401
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Deo R, Katz R, de Boer IH, Sotoodehnia N, Kestenbaum B, Mukamal KJ, Chonchol M, Sarnak MJ, Siscovick D, Shlipak MG, Ix JH. Fibroblast growth factor 23 and sudden versus non-sudden cardiac death: the Cardiovascular Health Study. Am J Kidney Dis 2015; 66:40-6. [PMID: 25572028 DOI: 10.1053/j.ajkd.2014.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/29/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Elevated fibroblast growth factor 23 (FGF-23) concentrations are associated with greater risk of cardiovascular events and mortality, especially among people with chronic kidney disease (CKD). Because individuals with CKD are at an increased risk of sudden cardiac death (SCD), we sought to understand whether FGF-23 level is a stronger risk factor for SCD versus non-SCD. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS 3,244 participants 65 years or older in the community-based Cardiovascular Health Study. PREDICTOR Plasma FGF-23 concentrations. OUTCOMES We assessed SCD and non-SCD in these analyses. SCD was adjudicated rigorously and was defined as a sudden pulseless condition of cardiac origin in a previously stable person occurring out of hospital or in the emergency department. MEASUREMENTS We estimated associations of baseline FGF-23 concentrations with SCD and non-SCD using Cox proportional hazards models after adjustment for demographics, cardiovascular risk factors, comorbid conditions, and kidney function. We also tested whether associations differed by CKD status. RESULTS During a median follow-up of 8.1 years, there were 118 adjudicated SCD and 570 non-SCD events. After multivariable adjustment for demographics, cardiovascular risk factors, comorbid conditions, and parameters of kidney function, higher FGF-23 concentrations were an independent risk factor for non-SCD (HR [per doubling], 1.17; 95% CI, 1.06-1.30). However, elevated FGF-23 concentrations were not associated independently with SCD (HR [per doubling], 1.07; 95% CI, 0.85-1.35). In stratified analysis by CKD status (36.5% of cohort), doubling of FGF-23 concentrations was associated independently with non-SCD (adjusted HR, 1.26; 95% CI, 1.10-1.45). A similar magnitude of association was observed between FGF-23 level and SCD in the CKD subgroup; however, it was not significant (HR, 1.20; 95% CI, 0.89-1.62). LIMITATIONS Limited power to detect moderate-sized effects between FGF-23 level and SCD in both the primary and stratified analyses. CONCLUSIONS In this population-based study, FGF-23 level elevations were associated independently with non-SCD. Among individuals with CKD, the associations between FGF-23 level and SCD and non-SCD were similar.
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Affiliation(s)
- Rajat Deo
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA
| | - Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA
| | | | - Bryan Kestenbaum
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA
| | - Kenneth J Mukamal
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver Health Sciences Center, Aurora, CO
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - David Siscovick
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Department of Health Services, University of Washington, Seattle, WA; Center for Health Studies, Group Health, Seattle, WA
| | - Michael G Shlipak
- General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA; Department of Epidemiology, University of California, San Francisco, CA; Department of Biostatistics, University of California, San Francisco, CA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, San Diego, CA; Division of Nephrology and Preventive Medicine, University of California, San Diego, San Diego, CA
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402
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Jabbari R, Engstrøm T, Glinge C, Risgaard B, Jabbari J, Winkel BG, Terkelsen CJ, Tilsted HH, Jensen LO, Hougaard M, Chiuve SE, Pedersen F, Svendsen JH, Haunsø S, Albert CM, Tfelt-Hansen J. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark. J Am Heart Assoc 2015; 4:e001399. [PMID: 25559012 PMCID: PMC4330064 DOI: 10.1161/jaha.114.001399] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. CONCLUSION Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.
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Affiliation(s)
- Reza Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Thomas Engstrøm
- Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| | - Charlotte Glinge
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Bjarke Risgaard
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Javad Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Bo Gregers Winkel
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | | | - Hans-Henrik Tilsted
- Department of Cardiology, Aalborg University Hospital, Copenhagen, Denmark (H.H.T.)
| | | | - Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., M.H.)
| | - Stephanie E Chiuve
- Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.E.C., C.M.A.)
| | - Frants Pedersen
- Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Jesper Hastrup Svendsen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| | - Stig Haunsø
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.E.C., C.M.A.)
| | - Jacob Tfelt-Hansen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
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403
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Safavi-Naeini P, Rasekh A, Razavi M, Saeed M, Massumi A. Sudden Cardiac Death in Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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404
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Koulaouzidis G, Das S, Cappiello G, Mazomenos EB, Maharatna K, Puddu PE, Morgan JM. Prompt and accurate diagnosis of ventricular arrhythmias with a novel index based on phase space reconstruction of ECG. Int J Cardiol 2014; 182:38-43. [PMID: 25576717 DOI: 10.1016/j.ijcard.2014.12.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
Abstract
AIM To develop a statistical index based on the phase space reconstruction (PSR) of the electrocardiogram (ECG) for the accurate and timely diagnosis of ventricular tachycardia (VT) and ventricular fibrillation (VF). METHODS Thirty-two ECGs with sinus rhythm (SR) and 32 ECGs with VT/VF were analyzed using the PSR technique. Firstly, the method of time delay embedding were employed with the insertion of delay "τ" in the original time-series X(t), which produces the Y(t)=X(t-τ). Afterwards, a PSR diagram was reconstructed by plotting Y(t) against X(t). The method of box counting was applied to analyze the behavior of the PSR trajectories. Measures as mean (μ), standard deviation (σ) and coefficient of variation (CV=σ/μ), kurtosis (β) for the box counting of PSR diagrams were reported. RESULTS During SR, CV was always <0.05, while with the onset of arrhythmia CV increased >0.05. A similar pattern was observed with β, where <6 was considered as the cut-off point between SR and VT/VF. Therefore, the upper threshold for SR was considered CVth=0.05 and βth<6. For optimisation of the accuracy, a new index (J) was proposed: J=wCVCVth+1-wββth. During SR the upper limit of J was the value of 1. Furthermore CV, β and J crossed the cut-off point timely before the onset of arrhythmia (average time: 4min 31s; SD: 2min 30s); allowing sufficient time for preventive therapy. CONCLUSION The J index improved ECG utility for arrhythmia monitoring and detection utility, allowing the prompt and accurate diagnosis of ventricular arrhythmias.
