolated left ventricular noncompaction cardiomyopathy (LVNC), also known as spongy myocardium, is an extremely rare congenital disorder belonging to unclassified cardiomyopathies by the World Health Organization and classified as a genetic cardiomyopathy by the American Heart Association. Adult prevalence is 0.017-0.26% in observational echocardiographic studies. The disease occurs due to the intrauterine arrest of normal myocardial compaction, leading to left ventricular dysfunction. Reported mortality is high, ranging from 35 to 47% over a 42- to 72-month follow-up period. Knowledge regarding proper diagnosis, morbidity, and prognosis is limited; thus, this disease is subdiagnosed. Our aim is to highlight a diagnostic approach to LVNC in an elderly patient and to stress specific diagnostic signs that make the disease more recognizable. We are reporting a case of noncompaction cardiomyopathy in a 62-year-old male without any significant past medical history who was referred to our clinic for arrhythmia evaluation. The patient had several brief episodes of palpitations over the past two months. On physical examination, he presented a blowing systolic murmur at the apex and an irregularly irregular rhythm. The 12-lead electrocardiogram (ECG) demonstrated atrial fibrillation and ST-T segment depression in the V4-V6 leads. A transthoracic echocardiogram (TTE) showed signs of dilated cardiomyopathy, severe eccentric left ventricular hypertrophy, decreased contractility with an ejection fraction (EF) <30%, moderate mitral and tricuspid regurgitations, and moderate pulmonary hypertension. Multiple prominent trabeculations were noticed in the middle and apical segments of the left ventricle. The noncompacted to compacted myocardium ratio was >2.5:1. Cardiac catheterization excluded ischemic heart disease. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis of LVNC. The patient started treatment with carvedilol, ramipril, verospiron, torasemide, and rivaroxaban. An implantable cardioverter-defibrillator (ICD) was recommended. In conclusion, the diagnosis of LVNC in the adult population is often delayed because of similarities with more frequently diagnosed diseases. TTE is the initial diagnostic test of choice. Additional imaging modalities (contrast echocardiography, CMR) can help confirm the diagnosis. Early diagnosis is crucial because of the high incidence of life-threatening complications related to heart failure, thromboembolic events, and ventricular arrhythmias. Additional prospective studies are needed to improve the management and outcomes of this rare cardiomyopathy.
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Affiliation(s)
- Tetyana Okan
- Department of Internal Medicine, Lviv National Medical University, Lviv, UKR
| | - Homayoon Lodeen
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Michael Abawkaw
- Department of Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Taras Stetsiv
- Department of Radiology, St. Paraskeva Medical Center, Lviv, UKR
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148
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Del Mestre E, Pio Loco Detto Gava C, Paldino A, Gigli M, Rossi M, Lalario A, Dal Ferro M, Merlo M, Sinagra G. Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy. Eur Heart J Suppl 2023; 25:B144-B148. [PMID: 37091665 PMCID: PMC10120952 DOI: 10.1093/eurheartjsupp/suad087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Dilated cardiomyopathy is a primary disease of the heart muscle, which affects relatively young patients with a low comorbidity profile. It is characterized by structural and/or functional abnormalities leading to systolic dysfunction of the left ventricle or of both ventricles, often associated with dilatation, in the absence of an ischaemic, valvular, or pressure overload cause sufficient to explain the phenotype. Although the prognosis of the disease has greatly improved over the last few decades, prognostic stratification remains a fundamental objective, especially about the prediction of potentially life-threatening arrhythmic events. An accurate diagnostic work-up and an appropriate aetiopathogenetic characterization affect the patients' outcome and represent the essential basis of an adequate prognostic stratification. It is necessary to adopt a multiparametric approach, especially when the aim is the prediction of arrhythmic risk; it includes an integration of medical history and physical examination with cardiac imaging and genetic testing, in order to obtain a personalized diagnosis and therapeutic strategies. Furthermore, the evaluation should be repeated at every clinical check-up, considering the dynamic trend of the pathology and the arrhythmic risk changes over time. This article aims to illustrate how, starting from an exhaustive aetiological and clinical-instrumental characterization, including all diagnostic methods available at present time, it is possible to obtain a tailored diagnostic evaluation and stratification of the arrhythmic risk as accurate as possible.
