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Wolthers SA, Kvisselgaard AD, Christensen HC. Heart to heart - Defying disparities in resuscitation. Resuscitation 2024; 201:110306. [PMID: 38992562 DOI: 10.1016/j.resuscitation.2024.110306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Signe Amalie Wolthers
- Department of Clinical Medicine, University of Copenhagen, Denmark; Emergency Medical Services, Prehospital Center, Region Zealand, Denmark.
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Tardo D, Jabbour A, Kovacic JC. Getting to the cART of the Matter: Risk Stratification for Cardiovascular Events With HIV Infection. JACC. ADVANCES 2023; 2:100724. [PMID: 38938479 PMCID: PMC11198434 DOI: 10.1016/j.jacadv.2023.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Daniel Tardo
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Cardiology Department, St Vincent’s Hospital, Sydney, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - Andrew Jabbour
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Cardiology Department, St Vincent’s Hospital, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Cardiology Department, St Vincent’s Hospital, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Garcia R, Warming PE, Hansen CJ, Rajan D, Torp-Pedersen C, Benfield T, Folke F, Tfelt-Hansen J. Out-of-Hospital Cardiac Arrest in Individuals With Human Immunodeficiency Virus: A Nationwide Population-Based Cohort Study. Clin Infect Dis 2023; 77:1578-1584. [PMID: 37448334 DOI: 10.1093/cid/ciad422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/12/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Little data exist on the risk and outcomes of out-of-hospital cardiac arrest (OHCA) in people with HIV (PWH). We aimed to describe OHCA in PWH as compared with the general population in terms of incidence, characteristics, and survival. METHODS This nationwide study assessed all individuals aged 18-85 years between 2001 and 2019 in Denmark. The cumulative incidence of OHCA was computed using cause-specific Cox models accounting for competing risk of death. RESULTS Among 6 565 309 individuals, 6 925 (median age: 36; interquartile range [IQR]: 28-44 y; 74% males) were infected at some point with HIV. The incidence of OHCA was 149 (95% CI: 123-180)/100 000 person-years in PWH versus 64 (95% CI: 64-65)/100 000 person-years in people without HIV (P < .001). Age at the time of cardiac arrest was 52 (IQR: 44-61) years in PWH versus 69 (IQR: 59-77) years in individuals without HIV (P < .001). In a multivariable model adjusted for age, sex, hypertension, diabetes, heart failure, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, cancer, and renal failure, PWH had a 2-fold higher risk of OHCA (hazard ratio: 2.84; 95% CI: 2.36-3.43; P < .001). Thirty-day mortality (89% vs 88%; P = .80) was comparable to individuals without HIV. CONCLUSIONS HIV is an independent risk factor for OHCA, and those who experience OHCA with HIV are much younger than those without HIV. Almost 90% of PWH died 1 month after OHCA. Further research should strive to find out how to reduce OHCA occurrence in this population.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402, University Hospital of Poitiers, Poitiers, France
| | - Peder Emil Warming
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Carl Johann Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Deepthi Rajan
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Center of Research and Disruption of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
- Copenhagen University Hospital-Emergency Medical Services Copenhagen, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
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Alomar FA, Tian C, Bidasee SR, Venn ZL, Schroder E, Palermo NY, AlShabeeb M, Edagwa BJ, Payne JJ, Bidasee KR. HIV-Tat Exacerbates the Actions of Atazanavir, Efavirenz, and Ritonavir on Cardiac Ryanodine Receptor (RyR2). Int J Mol Sci 2022; 24:ijms24010274. [PMID: 36613717 PMCID: PMC9820108 DOI: 10.3390/ijms24010274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
The incidence of sudden cardiac death (SCD) in people living with HIV infection (PLWH), especially those with inadequate viral suppression, is high and the reasons for this remain incompletely characterized. The timely opening and closing of type 2 ryanodine receptor (RyR2) is critical for ensuring rhythmic cardiac contraction-relaxation cycles, and the disruption of these processes can elicit Ca2+ waves, ventricular arrhythmias, and SCD. Herein, we show that the HIV protein Tat (HIV-Tat: 0-52 ng/mL) and therapeutic levels of the antiretroviral drugs atazanavir (ATV: 0-25,344 ng/mL), efavirenz (EFV: 0-11,376 ng/mL), and ritonavir (RTV: 0-25,956 ng/mL) bind to and modulate the opening and closing of RyR2. Abacavir (0-14,315 ng/mL), bictegravir (0-22,469 ng/mL), Rilpivirine (0-14,360 ng/mL), and tenofovir disoproxil fumarate (0-18,321 ng/mL) did not alter [3H]ryanodine binding to RyR2. Pretreating RyR2 with low HIV-Tat (14 ng/mL) potentiated the abilities of ATV and RTV to bind to open RyR2 and enhanced their ability to bind to EFV to close RyR2. In silico molecular docking using a Schrodinger Prime protein-protein docking algorithm identified three thermodynamically favored interacting sites for HIV-Tat on RyR2. The most favored site resides between amino acids (AA) 1702-1963; the second favored site resides between AA 467-1465, and the third site resides between AA 201-1816. Collectively, these new data show that HIV-Tat, ATV, EFV, and RTV can bind to and modulate the activity of RyR2 and that HIV-Tat can exacerbate the actions of ATV, EFV, and RTV on RyR2. Whether the modulation of RyR2 by these agents increases the risk of arrhythmias and SCD remains to be explored.