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Affiliation(s)
- George Koulaouzidis
- University Hospital Southampton NHS Foundation Trust, UK; Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull, UK
| | - Saptarshi Das
- School of Electronics and Computer Science, University of Southampton, UK
| | - Grazia Cappiello
- School of Electronics and Computer Science, University of Southampton, UK
| | | | - Koushik Maharatna
- School of Electronics and Computer Science, University of Southampton, UK
| | - Paolo E Puddu
- Department of Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - John M Morgan
- University Hospital Southampton NHS Foundation Trust, UK
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405
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Delayed QRS transition in the precordial leads of an electrocardiogram as a predictor of sudden cardiac death in the general population. Heart Rhythm 2014; 11:2254-60. [DOI: 10.1016/j.hrthm.2014.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Indexed: 11/20/2022]
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406
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Vohra J. Sudden Cardiac Death in the Young: What We Know, What We Don’t Know and What We Need To Do. Heart Lung Circ 2014; 23:1097-9. [DOI: 10.1016/j.hlc.2014.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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407
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Adabag S, Rector TS, Anand IS, McMurray JJ, Zile M, Komajda M, McKelvie RS, Massie B, Carson PE. A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2014; 16:1175-82. [DOI: 10.1002/ejhf.172] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 08/15/2014] [Accepted: 08/29/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Selcuk Adabag
- Veterans Affairs Health Care System; Minnesota MN USA
- University of Minnesota; Minnesota MN USA
| | - Thomas S. Rector
- Veterans Affairs Health Care System; Minnesota MN USA
- University of Minnesota; Minnesota MN USA
| | - Inder S. Anand
- Veterans Affairs Health Care System; Minnesota MN USA
- University of Minnesota; Minnesota MN USA
| | - John J. McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre; Glasgow UK
| | - Michael Zile
- RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina; Charleston SC USA
| | - Michel Komajda
- Université Paris 6; Pitie Salpetriere Hospital; Paris France
| | - Robert S. McKelvie
- Population Health Research Institute and McMaster University; Hamilton Ontario Canada
| | - Barry Massie
- San Francisco Veterans Affairs Medical Center and University of California; San Francisco CA USA
| | - Peter E. Carson
- Washington Veterans Affairs Medical Center and Georgetown University; Washington DC USA
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408
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Sutton NR, Pinsky DJ. Sex Steroid as a New Oracle to Predict Cardiovascular Risk∗. J Am Coll Cardiol 2014; 64:1811-3. [DOI: 10.1016/j.jacc.2014.07.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/22/2014] [Indexed: 11/16/2022]
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409
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The burden of asthma among the South Asian and Chinese population residing in Ontario. Can Respir J 2014; 21:346-350. [PMID: 25184509 DOI: 10.1155/2014/160476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The South Asian and Chinese populations represent a significant portion of the population of Ontario; however, little is known about the burden of respiratory OBJECTIVE: To investigate the prevalence of asthma and the associated health care burden among South Asian and Chinese populations living in Ontario. METHODS Using administrative health data for Ontario, the authors identified individuals of South Asian and Chinese descent using a validated surname algorithm and compared the prevalence of asthma in these groups with the general population using an established asthma case definition for the period 2002 to 2010. Also compared were the rates of asthma-specific emergency department visits and hospitalizations among the ethnic groups. RESULTS In 2010, the prevalence of asthma in South Asians residing in Ontario was similar to that of the general population (12.1% versus 12.4%), and was increasing at a faster rate than in the general population (0.51%⁄year versus 0.34%⁄year). Compared with the general population, the South Asian population had fewer emergency department visits for asthma, whereas the asthma-related hospitalization rate was greatest among the South Asian population (0.45 per 100 person-years). The Chinese population had the lowest asthma prevalence and associated health care use. CONCLUSION The burden of asthma among South Asians in Ontario is increasing and warrants further investigation to determine the reasons for this rise.
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410
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The predictive value of soluble urokinase plasminogen activator receptor (SuPAR) regarding 90-day mortality and 12-month neurological outcome in critically ill patients after out-of-hospital cardiac arrest. Data from the prospective FINNRESUSCI study. Resuscitation 2014; 85:1562-7. [PMID: 25193800 DOI: 10.1016/j.resuscitation.2014.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 12/31/2022]
Abstract
AIM The whole body ischaemia-reperfusion after cardiac arrest (CA) induces a systemic inflammation-reperfusion response. The expression of urokinase plasminogen activator receptor (uPAR) is known to be induced after hypoxia and increased levels of soluble form suPAR have been measured after hypoxia and ischaemia. Our aim was to evaluate, whether ischaemia/reperfusion injury after out-of-hospital cardiac arrest (OHCA) increases suPAR concentrations in serum and to evaluate the prognostic value of suPAR regarding 90-day mortality and 12-month neurological outcome. METHODS This is a pre-determined substudy of prospective FINNRESUSCI study. Total of 287 patients treated in the intensive care units after OHCA and with consent from the next-of-kin and serum samples between baseline and day 4 were included. Outcome and neurological outcome were evaluated according the Pittsburgh Cerebral Performance Categories (CPC). Kaplan-Meier survival curves, areas under receiver operational characteristics curves and positive likelihood ratios for mortality and poor neurological outcome were calculated. RESULTS Non-survivors had higher levels of suPAR after OHCA. Kaplan-Meier survival curves indicated high 90-day mortality in the highest concentration quintiles. LR+ for 1-year CPC 3-5 was 1.8-2.7 for the whole patient cohort and in shockable rhythms 2.0-2.4. In therapeutic hypothermia prognostic value remained. CONCLUSIONS We found that high SuPAR concentrations were associated with poor outcome in patients with OHCA admitted to critical care. However, suPAR alone had inadequate predictive value for poor outcome and did not associate with 12-month neurological outcome.
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411
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Nanavati PP, Mounsey JP, Pursell IW, Simpson RJ, Lewis ME, Mehta ND, Williams JG, Bachman MW, Myers JB, Chung EH. Sudden Unexpected Death in North Carolina (SUDDEN): methodology review and screening results. Open Heart 2014; 1:e000150. [PMID: 25332830 PMCID: PMC4189226 DOI: 10.1136/openhrt-2014-000150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This paper describes the methodology for a prospective, community-based study of sudden unexpected death in Wake County, North Carolina. METHODS From 1 March to 29 June 2013, data of presumed cardiac arrest cases were captured from Wake County Emergency Medical Services. Participants were screened into the presumed sudden unexpected death group based on specific and sequential screening criteria, and medical and public records were collected for each participant in this group. A committee of independent cardiologists reviewed all data to determine final inclusion/exclusion of each participant into registry. RESULTS We received 398 presumed cardiac arrest referrals. Of these, 105 participants, age 18-65 years old, were identified as presumed sudden unexpected deaths. The primary reason for exclusion was survival to hospital (38%). Ninety-five per cent of participants in the presumed sudden unexpected death group experienced an unwitnessed death. Hypertension was present in almost 50%, while dyslipidaemia and diabetes mellitus were present in almost 25% of the same group. In addition, the presumed sudden unexpected death group includes 67.6% males (95% CI 58 to 76) whereas the control group only included 58.9% (95% CI 46 to 55) males. CONCLUSIONS Participant identification and data collection processes identify presumed sudden unexpected death cases and secure medical and public data for screening and final adjudication. The study infrastructure developed in Wake County will allow its expansion to other counties in North Carolina. Preliminary data indicate the study presently focuses on a population demographically representative of North Carolina.
