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Baroni M, Albaba D, Ngo A, Livingston RK. Atrial Fibrillation Following Electroconvulsive Therapy: A Systematic Review and Case Report. J ECT 2024:00124509-990000000-00164. [PMID: 38830193 DOI: 10.1097/yct.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is considered the gold standard treatment for many psychiatric illnesses; however, it is not without risk. There have been no systematic reviews to date on new-onset atrial fibrillation following ECT. Thus, the aim of this study is to identify reported occurrences of new-onset atrial fibrillation following ECT and the ability to safely resume ECT thereafter.A case pertaining to the development of atrial fibrillation after ECT in a young healthy male is presented. In addition, a systematic review of the literature pertaining to atrial fibrillation after ECT was conducted through PubMed, PsycInfo, and EMBASE. Of the 233 articles screened, 15 articles were selected for in-depth review. Of the 15 articles, only 10 articles met inclusion criteria. These articles included 9 case reports and 1 retrospective review. The retrospective review included 1 patient that developed atrial fibrillation out of 13 patients receiving ECT at the site. The 10 patients included varied in age, risk factors, type of ECT conducted, and treatment of the atrial fibrillation. Of the 4 articles that discussed outcomes, all patients were able to return to ECT without further complications.There are many potential reasons ECT may induce atrial fibrillation, and there are additional treatment considerations for atrial fibrillation in patients receiving ECT. Notably, our results indicate that many have been able to continue ECT without further complications; however, more research is needed to identify the frequency of this adverse reaction.
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Affiliation(s)
| | - Dania Albaba
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College Medicine, Houston, TX
| | - Alexandra Ngo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College Medicine, Houston, TX
| | - Robin K Livingston
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College Medicine, Houston, TX
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2
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You H, Han W. Identification of necroptosis-related diagnostic biomarkers in coronary heart disease. Heliyon 2024; 10:e30269. [PMID: 38726127 PMCID: PMC11079106 DOI: 10.1016/j.heliyon.2024.e30269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Background The implication of necroptosis in cardiovascular disease was already recognized. However, the molecular mechanism of necroptosis has not been extensively studied in coronary heart disease (CHD). Methods The differentially expressed genes (DEGs) between CHD and control samples were acquired in the GSE20681 dataset downloaded from the GEO database. Key necroptosis-related DEGs were captured and ascertained by bioinformatics analysis techniques, including weighted gene co-expression network analysis (WGCNA) and two machine learning algorithms, while single-gene gene set enrichment analysis (GSEA) revealed their molecular mechanisms. The diagnostic biomarkers were selected via receiver operating characteristic (ROC) analysis. Moreover, an analysis of immune elements infiltration degree was carried out. Authentication of pivotal gene expression at the mRNA level was investigated in vitro utilizing quantitative real-time PCR (qRT-PCR). Results A total of 94 DE-NRGs were recognized here, among which, FAM166B, NEFL, POLDIP3, PRSS37, and ZNF594 were authenticated as necroptosis-related biomarkers, and the linear regression model based on them presented an acceptable ability to different sample types. Following regulatory analysis, the ascertained biomarkers were markedly abundant in functions pertinent to blood circulation, calcium ion homeostasis, and the MAPK/cAMP/Ras signaling pathway. Single-sample GSEA exhibited that APC co-stimulation and CCR were more abundant, and aDCs and B cells were relatively scarce in CHD patients. Consistent findings from bioinformatics and qRT-PCR analyses confirmed the upregulation of NEFL and the downregulation of FAM166B, POLDIP3, and PRSS37 in CHD. Conclusion Our current investigation identified 5 necroptosis-related genes that could be diagnostic markers for CHD and brought a novel comprehension of the latent molecular mechanisms of necroptosis in CHD.
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Affiliation(s)
- Hongjun You
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Wenqi Han
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
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3
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Colman MA, Varela M, MacLeod RS, Hancox JC, Aslanidi OV. Interactions between calcium-induced arrhythmia triggers and the electrophysiological-anatomical substrate underlying the induction of atrial fibrillation. J Physiol 2024; 602:835-853. [PMID: 38372694 DOI: 10.1113/jp285740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is sustained by spontaneous focal excitations and re-entry. Spontaneous electrical firing in the pulmonary vein (PV) sleeves is implicated in AF generation. The aim of this simulation study was to identify the mechanisms determining the localisation of AF triggers in the PVs and their contribution to the genesis of AF. A novel biophysical model of the canine atria was used that integrates stochastic, spontaneous subcellular Ca2+ release events (SCRE) with regional electrophysiological heterogeneity in ionic properties and a detailed three-dimensional model of atrial anatomy, microarchitecture and patchy fibrosis. Simulations highlighted the importance of the smaller inward rectifier potassium current (IK1 ) in PV cells compared to the surrounding atria, which enabled SCRE more readily to result in delayed-afterdepolarisations that induced triggered activity. There was a leftward shift in the dependence of the probability of triggered activity on sarcoplasmic reticulum Ca2+ load. This feature was accentuated in 3D tissue compared to single cells (Δ half-maximal [Ca2+ ]SR = 58 μM vs. 22 μM). In 3D atria incorporating electrical heterogeneity, excitations preferentially emerged from the PV region. These triggered focal excitations resulted in transient re-entry in the left atrium. Addition of fibrotic patches promoted localised emergence of focal excitations and wavebreaks that had a more substantial impact on generating AF-like patterns than the PVs. Thus, a reduced IK1 , less negative resting membrane potential, and fibrosis-induced changes of the electrotonic load all contribute to the emergence of complex excitation patterns from spontaneous focal triggers. KEY POINTS: Focal excitations in the atria are most commonly associated with the pulmonary veins, but the mechanisms for this localisation are yet to be elucidated. We applied a multi-scale computational modelling approach to elucidate the mechanisms underlying such localisations. Myocytes in the pulmonary vein region of the atria have a less negative resting membrane potential and reduced time-independent potassium current; we demonstrate that both of these factors promote triggered activity in single cells and tissues. The less negative resting membrane potential also contributes to heterogeneous inactivation of the fast sodium current, which can enable re-entrant-like excitation patterns to emerge without traditional conduction block.