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Affiliation(s)
- Fadhel A. Alomar
- Department of Pharmacology and Toxicology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Chengju Tian
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sean R. Bidasee
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Zachary L. Venn
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Evan Schroder
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Nicholas Y. Palermo
- Vice Chancellor for Research Cores, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mohammad AlShabeeb
- Population Health Research Section, King Abdullah International Medical Research Center, King Saudi bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Benson J. Edagwa
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jason J. Payne
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Keshore R. Bidasee
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Environment and Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Nebraska Redox Biology Center, Lincoln, NE 68588, USA
- Correspondence: ; Tel.: +402-559-9018; Fax: +402-559-7495
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Qrareya AN, Wise NS, Hodges ER, Mahdi F, Stewart JA, Paris JJ. HIV-1 Tat Upregulates the Receptor for Advanced Glycation End Products and Superoxide Dismutase-2 in the Heart of Transgenic Mice. Viruses 2022; 14:v14102191. [PMID: 36298745 PMCID: PMC9607872 DOI: 10.3390/v14102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiovascular disorder (CVD) is a common comorbidity in people living with HIV (PLWH). Although the underlying mechanisms are unknown, virotoxic HIV proteins, such as the trans-activator of transcription (Tat), likely contribute to CVD pathogenesis. Tat expression in mouse myocardium has been found to induce cardiac dysfunction and increase markers of endothelial toxicity. However, the role that Tat may play in the development of CVD pathogenesis is unclear. The capacity for Tat to impact cardiac function was assessed using AC16 human cardiomyocyte cells and adult male and female transgenic mice that conditionally expressed Tat [Tat(+)], or did not [Tat(-)]. In AC16 cardiomyocytes, Tat increased intracellular calcium. In Tat(+) mice, Tat expression was detected in both atrial and ventricular heart tissue. Tat(+) mice demonstrated an increased expression of the receptor for advanced glycation end products and superoxide dismutase-2 (SOD-2) in ventricular tissues compared to Tat(-) controls. No changes in SOD-1 or α-smooth muscle actin were observed. Despite Tat-mediated changes at the cellular level, no changes in echocardiographic measures were detected. Tat(+) mice had a greater proportion of ventricular mast cells and collagen; however, doxycycline exposure offset the latter effect. These data suggest that Tat exposure promotes cellular changes that can precede progression to CVD.
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Affiliation(s)
- Alaa N. Qrareya
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Nason S. Wise
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Emmanuel R. Hodges
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Fakhri Mahdi
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - James A. Stewart
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
- Correspondence: (J.A.S.J.); (J.J.P.); Tel.: +1-662-915-2309 (J.A.S.J.); +1-662-915-3096 (J.J.P.)
| | - Jason J. Paris
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
- Correspondence: (J.A.S.J.); (J.J.P.); Tel.: +1-662-915-2309 (J.A.S.J.); +1-662-915-3096 (J.J.P.)