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Affiliation(s)
- Parin P Nanavati
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Paul Mounsey
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Irion W Pursell
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ross J Simpson
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mary Elizabeth Lewis
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Neil D Mehta
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jefferson G Williams
- Department of Emergency Medical Services, Wake County, Raleigh, North Carolina, USA
- UNC Department of Emergency Medicine, UNC-CH, Chapel Hill, North Carolina, USA
| | - Michael W Bachman
- Department of Emergency Medical Services, Wake County, Raleigh, North Carolina, USA
- UNC Department of Emergency Medicine, UNC-CH, Chapel Hill, North Carolina, USA
| | - J Brent Myers
- Department of Emergency Medical Services, Wake County, Raleigh, North Carolina, USA
- UNC Department of Emergency Medicine, UNC-CH, Chapel Hill, North Carolina, USA
| | - Eugene H Chung
- Divisionsof Cardiology and Cardiac Electrophysiology, Department of Medicine, UNC Heart and Vascular, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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412
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Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, Palaniappan L, Piña IL, Ramirez SM, Rodriguez B, Sims M. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation 2014; 130:593-625. [PMID: 25098323 PMCID: PMC4577282 DOI: 10.1161/cir.0000000000000071] [Citation(s) in RCA: 277] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers. METHODS Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches. CONCLUSIONS Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.
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413
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Watanabe E, Tanabe T, Osaka M, Chishaki A, Takase B, Niwano S, Watanabe I, Sugi K, Katoh T, Takayanagi K, Mawatari K, Horie M, Okumura K, Inoue H, Atarashi H, Yamaguchi I, Nagasawa S, Moroe K, Kodama I, Sugimoto T, Aizawa Y. Sudden cardiac arrest recorded during Holter monitoring: Prevalence, antecedent electrical events, and outcomes. Heart Rhythm 2014; 11:1418-25. [DOI: 10.1016/j.hrthm.2014.04.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Indexed: 11/30/2022]
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414
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Abstract
Sudden cardiac deaths account for 350,000 to 380,000 deaths in the United States annually. Implantable cardioverter-defibrillators have improved sudden death outcomes in patients with heart failure, but only a minority of patients with defibrillators receives appropriate therapy for ventricular arrhythmias. The risk prediction for sudden death and selection of patients for defibrillators is based largely on left ventricular ejection fraction and heart failure symptoms because there are no other risk stratification tools that can determine the individual patients who will derive the greatest benefit. There are several other pharmacologic strategies designed to prevent sudden death in patients with heart failure.
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Affiliation(s)
- Liviu Klein
- Division of Cardiology, University of California San Francisco, San Francisco, CA 94143, USA
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415
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Reanimación cerebrocardiopulmonar prolongada exitosa en un paciente con muerte súbita: un reporte de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2014.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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416
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Reyes JG. Successful extended cerebrocardiopulmonary resuscitation of a sudden death patient: A case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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417
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Dumas F, Cariou A. [Epidemiology, prognostic data of cardiac arrest in 2014]. Presse Med 2014; 43:768-74. [PMID: 24890640 DOI: 10.1016/j.lpm.2014.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 04/15/2014] [Indexed: 11/17/2022] Open
Abstract
Epidemiological data on the incidence, the survival and the prognostic factors of cardiac arrest (CA) are often heterogeneous. However, recent advances in methodology and research have improved the knowledge on that topic. The prognosis of victims CA depends on the initial patient's characteristics, the circumstances of the CA and the quality of the management. As a result, the subsequent outcome of these patients relies on the efficiency of the chain of survival: prompt alert, bystander cardiopulmonary resuscitation and early defibrillation, the advanced care life support provided by the emergency medical services and the integration of in-hospital care. Other parameters are also likely to influence the prognosis (such as the system of care or the environment) though their assessment remains incomplete. More important, factors potentially affecting the long-term outcome are currently very less investigated. Finally, despite the potential improvements in the management of these patients for some years now, the temporal trends of the overall survival appear fairly stable. The transition in the profile of patients could partly explain the absence of clear effect on survival.
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Affiliation(s)
- Florence Dumas
- AP-HP, hôpital Cochin, Inserm U970 (équipe 4), université Paris Descartes, service des urgences, centre d'expertise mort subite, 75014 Paris, France.
| | - Alain Cariou
- AP-HP, hôpital Cochin, Inserm U970 (équipe 4), université Paris Descartes, service de réanimation médicale, 75014 Paris, France
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418
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Fan X, Hua W, Xu Y, Ding L, Niu H, Chen K, Xu B, Zhang S. Incidence and predictors of sudden cardiac death in patients with reduced left ventricular ejection fraction after myocardial infarction in an era of revascularisation. Heart 2014; 100:1242-9. [DOI: 10.1136/heartjnl-2013-305144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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419
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Peck KY, Lim YZ, Hopper I, Krum H. Medical therapy versus implantable cardioverter -defibrillator in preventing sudden cardiac death in patients with left ventricular systolic dysfunction and heart failure: A meta-analysis of >35,000 patients. Int J Cardiol 2014; 173:197-203. [DOI: 10.1016/j.ijcard.2014.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 02/02/2014] [Accepted: 02/13/2014] [Indexed: 11/29/2022]
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420
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Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P. Advances in post-mortem CT-angiography. Br J Radiol 2014; 87:20130488. [PMID: 24234582 PMCID: PMC4067028 DOI: 10.1259/bjr.20130488] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 12/31/2022] Open
Abstract
Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.