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Affiliation(s)
- Michael A Colman
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Marta Varela
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rob S MacLeod
- The Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Jules C Hancox
- School of Physiology, Pharmacology & Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Oleg V Aslanidi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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4
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Kapadia M, Jagadish PS, Hutchinson M, Lee H. Atrial fibrillation, electroconvulsive therapy, stroke risk, and anticoagulation. Egypt Heart J 2023; 75:94. [PMID: 38010438 PMCID: PMC10682349 DOI: 10.1186/s43044-023-00409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/17/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a therapy used to treat refractory mental health conditions, ranging from depression to catatonia, and it has gained renewed prominence in practice and the literature of late. Given that ECT involves the application of direct current to the body, there exists a risk of a change in cardiac rhythm during therapy. When atrial fibrillation is induced, ECT carries a potential risk of stroke. These risks have not been previously analyzed or summarized in the literature to allow physicians to make educated decisions about periprocedural risk and anticoagulation needs. METHODS To better describe this risk, the authors reviewed PubMed for articles that described the post-ECT cardioversion of AF to sinus rhythm, new development of AF post-ECT, and new stroke after either rhythm change. RESULTS Included were 14 studies describing 19 unique patients. Most patients had no rhythm change during at least one of many ECT sessions. Five patients converted from AF to sinus rhythm during at least one session, while AF followed ECT in seventeen patients during at least one ECT session. Four patients experienced both ECT-related cardioversion from AF to sinus rhythm as well as conversion from sinus rhythm to AF. Although no patients with a rhythm change experienced a stroke, one unanticoagulated patient who remained in AF developed a stroke post-ECT. CONCLUSIONS Electroconvulsive therapy is demonstrated to be associated with rhythm changes-from atrial fibrillation to sinus rhythm as well as from sinus rhythm to atrial fibrillation. Thus, stroke risk during and after ECT remains a possibility. The anticoagulation of patients with AF who undergo ECT should be based on individual stroke risk factors, using validated stroke risk models, rather than prescribed routinely.
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Affiliation(s)
- Meera Kapadia
- Department of Internal Medicine at McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, 77030, USA
| | - Pooja S Jagadish
- Division of Cardiology, Department of Medicine, University of Arizona-Tucson, 1501 N. Campbell Ave., PO Box 245046, Tucson, AZ, 85724-5035, USA.
| | - Marcus Hutchinson
- Department of Medicine, University of Arizona-Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724-5035, USA
| | - Hong Lee
- Division of Cardiology, Department of Medicine, University of Arizona-Tucson, 1501 N. Campbell Ave., PO Box 245046, Tucson, AZ, 85724-5035, USA
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5
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Huang J, Wu B, Qin P, Cheng Y, Zhang Z, Chen Y. Research on atrial fibrillation mechanisms and prediction of therapeutic prospects: focus on the autonomic nervous system upstream pathways. Front Cardiovasc Med 2023; 10:1270452. [PMID: 38028487 PMCID: PMC10663310 DOI: 10.3389/fcvm.2023.1270452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Atrial fibrillation (AF) is the most common clinical arrhythmia disorder. It can easily lead to complications such as thromboembolism, palpitations, dizziness, angina, heart failure, and stroke. The disability and mortality rates associated with AF are extremely high, significantly affecting the quality of life and work of patients. With the deepening of research into the brain-heart connection, the link between AF and stroke has become increasingly evident. AF is now categorized as either Known Atrial Fibrillation (KAF) or Atrial Fibrillation Detected After Stroke (AFDAS), with stroke as the baseline. This article, through a literature review, briefly summarizes the current pathogenesis of KAF and AFDAS, as well as the status of their clinical pharmacological and non-pharmacological treatments. It has been found that the existing treatments for KAF and AFDAS have limited efficacy and are often associated with significant adverse reactions and a risk of recurrence. Moreover, most drugs and treatment methods tend to focus on a single mechanism pathway. For example, drugs targeting ion channels primarily modulate ion channels and have relatively limited impact on other pathways. This limitation underscores the need to break away from the "one disease, one target, one drug/measurement" dogma for the development of innovative treatments, promoting both drug and non-drug therapies and significantly improving the quality of clinical treatment. With the increasing refinement of the overall mechanisms of KAF and AFDAS, a deeper exploration of physiological pathology, and comprehensive research on the brain-heart relationship, it is imperative to shift from long-term symptom management to more precise and optimized treatment methods that are effective for almost all patients. We anticipate that drugs or non-drug therapies targeting the central nervous system and upstream pathways can guide the simultaneous treatment of multiple downstream pathways in AF, thereby becoming a new breakthrough in AF treatment research.