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Affiliation(s)
- Eva Del Mestre
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Carola Pio Loco Detto Gava
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Alessia Paldino
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Marta Gigli
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Maddalena Rossi
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Andrea Lalario
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Matteo Dal Ferro
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Marco Merlo
- SC Cardiology, Cardiothoracovascular Department, Giuliano-Isontina University Health Authority (ASUGI) and University of Trieste, European Reference Network for Rare, Low-prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart)
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149
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Wang C, Ma Y, Liu Y, Li L, Cui C, Qin H, Zhao Z, Li C, Ju W, Chen M, Li D, Zhou W. Texture analysis of SPECT myocardial perfusion provides prognostic value for dilated cardiomyopathy. J Nucl Cardiol 2023; 30:504-515. [PMID: 35676551 DOI: 10.1007/s12350-022-03006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Texture analysis (TA) has demonstrated clinical values in extracting information, quantifying inhomogeneity, evaluating treatment outcomes, and predicting long-term prognosis for cardiac diseases. The aim of this study was to explore whether TA of SPECT myocardial perfusion could contribute to improving the prognosis of dilated cardiomyopathy (DCM) patients. METHODS Eighty-eight patients were recruited in our study between 2009 and 2020 who were diagnosed with DCM and underwent single-photon emission tomography myocardial perfusion imaging (SPECT MPI). Forty TA features were obtained from quantitative analysis of SPECT imaging in subjects with myocardial perfusion at rest. All patients were divided into two groups: the all-cause death group and the survival group. The prognostic value of texture parameters was assessed by Cox regression and Kaplan-Meier analysis. RESULTS Twenty-five all-cause deaths (28.4%) were observed during the follow-up (39.2±28.7 months). Compared with the survival group, NT-proBNP and total perfusion deficit (TPD) were higher and left ventricular ejection fraction (LVEF) was lower in the all-cause death group. In addition, 26 out of 40 texture parameters were significantly different between the two groups. Univariate Cox regression analysis revealed that NT-proBNP, LVEF, and 25 texture parameters were significantly associated with all-cause death. The multivariate Cox regression analysis showed that low gray-level emphasis (LGLE) (P = 0.010, HR = 4.698, 95% CI 1.457-15.145) and long-run low gray-level emphasis (LRLGE) (P =0.002, HR = 6.085, 95% CI 1.906-19.422) were independent predictors of the survival outcome. When added to clinical parameters, LVEF, TPD, and TA parameters, including LGLE and LRLGE, were incrementally associated with all-cause death (global chi-square statistic of 26.246 vs. 33.521; P = 0.028, global chi-square statistic of 26.246 vs. 34.711; P = 0.004). CONCLUSION TA based on gated SPECT MPI could discover independent prognostic predictors of all-cause death in medically treated patients with DCM. Moreover, TA parameters, including LGLE and LRLGE, independent of the total perfusion deficit of the cardiac myocardium, appeared to provide incremental prognostic value for DCM patients.
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Affiliation(s)
- Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ying Ma
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yanyun Liu
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Shaanxi, 710126, China
| | - Longxi Li
- School of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Huiyuan Qin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Zhongqiang Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Chunxiang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Weihua Zhou
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA.
- Center for Biocomputing and Digital Health, Institute of Computing and Cybersystems, and Health Research Institute, Michigan Technological University, Houghton, USA.
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150
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Tang HS, Kwan CT, He J, Ng PP, Hai SHJ, Kwok FYJ, Sze HF, So MH, Lo HY, Fong HTA, Wan EYF, Lee CH, Yu EYT, Lai YTA, Lee CYJ, Leung ST, Chan HL, Tse HF, Pennell DJ, Mohiaddin RH, Senior R, Yan AT, Yiu KH, Ng MY. Prognostic Utility of Cardiac MRI Myocardial Strain Parameters in Patients With Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study. AJR Am J Roentgenol 2023; 220:524-538. [PMID: 36321987 DOI: 10.2214/ajr.22.28415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND. Prior small single-center studies have yielded conflicting results regarding the prognostic significance of myocardial strain parameters derived from feature tracking (FT) on cardiac MRI in patients with dilated cardiomyopathy (DCM). OBJECTIVE. The purpose of this study was to evaluate the prognostic utility of FT parameters on cardiac MRI in patients with ischemic and nonischemic DCM and to determine the optimal strain parameter for outcome prediction. METHODS. This retrospective study included 471 patients (median age, 61 years; 365 men, 106 women) with ischemic (n = 233) or nonischemic (n = 238) DCM and left ventricular (LV) ejection fraction (EF) less than 50% who underwent cardiac MRI at any of four centers from January 2011 to December 2019. Cardiac MRI parameters were determined by manual contouring. In addition, software-based FT was used to calculate six myocardial strain parameters (LV and right ventricular [RV] global radial strain, global circumferential strain, and global longitudinal strain [GLS]). Late gadolinium enhancement (LGE) was also evaluated. Patients were assessed for a composite outcome of all-cause mortality and/or heart-failure hospitalization. Cox regression models were used to determine associations between strain parameters and the composite outcome. RESULTS. Mean LV EF was 27.5% and mean LV GLS was -6.9%. The median follow-up period was 1328 days. The composite outcome occurred in 220 patients (125 deaths, 95 heart-failure hospitalizations). All six myocardial strain parameters were significant independent predictors of the composite outcome (hazard ratio [HR] = 0.92-1.16; all p < .05). In multivariable models that included age, corrected LV and RV end-diastolic volume, LV and RV EF, and presence of LGE, the only strain parameter that was a significant independent predictor of the composite outcome was LV GLS (HR = 1.13, p = .006); LV EF and presence of LGE were not independent predictors of the composite outcome in the models (p > .05). A LV GLS threshold of -6.8% had sensitivity of 62.6% and specificity of 62.6% in predicting the composite outcome rate at 4.0 years. CONCLUSION. LV GLS, derived from FT on cardiac MRI, is a significant independent predictor of adverse outcomes in patients with DCM. CLINICAL IMPACT. This study strengthens the body of evidence supporting the clinical implementation of FT when performing cardiac MRI in patients with DCM.
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Affiliation(s)
- Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Jianlong He
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Pan Pan Ng
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Siu Han Jojo Hai
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
| | - Fung Yu James Kwok
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Ho Fung Sze
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Man Hon So
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Hong Yip Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR
| | - Chi-Ho Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR
| | - Yee Tak Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Chun Yin Jonan Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong SAR
| | - Siu Ting Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
- Imaging and Intervention Radiology Centre, CUHK Medical Centre, Hong Kong SAR
| | - Hiu Lam Chan
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
| | - Hung Fat Tse
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Dudley J Pennell
- Department of Cardiovascular Magnetic Resonance, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Raad H Mohiaddin
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Roxy Senior
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kai-Hang Yiu
- Department of Medicine, Division of Cardiology, Queen Mary Hospital, Hong Kong SAR
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Rm 406, Block K, Queen Mary Hospital, Hong Kong SAR
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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