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Affiliation(s)
- S Grabherr
- University Center of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne, Lausanne, Switzerland
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421
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Fanoe S, Kristensen D, Fink-Jensen A, Jensen HK, Toft E, Nielsen J, Videbech P, Pehrson S, Bundgaard H. Risk of arrhythmia induced by psychotropic medications: a proposal for clinical management. Eur Heart J 2014; 35:1306-15. [DOI: 10.1093/eurheartj/ehu100] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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422
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Bougouin W, Cariou A. Dysfonction myocardique post-arrêt cardiaque. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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423
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Rosenberg MA, Lopez FL, Bůžková P, Adabag S, Chen LY, Sotoodehnia N, Kronmal RA, Siscovick DS, Alonso A, Buxton A, Folsom AR, Mukamal KJ. Height and risk of sudden cardiac death: the Atherosclerosis Risk in Communities and Cardiovascular Health studies. Ann Epidemiol 2014; 24:174-179.e2. [PMID: 24360853 PMCID: PMC3945001 DOI: 10.1016/j.annepidem.2013.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Sudden cardiac death (SCD) is an important cause of mortality in the adult population. Height has been associated with cardiac hypertrophy and an increased risk of arrhythmias but also with decreased risk of coronary heart disease, suggesting a complex association with SCD. METHODS We examined the association of adult height with the risk of physician-adjudicated SCD in two large population-based cohorts: the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study. RESULTS Over an average follow-up time of 11.7 years in Cardiovascular Health Study, there were 199 (3.6%) cases of SCD among 5556 participants. In Atherosclerosis Risk in Communities study, over 12.6 years, there were 227 (1.5%) cases of SCD among 15,633 participants. In both cohorts, there was a trend toward decreased SCD with taller height. In fixed effects meta-analysis, the pooled hazard ratio per 10 cm of height was 0.84; 95% confidence interval, 0.73-0.98; P = .03. The association of increased height with lower risk of SCD was slightly attenuated after inclusion of risk factors associated with height, such as hypertension and left ventricular hypertrophy. The association appeared stronger among men than women in both cohorts. CONCLUSIONS In two population-based prospective cohorts of different ages, greater height was associated with lower risk of SCD.
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Affiliation(s)
- Michael A Rosenberg
- Division of Cardiac Electrophysiology, Veteran's Administration Hospitals of Boston, Harvard Medical School, West Roxbury, MA; Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Faye L Lopez
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle
| | - Selcuk Adabag
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN
| | - Lin Y Chen
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | | | - David S Siscovick
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Alfred Buxton
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Kenneth J Mukamal
- Division of General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center, Boston, MA
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424
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Morillo CA. Sudden cardiac death: improving our pathological diagnosis--are we there yet? Europace 2014; 16:785-6. [PMID: 24574494 DOI: 10.1093/europace/eut433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carlos A Morillo
- Department of Medicine, Cardiology Division, Arrhythmia Service, Hamilton Health Sciences, McMaster University, Population Health Research Institute, 237 Barton St. East, David Braley CVSRI, Room-C-3 120, Hamilton, ON, Canada L8L 2X2
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425
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Betensky BP, Dixit S. Sudden cardiac death in patients with nonischemic cardiomyopathy. Indian Heart J 2014; 66 Suppl 1:S35-45. [PMID: 24568827 DOI: 10.1016/j.ihj.2013.12.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/16/2013] [Indexed: 02/08/2023] Open
Abstract
Sudden cardiac death (SCD) is an important cause of mortality worldwide. Although SCD is most often associated with coronary heart disease, the risk of SCD in patients without ischemic heart disease is well-established. Nonischemic cardiomyopathies, including idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy represent three unique disease entities that have been shown to be highly associated with SCD and ventricular arrhythmias. A variety of risk stratification tools have been investigated, although the optimal strategy remains unknown. Identification of the arrhythmogenic substrate and treatment of ventricular arrhythmias in these subgroups can be challenging. Herein, we aim to discuss the current understanding of the anatomic and electrophysiologic substrate underlying ventricular arrhythmias and highlight features that may be associated with a higher risk of SCD in these 3 conditions.
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Affiliation(s)
- Brian P Betensky
- Division of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjay Dixit
- Division of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Cardiac Electrophysiology, Philadelphia VA Medical Center, Philadelphia, PA, USA.
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426
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Rijnierse MT, de Haan S, Harms HJ, Robbers LF, Wu L, Danad I, Beek AM, Heymans MW, van Rossum AC, Lammertsma AA, Allaart CP, Knaapen P. Impaired Hyperemic Myocardial Blood Flow Is Associated With Inducibility of Ventricular Arrhythmia in Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2014; 7:20-30. [DOI: 10.1161/circimaging.113.001158] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background—
Risk stratification for ventricular arrhythmias (VAs) is important to refine selection criteria for primary prevention implantable cardioverter defibrillator therapy. Impaired hyperemic myocardial blood flow (MBF) is associated with increased mortality rate in ischemic and nonischemic cardiomyopathy, which may be attributed to electric instability inducing VAs. The aim of this pilot study was to assess whether hyperemic MBF impairment may be related with VA inducibility in patients with ischemic cardiomyopathy.
Methods and Results—
Thirty patients with ischemic cardiomyopathy referred for primary prevention implantable cardioverter defibrillator implantation were prospectively included (26 men; 65±8 years old; left ventricular ejection fraction, 29±6%). [
15
O]H
2
O positron-emission tomography was performed to quantify resting MBF, hyperemic MBF, and coronary flow reserve. Left ventricular dimensions, function, and scar burden were assessed with cardiovascular magnetic resonance imaging. An electrophysiological study was performed to test VA inducibility. Positive electrophysiological study patients (n=12) showed reduced hyperemic MBF (1.25±0.30 versus 1.66±0.38 mL·min
−1
·g
−1
;
P
<0.01) and coronary flow reserve (1.59±0.49 versus 2.12±0.48;
P
<0.01) compared with electrophysiological study negative patients (n=18). In electrophysiological study positive patients, the number of scar segments >75% transmurality was higher (
P
<0.05), although scar size and border zone did not differ. Receiver-operating characteristic curve analysis indicated that impaired hyperemic MBF (area under the curve, 0.84; 95% confidence intervals [0.69–0.99]) and coronary flow reserve (area under the curve, 0.77; 95% confidence intervals [0.57–0.96]) were associated with VA inducibility.
Conclusions—
In this pilot study, impaired hyperemic MBF and coronary flow reserve were associated with VA inducibility in patients with ischemic cardiomyopathy. These results are hypothesis generating for a potential role of quantitative positron-emission tomography perfusion imaging in risk stratification for VAs.