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Affiliation(s)
- Jingjie Huang
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bangqi Wu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Peng Qin
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yupei Cheng
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ziyi Zhang
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yameng Chen
- Postgraduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Dorey TW, Liu Y, Jansen HJ, Bohne LJ, Mackasey M, Atkinson L, Prasai S, Belke DD, Fatehi-Hassanabad A, Fedak PWM, Rose RA. Natriuretic Peptide Receptor B Protects Against Atrial Fibrillation by Controlling Atrial cAMP Via Phosphodiesterase 2. Circ Arrhythm Electrophysiol 2023; 16:e012199. [PMID: 37933567 DOI: 10.1161/circep.123.012199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND β-AR (β-adrenergic receptor) stimulation regulates atrial electrophysiology and Ca2+ homeostasis via cAMP-dependent mechanisms; however, enhanced β-AR signaling can promote atrial fibrillation (AF). CNP (C-type natriuretic peptide) can also regulate atrial electrophysiology through the activation of NPR-B (natriuretic peptide receptor B) and cGMP-dependent signaling. Nevertheless, the role of NPR-B in regulating atrial electrophysiology, Ca2+ homeostasis, and atrial arrhythmogenesis is incompletely understood. METHODS Studies were performed using atrial samples from human patients with AF or sinus rhythm and in wild-type and NPR-B-deficient (NPR-B+/-) mice. Studies were conducted in anesthetized mice by intracardiac electrophysiology, in isolated mouse atrial preparations using high-resolution optical mapping, in isolated mouse and human atrial myocytes using patch-clamping and Ca2+ imaging, and in mouse and human atrial tissues using molecular biology. RESULTS Atrial NPR-B protein levels were reduced in patients with AF, and NPR-B+/- mice were more susceptible to AF. Atrial cGMP levels and PDE2 (phosphodiesterase 2) activity were reduced in NPR-B+/- mice leading to larger increases in atrial cAMP in the presence of the β-AR agonist isoproterenol. NPR-B+/- mice displayed larger increases in action potential duration and L-type Ca2+ current in the presence of isoproterenol. This resulted in the occurrence of spontaneous sarcoplasmic reticulum Ca2+ release events and delayed afterdepolarizations in NPR-B+/- atrial myocytes. Phosphorylation of the RyR2 (ryanodine receptor) and phospholamban was increased in NPR-B+/- atria in the presence of isoproterenol compared with the wildtypes. C-type natriuretic peptide inhibited isoproterenol-stimulated L-type Ca2+ current through PDE2 in mouse and human atrial myocytes. CONCLUSIONS NPR-B protects against AF by preventing enhanced atrial responses to β-adrenergic receptor agonists.
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Affiliation(s)
- Tristan W Dorey
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Yingjie Liu
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Hailey J Jansen
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Loryn J Bohne
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Martin Mackasey
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Logan Atkinson
- Department of Physiology and Biophysics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (L.A.)
| | - Shuvam Prasai
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Darrell D Belke
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Ali Fatehi-Hassanabad
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Paul W M Fedak
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
| | - Robert A Rose
- Department of Cardiac Sciences (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., D.D.B, A.F.-H., P.W.M.F., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology (T.W.D., Y.L., H.J.J., L.J.B., M.M., S.P., R.A.R.), Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary, Alberta, Canada
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Ni H, Morotti S, Zhang X, Dobrev D, Grandi E. Integrative human atrial modelling unravels interactive protein kinase A and Ca2+/calmodulin-dependent protein kinase II signalling as key determinants of atrial arrhythmogenesis. Cardiovasc Res 2023; 119:2294-2311. [PMID: 37523735 DOI: 10.1093/cvr/cvad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023] Open
Abstract
AIMS Atrial fibrillation (AF), the most prevalent clinical arrhythmia, is associated with atrial remodelling manifesting as acute and chronic alterations in expression, function, and regulation of atrial electrophysiological and Ca2+-handling processes. These AF-induced modifications crosstalk and propagate across spatial scales creating a complex pathophysiological network, which renders AF resistant to existing pharmacotherapies that predominantly target transmembrane ion channels. Developing innovative therapeutic strategies requires a systems approach to disentangle quantitatively the pro-arrhythmic contributions of individual AF-induced alterations. METHODS AND RESULTS Here, we built a novel computational framework for simulating electrophysiology and Ca2+-handling in human atrial cardiomyocytes and tissues, and their regulation by key upstream signalling pathways [i.e. protein kinase A (PKA), and Ca2+/calmodulin-dependent protein kinase II (CaMKII)] involved in AF-pathogenesis. Populations of atrial cardiomyocyte models were constructed to determine the influence of subcellular ionic processes, signalling components, and regulatory networks on atrial arrhythmogenesis. Our results reveal a novel synergistic crosstalk between PKA and CaMKII that promotes atrial cardiomyocyte electrical instability and arrhythmogenic triggered activity. Simulations of heterogeneous tissue demonstrate that this cellular triggered activity is further amplified by CaMKII- and PKA-dependent alterations of tissue properties, further exacerbating atrial arrhythmogenesis. CONCLUSIONS Our analysis reveals potential mechanisms by which the stress-associated adaptive changes turn into maladaptive pro-arrhythmic triggers at the cellular and tissue levels and identifies potential anti-AF targets. Collectively, our integrative approach is powerful and instrumental to assemble and reconcile existing knowledge into a systems network for identifying novel anti-AF targets and innovative approaches moving beyond the traditional ion channel-based strategy.
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Affiliation(s)
- Haibo Ni
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA
| | - Stefano Morotti
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA
| | - Xianwei Zhang
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA
| | - Dobromir Dobrev
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Canada
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Eleonora Grandi
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA
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Gaffey AE, Rosman L, Lampert R, Yaggi HK, Haskell SG, Brandt CA, Enriquez AD, Mazzella AJ, Skanderson M, Burg MM. Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans. J Am Heart Assoc 2023; 12:e030331. [PMID: 37791503 PMCID: PMC10757545 DOI: 10.1161/jaha.123.030331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 10/05/2023]
Abstract
Background There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. Methods and Results This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post-9/11) and received Veterans Health Administration care, 2001 to 2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post-9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person-years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21-1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia-AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17-1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24-1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07-1.50]). Conclusions In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Lindsey Rosman
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | - Rachel Lampert
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Henry K. Yaggi
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Pulmonary, Critical Care & Sleep Medicine)Yale School of MedicineCTNew HavenUSA
| | - Sally G. Haskell
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (General Medicine)Yale School of MedicineNew HavenCTUSA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Yale Center for Medical InformaticsYale School of MedicineNew HavenCTUSA
| | - Alan D. Enriquez
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Anthony J. Mazzella
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | | | - Matthew M. Burg
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
- Department of AnesthesiologyYale School of MedicineNew HavenCTUSA
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9
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Zhong Z, Li X, Gao L, Wu X, Ye Y, Zhang X, Zeng Q, Zhou C, Lu X, Wei Y, Ding Y, Chen S, Zhou G, Xu J, Liu S. Long Non-coding RNA Involved in the Pathophysiology of Atrial Fibrillation. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07491-8. [PMID: 37702834 DOI: 10.1007/s10557-023-07491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a prevalent and chronic cardiovascular disorder associated with various pathophysiological alterations, including atrial electrical and structural remodeling, disrupted calcium handling, autonomic nervous system dysfunction, aberrant energy metabolism, and immune dysregulation. Emerging evidence suggests that long non-coding RNAs (lncRNAs) play a significant role in the pathogenesis of AF. OBJECTIVE This discussion aims to elucidate the involvement of AF-related lncRNAs, with a specific focus on their role as miRNA sponges that modulate crucial signaling pathways, contributing to the progression of AF. We also address current limitations in AF-related lncRNA research and explore potential future directions in this field. Additionally, we summarize feasible strategies and promising delivery systems for targeting lncRNAs in AF therapy. CONCLUSION In conclusion, targeting AF-related lncRNAs holds substantial promise for future investigations and represents a potential therapeutic avenue for managing AF.