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Narla VA, Yang H, Li Q. Outcomes of implantable cardioverter-defibrillator implantation in HIV-infected patients: A single-center retrospective cohort study. Clin Cardiol 2022; 45:857-863. [PMID: 35642740 PMCID: PMC9346971 DOI: 10.1002/clc.23868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND HIV-infected individuals have a known increased risk of sudden cardiac death (SCD) compared to uninfected individuals. Implantable cardioverter-defibrillators (ICDs) are standard therapy for preventing SCD; however, there is limited data on the outcomes of ICDs in HIV-infected individuals. HYPOTHESIS HIV-infected subjects receive a higher number of appropriate ICD therapies than uninfected controls. METHODS This is a retrospective cohort study of 35 consecutive HIV-Infected patients and 36 uninfected controls matched by age, race, and gender who were treated at the University of North Carolina Medical Center in the outpatient or inpatient setting from 2014 to the present and had undergone ICD implantation. For HIV-infected subjects, a multivariate Poisson regression analysis was performed to evaluate the association between covariates and ICD therapies. RESULTS Among HIV-infected subjects, the mean CD4 count was 582.5 cells/mm3 and 69% had an undetectable viral load. The median follow-up was 6.4 years. HIV-infected subjects had both a higher number of appropriate ICD shocks or antitachycardia pacing (ATP) therapy per person-year as well as a higher number of inappropriate ICD shocks per person-year than uninfected controls (1.512 vs. 0.590 and 0.122 vs. 0.0166, respectively, p < .001 for both comparisons). After multivariate adjustment, the presence of detectable/unsuppressed viral load at the time of ICD implantation was an independent predictor of both of the following in HIV-infected subjects: (1) appropriate ICD discharge (p = .004), and (2) appropriate ICD discharge or appropriate ATP therapy (p < .001). CONCLUSION HIV-infected subjects had a higher number of appropriate ICD discharge or ATP therapy per person-year than matched uninfected controls.
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Affiliation(s)
- Venkata A. Narla
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Hannan Yang
- Department of Biostatistics, Gillings School of Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Ha ACT, Doumouras BS, Wang CN, Tranmer J, Lee DS. Prediction of sudden cardiac arrest in the general population: Review of traditional and emerging risk factors. Can J Cardiol 2022; 38:465-478. [PMID: 35041932 DOI: 10.1016/j.cjca.2022.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 12/28/2022] Open
Abstract
Sudden cardiac death (SCD) is the most common and devastating outcome of sudden cardiac arrest (SCA), defined as an abrupt and unexpected cessation of cardiovascular function leading to circulatory collapse. The incidence of SCD is relatively infrequent for individuals in the general population, in the range of 0.03-0.10% per year. Yet, the absolute number of cases around the world is high due to the sheer size of the population at risk, making SCA/SCD a major global health issue. Based on conservative estimates, there are at least 2 million cases of SCA occurring worldwide on a yearly basis. As such, identification of risk factors associated with SCA in the general population is an important objective from a clinical and public health standpoint. This review will provide an in-depth discussion of established and emerging factors predictive of SCA/SCD in the general population beyond coronary artery disease and impaired left ventricular ejection fraction. Contemporary studies evaluating the association between age, sex, race, socioeconomic status and the emerging contribution of diabetes and obesity to SCD risk beyond their role as atherosclerotic risk factors will be reviewed. In addition, the role of biomarkers, particularly electrocardiographic ones, on SCA/SCD risk prediction in the general population will be discussed. Finally, the use of machine learning as a tool to facilitate SCA/SCD risk prediction will be examined.
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Affiliation(s)
- Andrew C T Ha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Barbara S Doumouras
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Chang Nancy Wang
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; ICES Central, Toronto, Ontario, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, Ontario, Canada; ICES Queens, Queen's University, Kingston, Ontario, Canada
| | - Douglas S Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; ICES Central, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.
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Hamaya E, Kamekura N, Fujisawa T. Suspected bradycardia due to interactions between HIV protease inhibitors and lidocaine: a case report. J Dent Anesth Pain Med 2021; 21:475-477. [PMID: 34703897 PMCID: PMC8520839 DOI: 10.17245/jdapm.2021.21.5.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Eri Hamaya
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuhito Kamekura
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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Monsuez JJ, Lopez-Sublet M. Prevention of sudden cardiac death in persons living with HIV infection. Curr HIV Res 2021; 20:2-6. [PMID: 34551692 DOI: 10.2174/1570162x19666210922154011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/25/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Abstract
Persons living with HIV infection (PLWH) have been recognized to have an increased risk of sudden cardiac death (SCD). Prevention of this risk should theoretically be included in their long-term management. However, only a few approaches have been proposed to optimize such interventions. Targeting detection of the commonly associated conditions such as coronary artery disease, left ventricular dysfunction, heart failure, QT interval prolongation and ventricular arrhythmias is the first step of this prevention. However, although detection of the risk of SCD is a suitable challenge in PLWH, it remains uncertain whether optimized treatment of the identified risks would unequivocally translate into a decrease in SCD rates.
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Affiliation(s)
- Jean-Jacques Monsuez
- Cardiology, Hôpital René Muret, Hôpitaux Universitaires de Paris Seine Saint-Denis. France
| | - Marilucy Lopez-Sublet
- Center of Hypertension, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine Saint-Denis. France
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