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Affiliation(s)
- Mischa T. Rijnierse
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Stefan de Haan
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Hendrik J. Harms
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Lourens F. Robbers
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - LiNa Wu
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Ibrahim Danad
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Aernout M. Beek
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W. Heymans
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C. van Rossum
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A. Lammertsma
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Knaapen
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
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427
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Rao D, Sood D, Pathak P, Dongre S. A cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report. EMERGENCY (TEHRAN, IRAN) 2014; 2:12-7. [PMID: 26495335 PMCID: PMC4614613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Incidence of sudden cardiac death (SCD) has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India. METHODS The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred. RESULTS A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127), followed closely by the age group 60-69 (28.43%; n-58). Male to female ratio was around 10:1. The maximum number of deaths (n=78) was within few hours (6 hours) after the onset of signs and symptoms. In 24 (11.8%) cases major narrowing was noted in both the main coronaries, in 87 (42.6%) cases in the left anterior descending coronary artery (LAD), and in 18 (51.5%) cases in the right coronary artery (RCA). The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86%) and myocardial infarction (n-104; 50.9%). most of the SCDs occurred in the place of residence (n-80; 39.2%) followed closely by death in hospital (n-49; 24.01%). CONCLUSION Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1.
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Affiliation(s)
- Dinesh Rao
- Executive Director and Chief of Forensic Pathologist, Legal Medicine Unit, Kingston, Jamaica,Corresponding Author: Dinesh Rao; Department of Forensic Medicine, No 15, Chikkasandra, Hesargatta Main Road, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India. Phone/Fax +9741360206;
| | - Divya Sood
- Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India
| | - P. Pathak
- Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India
| | - Sudhir.D Dongre
- Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India
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428
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Berger RJ, O'Shea JG. AEDs at your fingertips: automated external defibrillators on college campuses and a novel approach for increasing accessibility. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2014; 62:592-596. [PMID: 25116796 DOI: 10.1080/07448481.2014.947993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The use of automated external defibrillators (AEDs) increases survival in cardiac arrest events. Due to the success of previous efforts and free, readily available mobile mapping software, the discussion is to emphasize the importance of the use of AEDs to prevent sudden cardiac arrest-related deaths on college campuses and abroad, while suggesting a novel approach to aiding in access and awareness issues. A user-friendly mobile application (a low-cost iOS map) was developed at Florida State University to decrease AED retrieval distance and time. The development of mobile AED maps is feasible for a variety of universities and other entities, with the potential to save lives. Just having AEDs installed is not enough--they need to be easily locatable. Society increasingly relies on phones to provide information, and there are opportunities to use mobile technology to locate and share information about relevant emergency devices; these should be incorporated into the chain of survival.
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Affiliation(s)
- Ryan J Berger
- a College of Medicine , Florida State University , Tallahassee , Florida
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429
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Successful extended cerebrocardiopulmonary resuscitation of a sudden death patient: A case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442030-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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430
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Hussein AA, Gottdiener JS, Bartz TM, Sotoodehnia N, DeFilippi C, Dickfeld T, Deo R, Siscovick D, Stein PK, Lloyd-Jones D. Cardiomyocyte injury assessed by a highly sensitive troponin assay and sudden cardiac death in the community: the Cardiovascular Health Study. J Am Coll Cardiol 2013; 62:2112-20. [PMID: 23973690 PMCID: PMC4157919 DOI: 10.1016/j.jacc.2013.07.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/27/2013] [Accepted: 07/12/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This study sought to determine the association between markers of cardiomyocyte injury in ambulatory subjects and sudden cardiac death (SCD). BACKGROUND The pathophysiology of SCD is complex but is believed to be associated with an abnormal cardiac substrate in most cases. The association between biomarkers of cardiomyocyte injury in ambulatory subjects and SCD has not been investigated. METHODS Levels of cardiac troponin T, a biomarker of cardiomyocyte injury, were measured by a highly sensitive assay (hsTnT) in 4,431 ambulatory participants in the Cardiovascular Health Study, a longitudinal community-based prospective cohort study. Serial measures were obtained in 3,089 subjects. All deaths, including SCD, were adjudicated by a central events committee. RESULTS Over a median follow-up of 13.1 years, 246 participants had SCD. Baseline levels of hsTnT were significantly associated with SCD (hazard ratio [HR] for +1 log(hsTnT): 2.04, 95% confidence interval [CI]: 1.78 to 2.34]. This association persisted in covariate-adjusted Cox analyses accounting for baseline risk factors (HR: 1.30, 95% CI: 1.05 to 1.62), as well as for incident heart failure and myocardial infarction (HR: 1.26, 95% CI: 1.01 to 1.57). The population was also categorized into 3 groups based on baseline hsTnT levels and SCD risk [fully adjusted HR: 1.89 vs. 1.55 vs. 1 (reference group) for hsTnT ≥12.10 vs. 5.01 to 12.09 vs. ≤ 5.00 pg/ml, respectively; p trend = 0.005]. On serial measurements, change in hsTnT levels was also associated with SCD risk (fully adjusted HR for +1 pg/ml per year increase from baseline: 1.03, 95% CI: 1.01 to 1.06). CONCLUSIONS The findings suggest an association between cardiomyocyte injury in ambulatory subjects and SCD risk beyond that of traditional risk factors.
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Affiliation(s)
| | | | | | | | | | | | - Rajat Deo
- University of Pennsylvania, Philadelphia, PA
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431
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Wazni O, Baranowski B. Highly sensitive troponin assay and sudden cardiac death in the community: unlocking the pathophysiology of sudden cardiac death one biomarker at a time. J Am Coll Cardiol 2013; 62:2121-3. [PMID: 23973705 DOI: 10.1016/j.jacc.2013.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Oussama Wazni
- Out Patient Department, Section of Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio.
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432
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Marijon E, Bougouin W, Celermajer DS, Périer MC, Dumas F, Benameur N, Karam N, Lamhaut L, Tafflet M, Mustafic H, de Deus NM, Le Heuzey JY, Desnos M, Avillach P, Spaulding C, Cariou A, Prugger C, Empana JP, Jouven X. Characteristics and Outcomes of Sudden Cardiac Arrest During Sports in Women. Circ Arrhythm Electrophysiol 2013; 6:1185-91. [DOI: 10.1161/circep.113.000651] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
No specific data are available on characteristics and outcome of sudden cardiac death (SCD) during sport activities among women in the general population.
Methods and Results—
From a prospective 5-year national survey, involving 820 subjects 10 to 75 years old who presented with SCD (resuscitated or not) during competitive or recreational sport activities, 43 (5.2%) such events occurred in women, principally during jogging, cycling, and swimming. The level of activity at the time of SCD was moderate to vigorous in 35 cases (81.4%). The overall incidence of sport-related SCD, among 15- to 75-year-old women, was estimated as 0.59 (95% confidence interval [CI], 0.39–0.79) to 2.17 (95% CI, 1.38–2.96) per year per million female sports participants for the 80th and 20th percentiles of reporting districts, respectively. Compared with men, the incidence of SCDs in women was dramatically lower, particularly in the 45- to 54-year range (relative risk, 0.033; 95% CI, 0.015–0.075). Despite similar circumstances of occurrence, survival at hospital admission (46.5%; 95% CI, 31.0–60.0) was significantly higher than that for men (30.0%; 95% CI, 26.8–33.2;
P
=0.02), although this did not reach statistical significance for hospital discharge. Favorable neurological outcomes were similar (80%). Cause of death seemed less likely to be associated with structural heart disease in women compared with men (58.3% versus 95.8%;
P
=0.003).