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Affiliation(s)
- Zikan Zhong
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xintao Li
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Longzhe Gao
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Wu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yutong Ye
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Zhang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingye Zeng
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changzuan Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Ding
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Juan Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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10
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Verkerk AO, Wilders R. The Action Potential Clamp Technique as a Tool for Risk Stratification of Sinus Bradycardia Due to Loss-of-Function Mutations in HCN4: An In Silico Exploration Based on In Vitro and In Vivo Data. Biomedicines 2023; 11:2447. [PMID: 37760888 PMCID: PMC10525944 DOI: 10.3390/biomedicines11092447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
These days, in vitro functional analysis of gene variants is becoming increasingly important for risk stratification of cardiac ion channelopathies. So far, such risk stratification has been applied to SCN5A, KCNQ1, and KCNH2 gene variants associated with Brugada syndrome and long QT syndrome types 1 and 2, respectively, but risk stratification of HCN4 gene variants related to sick sinus syndrome has not yet been performed. HCN4 is the gene responsible for the hyperpolarization-activated 'funny' current If, which is an important modulator of the spontaneous diastolic depolarization underlying the sinus node pacemaker activity. In the present study, we carried out a risk classification assay on those loss-of-function mutations in HCN4 for which in vivo as well as in vitro data have been published. We used the in vitro data to compute the charge carried by If (Qf) during the diastolic depolarization phase of a prerecorded human sinus node action potential waveform and assessed the extent to which this Qf predicts (1) the beating rate of the comprehensive Fabbri-Severi model of a human sinus node cell with mutation-induced changes in If and (2) the heart rate observed in patients carrying the associated mutation in HCN4. The beating rate of the model cell showed a very strong correlation with Qf from the simulated action potential clamp experiments (R2 = 0.95 under vagal tone). The clinically observed minimum or resting heart rates showed a strong correlation with Qf (R2 = 0.73 and R2 = 0.71, respectively). While a translational perspective remains to be seen, we conclude that action potential clamp on transfected cells, without the need for further voltage clamp experiments and data analysis to determine individual biophysical parameters of If, is a promising tool for risk stratification of sinus bradycardia due to loss-of-function mutations in HCN4. In combination with an If blocker, this tool may also prove useful when applied to human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) obtained from mutation carriers and non-carriers.
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Affiliation(s)
- Arie O. Verkerk
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Ronald Wilders
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
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11
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Magtibay K, Massé S, Nanthakumar K, Umapathy K. Pro-arrhythmic role of adrenergic spatial densities in the human atria: An in-silico study. PLoS One 2023; 18:e0290676. [PMID: 37624832 PMCID: PMC10456151 DOI: 10.1371/journal.pone.0290676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic stress among young patients (≤ 45 years old) could result in autonomic dysfunction. Autonomic dysfunction could be exhibited via sympathetic hyperactivity, sympathetic nerve sprouting, and diffuse adrenergic stimulation in the atria. Adrenergic spatial densities could alter atrial electrophysiology and increase arrhythmic susceptibility. Therefore, we examined the role of adrenergic spatial densities in creating arrhythmogenic substrates in silico. We simulated three 25 cm2 atrial sheets with varying adrenergic spatial densities (ASD), activation rates, and external transmembrane currents. We measured their effects on spatial and temporal heterogeneity of action potential durations (APD) at 50% and 20%. Increasing ASD shortens overall APD, and maximum spatial heterogeneity (31%) is achieved at 15% ASD. The addition of a few (5% to 10%) adrenergic elements decreases the excitation threshold, below 18 μA/cm2, while ASDs greater than 10% increase their excitation threshold up to 22 μA/cm2. Increase in ASD during rapid activation increases APD50 and APD20 by 21% and 41%, respectively. Activation times of captured beats during rapid activation could change by as much as 120 ms from the baseline cycle length. Rapidly activated atrial sheets with high ASDs significantly increase temporal heterogeneity of APD50 and APD20. Rapidly activated atrial sheets with 10% ASD have a high likelihood (0.7 ± 0.06) of fragmenting otherwise uniform wavefronts due to the transient inexcitability of adrenergically stimulated elements, producing an effective functional block. The likelihood of wave fragmentation due to ASD highly correlates with the spatial variations of APD20 (ρ = 0.90, p = 0.04). Our simulations provide a novel insight into the contributions of ASD to spatial and temporal heterogeneities of APDs, changes in excitation thresholds, and a potential explanation for wave fragmentation in the human atria due to sympathetic hyperactivity. Our work may aid in elucidating an electrophysiological link to arrhythmia initiation due to chronic stress among young patients.