Conclusions—
Sports-related SCDs in women participants seems dramatically less common (up to 30-fold less frequent) compared with men. Our results also suggest a higher likelihood of successful resuscitation as well as less frequency of structural heart disease in women compared with men.
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Affiliation(s)
- Eloi Marijon
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Wulfran Bougouin
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - David S. Celermajer
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Marie-Cécile Périer
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Florence Dumas
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Nordine Benameur
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Nicole Karam
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Lionel Lamhaut
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Muriel Tafflet
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Hazrije Mustafic
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Natalia Machado de Deus
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Jean-Yves Le Heuzey
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Michel Desnos
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Paul Avillach
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Christian Spaulding
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Alain Cariou
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Christof Prugger
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Jean-Philippe Empana
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Xavier Jouven
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
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433
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Katritsis GD, Katritsis DG. The Electrocardiogram in Athletes Revisited. Arrhythm Electrophysiol Rev 2013; 2:99-104. [PMID: 26835048 DOI: 10.15420/aer.2013.2.2.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/28/2013] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular-related sudden death is the leading cause of mortality in athletes during sport. Thus, it is of clinical importance to identify ECG changes that represent normal adaptation in athletes, and differentiate them from truly pathological findings. However, a distinction between adaptive and pathological ECG changes in athletes is not always easy. This article discusses exercise-induced ECG changes and the differential diagnosis of conditions that present with similar ECG patterns.
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434
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Bougouin W, Marijon E, Puymirat E, Defaye P, Celermajer DS, Le Heuzey JY, Boveda S, Kacet S, Mabo P, Barnay C, Da Costa A, Deharo JC, Daubert JC, Ferrieres J, Simon T, Danchin N. Incidence of sudden cardiac death after ventricular fibrillation complicating acute myocardial infarction: a 5-year cause-of-death analysis of the FAST-MI 2005 registry. Eur Heart J 2013; 35:116-22. [DOI: 10.1093/eurheartj/eht453] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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435
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Polymorphic Ventricular Tachycardia—Part I: Structural Heart Disease and Acquired Causes. Curr Probl Cardiol 2013; 38:463-96. [DOI: 10.1016/j.cpcardiol.2013.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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436
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Hussein AA, Gottdiener JS, Bartz TM, Sotoodehnia N, DeFilippi C, See V, Deo R, Siscovick D, Stein PK, Lloyd-Jones D. Inflammation and sudden cardiac death in a community-based population of older adults: The Cardiovascular Health Study. Heart Rhythm 2013; 10:1425-32. [DOI: 10.1016/j.hrthm.2013.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Indexed: 11/28/2022]
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437
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Nikolaou NI, Christou AH. Cardiac aetiology of cardiac arrest: percutaneous coronary interventions during and after cardiopulmonary resuscitation. Best Pract Res Clin Anaesthesiol 2013; 27:347-58. [PMID: 24054513 DOI: 10.1016/j.bpa.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/23/2013] [Indexed: 11/17/2022]
Abstract
Management and prevention of cardiac arrest in the setting of heart disease is a challenge for modern cardiology. After reviewing the aetiology of sudden cardiac death and discussing the way to identify candidates at risk, we emphasise the role of percutaneous coronary interventions during and after cardiopulmonary resuscitation in the treatment of patients with return of spontaneous circulation after cardiac arrest.
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Affiliation(s)
- Nikolaos I Nikolaou
- Konstantopouleio General Hospital, Agias Olgas 3-5, 14233 N. Ionia-Athens, Greece.
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438
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Wagner JK. Playing with heart and soul…and genomes: sports implications and applications of personal genomics. PeerJ 2013; 1:e120. [PMID: 23940833 PMCID: PMC3740137 DOI: 10.7717/peerj.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/10/2013] [Indexed: 12/19/2022] Open
Abstract
Whether the integration of genetic/omic technologies in sports contexts will facilitate player success, promote player safety, or spur genetic discrimination depends largely upon the game rules established by those currently designing genomic sports medicine programs. The integration has already begun, but there is not yet a playbook for best practices. Thus far discussions have focused largely on whether the integration would occur and how to prevent the integration from occurring, rather than how it could occur in such a way that maximizes benefits, minimizes risks, and avoids the exacerbation of racial disparities. Previous empirical research has identified members of the personal genomics industry offering sports-related DNA tests, and previous legal research has explored the impact of collective bargaining in professional sports as it relates to the employment protections of the Genetic Information Nondiscrimination Act (GINA). Building upon that research and upon participant observations with specific sports-related DNA tests purchased from four direct-to-consumer companies in 2011 and broader personal genomics (PGx) services, this anthropological, legal, and ethical (ALE) discussion highlights fundamental issues that must be addressed by those developing personal genomic sports medicine programs, either independently or through collaborations with commercial providers. For example, the vulnerability of student-athletes creates a number of issues that require careful, deliberate consideration. More broadly, however, this ALE discussion highlights potential sports-related implications (that ultimately might mitigate or, conversely, exacerbate racial disparities among athletes) of whole exome/genome sequencing conducted by biomedical researchers and clinicians for non-sports purposes. For example, the possibility that exome/genome sequencing of individuals who are considered to be non-patients, asymptomatic, normal, etc. will reveal the presence of variants of unknown significance in any one of the genes associated with hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), Marfan's syndrome, and other conditions is not inconsequential, and how this information is reported, interpreted, and used may ultimately prevent the individual from participation in competitive sports. Due to the distribution of genetic diversity that reflects our evolutionary and demographic history (including the discernible effects of restricted gene flow and genetic drift associated with cultural constructs of race) and in recognition of previous policies for "leveling" the playing field in competitive sports based on "natural" athletic abilities, preliminary recommendations are provided to discourage genetic segregation of sports and to develop best practice guidelines for genomic sports medicine programs that will facilitate player success, promote player safety, and avoid genetic discrimination within and beyond the program.
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Affiliation(s)
- Jennifer K. Wagner
- Center for the Integration of Genetic Healthcare Technologies, Division of Translational Medicine and Human Genetics, University of Pennsylvania, United States
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439
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Porthan K, Viitasalo M, Toivonen L, Havulinna AS, Jula A, Tikkanen JT, Väänänen H, Nieminen MS, Huikuri HV, Newton-Cheh C, Salomaa V, Oikarinen L. Predictive value of electrocardiographic T-wave morphology parameters and T-wave peak to T-wave end interval for sudden cardiac death in the general population. Circ Arrhythm Electrophysiol 2013; 6:690-6. [PMID: 23881778 DOI: 10.1161/circep.113.000356] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous population studies have found an association between electrocardiographic T-wave morphology parameters and cardiovascular mortality, but their relationship to sudden cardiac death (SCD) is not clear. To our knowledge, there are no follow-up studies assessing the association between electrocardiographic T-wave peak to T-wave end interval (TPE) and SCD. We assessed the predictive value of electrocardiographic T-wave morphology parameters and TPE for SCD in an adult general population sample. METHODS AND RESULTS A total of 4 T-wave morphology parameters (principal component analysis ratio, T-wave morphology dispersion, total cosine R-to-T, T-wave residuum) as well as TPE were measured from digital standard 12-lead ECGs in 5618 adults (46% men; mean age 50.9±12.5 years) participating in the Finnish population-based Health 2000 Study. After a mean follow-up time of 7.7±1.4 years, 72 SCDs had occurred. In univariable analyses, all T-wave morphology parameters were associated with an increased SCD risk. In multivariable Cox models, T-wave morphology dispersion and total cosine R-to-T remained as predictors of SCD, with T-wave morphology dispersion showing the highest SCD risk (hazard ratio of 1.4 [95% confidence interval 1.1-1.7, P=0.001] per 1 SD increase in the loge T-wave morphology dispersion). In contrast, TPE was not associated with SCD in univariable or multivariable analyses. CONCLUSIONS Electrocardiographic T-wave morphology parameters describing the 3-dimensional shape of the T-wave stratify SCD risk in the general population, but we did not find an association between TPE and SCD.
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Affiliation(s)
- Kimmo Porthan
- Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Finland
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440
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441
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Chang KC, Sasano T, Wang YC, Huang SKS. Nitric Oxide Synthase 1 Adaptor Protein, an Emerging New Genetic Marker for QT Prolongation and Sudden Cardiac Death. ACTA CARDIOLOGICA SINICA 2013; 29:217-225. [PMID: 27122710 PMCID: PMC4804833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/26/2013] [Indexed: 06/05/2023]
Abstract
UNLABELLED Sudden cardiac death (SCD) is defined as sudden unexplained death due to cardiac causes with an acute change in cardiovascular status within 1 hour of onset of symptoms. Alternatively, in unwitnessed cases, SCD can also be defined as a person last seen functionally normal 24 hours before being found dead. Despite significant advances in understanding the pathophysiology of cardiovascular diseases and the resultant improvement in resuscitation science, SCD remains a major healthcare challenge worldwide. Although the most pronounced risk factor for SCD is the presence of coronary artery disease in the setting of a depressed left ventricular function, most deaths occur in the larger, lower-risk subgroups where genetic variations and other conditions may be the precipitating factors in triggering SCD. Recently, a common genetic variation in a neuronal nitric oxide synthase regulator, nitric oxide synthase 1 adaptor protein (NOS1AP) also known as carboxyl-terminal PDZ ligand of neuronal nitric oxide synthase protein (CAPON) gene, has been identified as a new genetic marker in modulating QT interval prolongation and SCD in general populations. Animal study revealed that NOS1AP is expressed in the heart and interacts with NOS1-NO pathways to modulate cardiac repolarization via suppressing the sarcolemmal L-type calcium current and enhancing the IKr current. This important genetic implication was soon replicated in other racial/ethnic populations and extended to a variety of clinical settings including diabetes mellitus, coronary artery disease, myocardial infarction, and congenital or drug-induced long QT syndrome. The purpose of this review aims to provide up-to-date information about the emerging new genetic marker, NOS1AP, in relation to QT prolongation and SCD. KEY WORDS NOS1AP; QT interval; Sudden cardiac death.
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Affiliation(s)
- Kuan-Cheng Chang
- Division of Cardiology, Department of Medicine, China Medical University Hospital
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Tetsuo Sasano
- Department of Biofunctional Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Medicine, China Medical University Hospital
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Shoei K. Stephen Huang
- Section of Cardiac Electrophysiology and Pacing, Scott & White Healthcare, Texas A & M University College of Medicine, Temple, TX, USA
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442
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Abstract
BACKGROUND In postmyocardial infarction patients, transient episodes of ischemia are associated with a greater incidence of sudden cardiac death (SCD). Ventricular tachycardia and ventricular fibrillation (VF) are responsible for the majority of SCDs, but current pharmacological interventions for prevention of lethal ventricular arrhythmias are less than satisfactory. We investigated the efficacy of HBI-3000 (HBI), a novel antiarrhythmic agent, in preventing SCD in a conscious canine model. METHODS After 3 to 7 days of a surgically induced myocardial infarction (ie, 90-minute occlusion of the left anterior descending coronary artery followed by 30 minutes of reperfusion), conscious animals were administered vehicle (0.9% NaCl solution for injection) or HBI (15 mg/kg) intravenously. An occlusive thrombus at a site remote from the previous myocardial infarction was induced by electrolytic injury to the intimal surface of the left circumflex coronary artery. RESULTS Control animals developed premature ventricular complexes (PVCs) followed by ventricular tachycardia, which terminated in VF in 5 of the 8 dogs. HBI reduced the frequency of PVCs, and only 1 of the 9 HBI-treated animals developed VF (P < .05). In a separate group of postinfarcted animals, the electrical conversion threshold was assessed before and after the intravenous administration of HBI (5, 10, or 15 mg/kg) or flecainide (3 mg/kg), a class IC antiarrhythmic agent. The electrical conversion threshold was not altered by HBI, whereas the administration of flecainide increased the threshold (P < .01 vs baseline). CONCLUSIONS The data indicate that HBI is an effective antiarrhythmic and antifibrillatory agent for the prevention of VF or sudden cardiac death.
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Affiliation(s)
- Jullia Y Lee
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109-5632, USA.