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Affiliation(s)
- Karl Magtibay
- Biomedical Signal and Image Processing Laboratory, Faculty of Engineering and Architectural Science, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Stéphane Massé
- Toby Hull Cardiac Fibrillation Management Laboratory, Department of Medicine/Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Toby Hull Cardiac Fibrillation Management Laboratory, Department of Medicine/Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karthikeyan Umapathy
- Biomedical Signal and Image Processing Laboratory, Department of Electrical, Computer, and Biomedical Engineering, Faculty of Engineering and Architectural Science, Toronto Metropolitan University, Toronto, Ontario, Canada
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12
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Kervadec A, Kezos J, Ni H, Yu M, Marchant J, Spiering S, Kannan S, Kwon C, Andersen P, Bodmer R, Grandi E, Ocorr K, Colas AR. Multiplatform modeling of atrial fibrillation identifies phospholamban as a central regulator of cardiac rhythm. Dis Model Mech 2023; 16:dmm049962. [PMID: 37293707 PMCID: PMC10387351 DOI: 10.1242/dmm.049962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
Atrial fibrillation (AF) is a common and genetically inheritable form of cardiac arrhythmia; however, it is currently not known how these genetic predispositions contribute to the initiation and/or maintenance of AF-associated phenotypes. One major barrier to progress is the lack of experimental systems to investigate the effects of gene function on rhythm parameters in models with human atrial and whole-organ relevance. Here, we assembled a multi-model platform enabling high-throughput characterization of the effects of gene function on action potential duration and rhythm parameters using human induced pluripotent stem cell-derived atrial-like cardiomyocytes and a Drosophila heart model, and validation of the findings using computational models of human adult atrial myocytes and tissue. As proof of concept, we screened 20 AF-associated genes and identified phospholamban loss of function as a top conserved hit that shortens action potential duration and increases the incidence of arrhythmia phenotypes upon stress. Mechanistically, our study reveals that phospholamban regulates rhythm homeostasis by functionally interacting with L-type Ca2+ channels and NCX. In summary, our study illustrates how a multi-model system approach paves the way for the discovery and molecular delineation of gene regulatory networks controlling atrial rhythm with application to AF.
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Affiliation(s)
- Anaïs Kervadec
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - James Kezos
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Haibo Ni
- Department of Pharmacology, UC Davis, Davis, CA 95616, USA
| | - Michael Yu
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - James Marchant
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Sean Spiering
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Suraj Kannan
- Johns Hopkins University, Baltimore, MD 21205, USA
| | - Chulan Kwon
- Johns Hopkins University, Baltimore, MD 21205, USA
| | | | - Rolf Bodmer
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | | | - Karen Ocorr
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Alexandre R. Colas
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
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13
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Leo DG, Ozdemir H, Lane DA, Lip GYH, Keller SS, Proietti R. At the heart of the matter: how mental stress and negative emotions affect atrial fibrillation. Front Cardiovasc Med 2023; 10:1171647. [PMID: 37408656 PMCID: PMC10319071 DOI: 10.3389/fcvm.2023.1171647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/07/2023] [Indexed: 07/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, affecting 2%-3% of the world's population. Mental and emotional stress, as well as some mental health conditions (e.g., depression) have been shown to significantly impact the heart and have been suggested to act both as independent risk factors and triggers in the onset of AF. In this paper, we review the current literature to examine the role that mental and emotional stress have in the onset of AF and summarise the current knowledge on the interaction between the brain and heart, and the cortical and subcortical pathways involved in the response to stress. Review of the evidence suggests that mental and emotional stress negatively affect the cardiac system, potentially increasing the risk for developing and/or triggering AF. Further studies are required to further understand the cortical and sub-cortical structures involved in the mental stress response and how these interact with the cardiac system, which may help in defining new strategies and interventions to prevent the development of, and improve the management of AF.
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Affiliation(s)
- Donato Giuseppe Leo
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hizir Ozdemir
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon S. Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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14
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Liu X, Ren L, Yu S, Li G, He P, Yang Q, Wei X, Thai PN, Wu L, Huo Y. Late sodium current in synergism with Ca 2+/calmodulin-dependent protein kinase II contributes to β-adrenergic activation-induced atrial fibrillation. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220163. [PMID: 37122215 PMCID: PMC10150221 DOI: 10.1098/rstb.2022.0163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Atrial fibrillation (AF) is frequently associated with β-adrenergic stimulation, especially in patients with structural heart diseases. The objective of this study was to determine the synergism of late sodium current (late INa) and Ca2+/calmodulin-dependent protein kinase (CaMKII)-mediated arrhythmogenic activities in β-adrenergic overactivation-associated AF. Monophasic action potential, conduction properties, protein phosphorylation, ion currents and cellular trigger activities were measured from rabbit-isolated hearts, atrial tissue and atrial myocytes, respectively. Isoproterenol (ISO, 1-15 nM) increased atrial conduction inhomogeneity index, phospho-Nav1.5 and phospho-CaMKII protein levels and late INa by 108%, 65%, 135% and 87%, respectively, and induced triggered activities and episodes of AF in all hearts studied (p < 0.05). Sea anemone toxin II (ATX-II, 2 nM) was insufficient to induce any atrial arrhythmias, whereas the propensities of AF were greater in hearts treated with a combination of ATX-II and ISO. Ranolazine, eleclazine and KN-93 abolished ISO-induced AF, attenuated the phosphorylation of Nav1.5 and CaMKII, and reversed the increase of late INa (p < 0.05) in a synergistic mode. Overall, late INa in association with the activation of CaMKII potentiates β-adrenergic stimulation-induced AF and the inhibition of both late INa and CaMKII exerted synergistic anti-arrhythmic effects to suppress atrial arrhythmic activities associated with catecholaminergic activation. This article is part of the theme issue 'The heartbeat: its molecular basis and physiological mechanisms'.
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Affiliation(s)
- Xiaoyan Liu
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Lu Ren
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, CA, 95616, USA
| | - Shandong Yu
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Gang Li
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
| | - Pengkang He
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
| | - Qiaomei Yang
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
| | - Xiaohong Wei
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
| | - Phung N Thai
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, CA, 95616, USA
| | - Lin Wu
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, 8, Xishiku Street, West District, Beijing 100034, People's Republic of China
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15
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Godoy-Marín H, Jiménez-Sábado V, Tarifa C, Ginel A, Santos JLD, Bentzen BH, Hove-Madsen L, Ciruela F. Increased Density of Endogenous Adenosine A 2A Receptors in Atrial Fibrillation: From Cellular and Porcine Models to Human Patients. Int J Mol Sci 2023; 24:ijms24043668. [PMID: 36835078 PMCID: PMC9963500 DOI: 10.3390/ijms24043668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Adenosine, an endogenous nucleoside, plays a critical role in maintaining homeostasis during stressful situations, such as energy deprivation or cellular damage. Therefore, extracellular adenosine is generated locally in tissues under conditions such as hypoxia, ischemia, or inflammation. In fact, plasma levels of adenosine in patients with atrial fibrillation (AF) are elevated, which also correlates with an increased density of adenosine A2A receptors (A2ARs) both in the right atrium and in peripheral blood mononuclear cells (PBMCs). The complexity of adenosine-mediated effects in health and disease requires simple and reproducible experimental models of AF. Here, we generate two AF models, namely the cardiomyocyte cell line HL-1 submitted to Anemonia toxin II (ATX-II) and a large animal model of AF, the right atrium tachypaced pig (A-TP). We evaluated the density of endogenous A2AR in those AF models. Treatment of HL-1 cells with ATX-II reduced cell viability, while the density of A2AR increased significantly, as previously observed in cardiomyocytes with AF. Next, we generated the animal model of AF based on tachypacing pigs. In particular, the density of the key calcium regulatory protein calsequestrin-2 was reduced in A-TP animals, which is consistent with the atrial remodelling shown in humans suffering from AF. Likewise, the density of A2AR in the atrium of the AF pig model increased significantly, as also shown in the biopsies of the right atrium of subjects with AF. Overall, our findings revealed that these two experimental models of AF mimicked the alterations in A2AR density observed in patients with AF, making them attractive models for studying the adenosinergic system in AF.
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Affiliation(s)
- Héctor Godoy-Marín
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907 L’Hospitalet de Llobregat, Spain
| | - Verónica Jiménez-Sábado
- Biomedical Research Institute Sant Pau, IIB Sant Pau, 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Carmen Tarifa
- Biomedical Research Institute Sant Pau, IIB Sant Pau, 08025 Barcelona, Spain
- Biomedical Research Institute of Barcelona, IIBB-CSIC, 08036 Barcelona, Spain
| | - Antonino Ginel
- Department Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, 08036 Barcelona, Spain
| | | | - Bo Hjorth Bentzen
- Department of Biomedical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Leif Hove-Madsen
- Biomedical Research Institute Sant Pau, IIB Sant Pau, 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Biomedical Research Institute of Barcelona, IIBB-CSIC, 08036 Barcelona, Spain
- Correspondence: (L.H.-M.); (F.C.)
| | - Francisco Ciruela
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907 L’Hospitalet de Llobregat, Spain
- Correspondence: (L.H.-M.); (F.C.)
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16
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Rafaqat S, Rafaqat S, Rafaqat S. The Role of Major Biomarkers of Stress in Atrial Fibrillation: A Literature Review. J Innov Card Rhythm Manag 2023; 14:5355-5364. [PMID: 36874560 PMCID: PMC9983621 DOI: 10.19102/icrm.2023.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/19/2022] [Indexed: 03/07/2023] Open
Abstract
Numerous studies have reported that physical or emotional stress can provoke atrial fibrillation (AF) or vice versa, which suggests a potential link between exposure to external stressors and AF. This review article sought to describe in detail the relationship between major stress biomarkers and the pathogenesis of AF and presents up-to-date knowledge on the role of physiological and psychological stress in AF patients. For this purpose, this review article contends that plasma cortisol is linked to a greater risk of AF. A previous study has investigated the association between increased copeptin levels and paroxysmal AF (PAF) in rheumatic mitral stenosis and reported that copeptin concentration was not independently associated with AF duration. Reduced levels of chromogranin were measured in patients with AF. Furthermore, the dynamic activity of antioxidant enzymes, including catalase as well as superoxide dismutase, was examined in PAF patients during a period of <48 h. Malondialdehyde activity, serum high-sensitivity C-reactive protein, and high mobility group box 1 protein concentrations were significantly greater in patients with persistent AF or PAF compared to controls. Pooled data from 13 studies confirmed a significant reduction in the risk of AF related to the administration of vasopressin. Other studies have revealed the mechanism of action of heat shock proteins (HSPs) in preventing AF and also discussed the therapeutic potential of HSP-inducing compounds in clinical AF. More research is required to detect other biomarkers of stress, which have not been reported in the pathogenesis of AF. Further studies are required to identify their mechanism of action and drugs to manage these biomarkers of stress in AF patients, which might help to reduce the prevalence of AF globally.
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Affiliation(s)
- Saira Rafaqat
- Department of Zoology, Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Sana Rafaqat
- Department of Biotechnology, Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Simon Rafaqat
- Department of Business, Forman Christian College (A Chartered University), Lahore, Punjab, Pakistan
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17
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Reyes Gaido OE, Nkashama LJ, Schole KL, Wang Q, Umapathi P, Mesubi OO, Konstantinidis K, Luczak ED, Anderson ME. CaMKII as a Therapeutic Target in Cardiovascular Disease. Annu Rev Pharmacol Toxicol 2023; 63:249-272. [PMID: 35973713 PMCID: PMC11019858 DOI: 10.1146/annurev-pharmtox-051421-111814] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CaMKII (the multifunctional Ca2+ and calmodulin-dependent protein kinase II) is a highly validated signal for promoting a variety of common diseases, particularly in the cardiovascular system. Despite substantial amounts of convincing preclinical data, CaMKII inhibitors have yet to emerge in clinical practice. Therapeutic inhibition is challenged by the diversity of CaMKII isoforms and splice variants and by physiological CaMKII activity that contributes to learning and memory. Thus, uncoupling the harmful and beneficial aspects of CaMKII will be paramount to developing effective therapies. In the last decade, several targeting strategies have emerged, including small molecules, peptides, and nucleotides, which hold promise in discriminating pathological from physiological CaMKII activity. Here we review the cellular and molecular biology of CaMKII, discuss its role in physiological and pathological signaling, and consider new findings and approaches for developing CaMKII therapeutics.