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443
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Jabbari R, Risgaard B, Holst AG, Nielsen JB, Glinge C, Engstrøm T, Bundgaard H, Svendsen JH, Haunsø S, Winkel BG, Tfelt-Hansen J. Cardiac symptoms before sudden cardiac death caused by coronary artery disease: a nationwide study among young Danish people. Heart 2013; 99:938-43. [PMID: 23574972 DOI: 10.1136/heartjnl-2012-303534] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD). METHODS We have previously investigated the incidence of sudden cardiac death (SCD) in young Danish people aged 1-35 years in Denmark during 2000-2006. We included all deaths (n=6629) and identified 314 autopsied cases of SCD, 40 of whom (13%) died from CAD. To compare symptoms before death, the CAD case group was sex- and age-matched 1:2 with a control group randomly sampled from a population of 1497 individuals who had died in accidents. We used data from the National Patient Registry on previous contacts with the healthcare system for all persons and read all available patient records, including death certificates and autopsy reports. RESULTS A total of 31 (79%) persons with CAD-SCD had cardiac symptoms such as angina pectoris (n=24, 62%) and dyspnoea during the 12 months before death, and this was significantly higher than in the control group (p<0.001). In the case group, 18 persons (46%) had contacts with the healthcare system for cardiac symptoms before death, and this was also significantly higher than the control group (p<0.001). CONCLUSIONS In this nationwide study we found that 62% of young persons with SCD experienced angina before death, and nearly half of them who died of CAD had sought medical attention within the last year before death.
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Affiliation(s)
- Reza Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Rigshospitalet, Juliane Maries Vej 20, 2100 Copenhagen, Denmark.
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444
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Michaud K, Grabherr S, Jackowski C, Bollmann MD, Doenz F, Mangin P. Postmortem imaging of sudden cardiac death. Int J Legal Med 2013; 128:127-37. [PMID: 23322013 DOI: 10.1007/s00414-013-0819-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/04/2013] [Indexed: 12/25/2022]
Abstract
Postmortem imaging is increasingly used in forensic practice in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. At present, multidetector computed tomography (MDCT), CT angiography, and cardiac magnetic resonance imaging (MRI) are used in postmortem radiological investigation of cardiovascular pathologies. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations. The radiological evaluation of ischemic heart disease (IHD), the most frequent cause of SCD in the general population of industrialized countries, includes the examination of the coronary arteries and myocardium. Postmortem CT angiography (PMCTA) is very useful for the detection of stenoses and occlusions of coronary arteries but less so for the identification of ischemic myocardium. MRI is the method of choice for the radiological investigation of the myocardium in clinical practice, but its accessibility and application are still limited in postmortem practice. There are very few reports implicating postmortem radiology in the investigation of other causes of SCD, such as cardiomyopathies, coronary artery abnormalities, and valvular pathologies. Cardiomyopathies representing the most frequent cause of SCD in young athletes cannot be diagnosed by echocardiography, the most widely available technique in clinical practice for the functional evaluation of the heart and the detection of cardiomyopathies. PMCTA and MRI have the potential to detect advanced stages of diseases when morphological substrate is present, but these methods have yet to be sufficiently validated for postmortem cases. Genetically determined channelopathies cannot be detected radiologically. This review underlines the need to establish the role of postmortem radiology in the diagnosis of SCD.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine, Lausanne and Geneva, Rue du Bugnon 21, 1011, Lausanne, Switzerland,
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445
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Abstract
The abrupt cessation of effective cardiac function due to an aberrant heart rhythm can cause sudden and unexpected death at any age, a syndrome called sudden cardiac death (SCD). Annually, more than 300,000 cases of SCD occur in the United States alone, making this a major public health concern. Our current understanding of the mechanisms responsible for SCD has emerged from decades of basic science investigation into the normal electrophysiology of the heart, the molecular physiology of cardiac ion channels, fundamental cellular and tissue events associated with cardiac arrhythmias, and the molecular genetics of monogenic disorders of heart rhythm. This knowledge has helped shape the current diagnosis and treatment of inherited arrhythmia susceptibility syndromes associated with SCD and has provided a pathophysiological framework for understanding more complex conditions predisposing to this tragic event. This Review presents an overview of the molecular basis of SCD, with a focus on monogenic arrhythmia syndromes.
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Affiliation(s)
- Alfred L George
- Department of Medicine, Vanderbilt University, Nashville, Tennessee 37232, USA.
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446
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Neumann JT, Cohan CH, Dave KR, Wright CB, Perez-Pinzon MA. Global cerebral ischemia: synaptic and cognitive dysfunction. Curr Drug Targets 2013; 14:20-35. [PMID: 23170794 PMCID: PMC5800514 DOI: 10.2174/138945013804806514] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/27/2012] [Accepted: 11/16/2012] [Indexed: 11/22/2022]
Abstract
Cardiopulmonary arrest is one of the leading causes of death and disability, primarily occurring in the aged population. Numerous global cerebral ischemia animal models induce neuronal damage similar to cardiac arrest. These global cerebral ischemia models range from vessel occlusion to total cessation of cardiac function, both of which have allowed for the investigation of this multifaceted disease and detection of numerous agents that are neuroprotective. Synapses endure a variety of alterations after global cerebral ischemia from the resulting excitotoxicity and have been a major target for neuroprotection; however, neuroprotective agents have proven unsuccessful in clinical trials, as neurological outcomes have not displayed significant improvements in patients. A majority of these neuroprotective agents have specific neuronal targets, where the success of future neuroprotective agents may depend on non-specific targets and numerous cognitive improvements. This review focuses on the different models of global cerebral ischemia, neuronal synaptic alterations, synaptic neuroprotection and behavioral tests that can be used to determine deficits in cognitive function after global cerebral ischemia.
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Affiliation(s)
- Jake T Neumann
- Cerebral Vascular Disease Research Laboratories, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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447
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Denjoy I, Maltret A, Probst V. Syndrome du QT long congénital, tachycardie ventriculaire catécholergique, syndrome de Brugada et mort subite inexpliquée en pédiatrie. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2012. [DOI: 10.1016/s1878-6480(12)70829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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448
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Abstract
Wnt signaling has proven to be essential for neural development at various stages and across species. Wnts are involved in morphogenesis and patterning, and their proliferation-promoting role is a key function in stem cell maintenance and the expansion of progenitor pools. Moreover, Wnt signaling is involved in differentiation processes and lineage decision events during both central and peripheral nervous system development. Additionally, several reports point to a role of Wnt signaling in axon guidance and neurite outgrowth. This article reviews and consolidates the existing evidence for the functions of Wnt signaling in neural development.
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Affiliation(s)
- F. Ille
- Institute of Cell Biology, Department of Biology, Swiss Federal Institute of Technology, 8093 Zürich, Switzerland
| | - L. Sommer
- Institute of Cell Biology, Department of Biology, Swiss Federal Institute of Technology, 8093 Zürich, Switzerland
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