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Affiliation(s)
- Oscar E Reyes Gaido
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | | | - Kate L Schole
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Qinchuan Wang
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Priya Umapathi
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Olurotimi O Mesubi
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Klitos Konstantinidis
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Elizabeth D Luczak
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Mark E Anderson
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
- Departments of Physiology and Genetic Medicine and Program in Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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18
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Bedford JP, Garside T, Darbyshire JL, Betts TR, Young JD, Watkinson PJ. Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study. J Intensive Care Soc 2022; 23:414-424. [PMID: 36751347 PMCID: PMC9679893 DOI: 10.1177/17511437211022132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is common during critical illness and is associated with poor outcomes. Many risk factors for NOAF during critical illness have been identified, overlapping with risk factors for atrial fibrillation in patients in community settings. To develop interventions to prevent NOAF during critical illness, modifiable risk factors must be identified. These have not been studied in detail and it is not clear which variables warrant further study. Methods We undertook an international three-round Delphi process using an expert panel to identify important predictors of NOAF risk during critical illness. Results Of 22 experts invited, 12 agreed to participate. Participants were located in Europe, North America and South America and shared 110 publications on the subject of atrial fibrillation. All 12 completed the three Delphi rounds. Potentially modifiable risk factors identified include 15 intervention-related variables. Conclusions We present the results of the first Delphi process to identify important predictors of NOAF risk during critical illness. These results support further research into modifiable risk factors including optimal plasma electrolyte concentrations, rates of change of these electrolytes, fluid balance, choice of vasoactive medications and the use of preventative medications in high-risk patients. We also hope our findings will aid the development of predictive models for NOAF.
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Affiliation(s)
- Jonathan P Bedford
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK,Jonathan P Bedford, Kadoorie Centre for
Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley
Way, Headington, Oxford OX3 9DU, UK.
| | - Tessa Garside
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Julie L Darbyshire
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Timothy R Betts
- Radcliffe Department of Medicine, University of Oxford, Oxford,
UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, Oxford, UK
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19
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Saxena P, Myles RC, Smith GL, Workman AJ. Adrenoceptor sub-type involvement in Ca 2+ current stimulation by noradrenaline in human and rabbit atrial myocytes. Pflugers Arch 2022; 474:1311-1321. [PMID: 36131146 DOI: 10.1007/s00424-022-02746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
Atrial fibrillation (AF) from elevated adrenergic activity may involve increased atrial L-type Ca2+ current (ICaL) by noradrenaline (NA). However, the contribution of the adrenoceptor (AR) sub-types to such ICaL-increase is poorly understood, particularly in human. We therefore investigated effects of various broad-action and sub-type-specific α- and β-AR antagonists on NA-stimulated atrial ICaL. ICaL was recorded by whole-cell-patch clamp at 37 °C in myocytes isolated enzymatically from atrial tissues from consenting patients undergoing elective cardiac surgery and from rabbits. NA markedly increased human atrial ICaL, maximally by ~ 2.5-fold, with EC75 310 nM. Propranolol (β1 + β2-AR antagonist, 0.2 microM) substantially decreased NA (310 nM)-stimulated ICaL, in human and rabbit. Phentolamine (α1 + α2-AR antagonist, 1 microM) also decreased NA-stimulated ICaL. CGP20712A (β1-AR antagonist, 0.3 microM) and prazosin (α1-AR antagonist, 0.5 microM) each decreased NA-stimulated ICaL in both species. ICI118551 (β2-AR antagonist, 0.1 microM), in the presence of NA + CGP20712A, had no significant effect on ICaL in human atrial myocytes, but increased it in rabbit. Yohimbine (α2-AR antagonist, 10 microM), with NA + prazosin, had no significant effect on human or rabbit ICaL. Stimulation of atrial ICaL by NA is mediated, based on AR sub-type antagonist responses, mainly by activating β1- and α1-ARs in both human and rabbit, with a β2-inhibitory contribution evident in rabbit, and negligible α2 involvement in either species. This improved understanding of AR sub-type contributions to noradrenergic activation of atrial ICaL could help inform future potential optimisation of pharmacological AR-antagonism strategies for inhibiting adrenergic AF.
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Affiliation(s)
- Priyanka Saxena
- Institute of Cardiovascular & Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Rachel C Myles
- Institute of Cardiovascular & Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Godfrey L Smith
- Institute of Cardiovascular & Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Antony J Workman
- Institute of Cardiovascular & Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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20
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Iwasaki YK, Sekiguchi A, Kato T, Yamashita T. Glucocorticoid Induces Atrial Arrhythmogenesis via Modification of Ion Channel Gene Expression in Rats. Int Heart J 2022; 63:375-383. [PMID: 35354756 DOI: 10.1536/ihj.21-677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Excess psychological stress is one of the precipitating factors for paroxysmal atrial fibrillation (AF), although the involved mechanisms are still uncertain. To test a hypothesis that one of the stress-induced hormones, glucocorticoid, is involved in the pathogenesis of stress-induced AF, we investigated whether the glucocorticoid could alter the temporal profile of cardiac ion channels gene expression, thereby leading to atrial arrhythmogenesis.Dexamethasone (DEX, 1.0 mg/kg) was injected subcutaneously in Sprague-Dawley rats. At predetermined times after DEX injection (0, 1, 3, 6, 12, and 24 hours), the mRNA levels of cardiac ion channel genes (erg, KvLQT1, Kv4.3, Kv4.2, Kv2.1, Kv1.5, Kv1.4, Kv1.2, SUR2A, Kir6.2, Kir3.4, Kir3.1 Kir2.2, Kir2.1, SCN5A, and α1C) were determined using RNase protection assay. DEX induced immediate and transient increase in the mRNA level of Kv1.5 and Kir2.2 with peaks at 6 (5.0 fold) and 3 hours (3.3 fold) after DEX injection, respectively. Patch-clamp studies revealed a significantly increased current density of the corresponding current, IKur and IK1 at 6 hours after DEX injection. Simultaneously, electrophysiological study in isolated perfused hearts showed significantly increased number of repetitive atrial responses induced by single atrial extrastimulus (3.2 ± 2.4 to 26.7 ± 16.4, P = 0.004) with shorting of the refractory period (36.4 ± 4.6 to 27.4 ± 5.5 ms, P = 0.049) after DEX injection.Glucocorticoid immediately modified Kv1.5 and Kir2.2 gene expression at pretranslational levels, thus leading to effective refractory period shortening that could be arrhythmogenic. These results implied that transient glucocorticoid-induced biochemical modification of cardiac ion channels might be one of the mechanisms underlying the stress-induced paroxysmal AF.
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Affiliation(s)
- Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Takeshi Kato
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University
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21
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Faris M, Goebel J, Sherertz R. Post Paddle Boarding Atrial Fibrillation in an Aging Athlete. Cureus 2022; 14:e22577. [PMID: 35228987 PMCID: PMC8872848 DOI: 10.7759/cureus.22577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/05/2022] Open
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22
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Enhanced Cardiac CaMKII Oxidation and CaMKII-Dependent SR Ca Leak in Patients with Sleep-Disordered Breathing. Antioxidants (Basel) 2022; 11:antiox11020331. [PMID: 35204213 PMCID: PMC8868143 DOI: 10.3390/antiox11020331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Sleep-disordered breathing (SDB) is associated with increased oxidant generation. Oxidized Ca/calmodulin kinase II (CaMKII) can contribute to atrial arrhythmias by the stimulation of sarcoplasmic reticulum Ca release events, i.e., Ca sparks. Methods: We prospectively enrolled 39 patients undergoing cardiac surgery to screen for SDB and collected right atrial appendage biopsies. Results: SDB was diagnosed in 14 patients (36%). SDB patients had significantly increased levels of oxidized and activated CaMKII (assessed by Western blotting/specific pulldown). Moreover, SDB patients showed a significant increase in Ca spark frequency (CaSpF measured by confocal microscopy) compared with control subjects. CaSpF was 3.58 ± 0.75 (SDB) vs. 2.49 ± 0.84 (no SDB) 1/100 µm−1s−1 (p < 0.05). In linear multivariable regression models, SDB severity was independently associated with increased CaSpF (B [95%CI]: 0.05 [0.03; 0.07], p < 0.001) after adjusting for important comorbidities. Interestingly, 30 min exposure to the CaMKII inhibitor autocamtide-2 related autoinhibitory peptide normalized the increased CaSpF and eliminated the association between SDB and CaSpF (B [95%CI]: 0.01 [−0.1; 0.03], p = 0.387). Conclusions: Patients with SDB have increased CaMKII oxidation/activation and increased CaMKII-dependent CaSpF in the atrial myocardium, independent of major clinical confounders, which may be a novel target for treatment of atrial arrhythmias in SDB.
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23
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Xie L, Huang G, Gao M, Huang J, Li H, Xia H, Xiang X, Wu S, Ruan Y. Identification of Atrial Fibrillation-Related lncRNA Based on Bioinformatic Analysis. DISEASE MARKERS 2022; 2022:8307975. [PMID: 35154514 PMCID: PMC8837454 DOI: 10.1155/2022/8307975] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in the world. Long noncoding RNA (lncRNA) has been found to play an important role in cardiovascular diseases including heart failure, myocardial infarction, and atherosclerosis. However, the role of lncRNA in AF has rarely been studied. The purpose of this study is to identify the expression profile of lncRNA in AF patients, explore the function of lncRNA in AF, and provide a potential scientific basis for the treatment of AF in the future. METHODS The lncRNA and mRNA expression profiles were obtained from the atrial appendage samples of GSE31821, GSE411774, GSE79768, and GSE115574 in the Gene Expression Omnibus (GEO) database. Functional analysis was performed via Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Variation Analysis (GSVA). The "CIBERSORT" R kit was used to analyze 22 immune cell infiltrates in AF and sinus rhythm (SR) patients. The "CORRPLOT" R package was used to analyze the immune correlation between lncRNA and immune cells. RESULTS A total of 6 differentially expressed lncRNAs and 45 differentially expressed mRNAs were identified in the AF and SR groups. GO, KEGG, and GSVA results showed that abnormally expressed lncRNAs were involved in signaling pathways related to the atrium, including the Toll-like receptor signaling pathway and calcium signaling pathway. Immune cell infiltration analysis revealed that native B cells, follicular helper T cells, and resting dendritic cells may be involved in the AF process. In addition, LINC00844 was negatively correlated with resting dendritic cells. CONCLUSION The expression profile of lncRNA in AF patients was different from that in normal controls. The physiological functions of these differentially expressed lncRNAs may be related to the pathogenesis of AF, which provide a scientific basis for the prognosis and treatment of patients with AF.
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Affiliation(s)
- Liangzhen Xie
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - GuanShen Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingjian Gao
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jianming Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hai Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hao Xia
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Xiuting Xiang
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong 518000, China
| | - Saizhu Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yunjun Ruan
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
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24
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Omerovic E, Citro R, Bossone E, Redfors B, Backs J, Bruns B, Ciccarelli M, Couch LS, Dawson D, Grassi G, Iacoviello M, Parodi G, Schneider B, Templin C, Ghadri JR, Thum T, Chioncel O, Tocchetti CG, Van Der Velden J, Heymans S, Lyon AR. Pathophysiology of Takotsubo Syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 1: Overview and the central role for catecholamines and sympathetic nervous system. Eur J Heart Fail 2021; 24:257-273. [PMID: 34907620 DOI: 10.1002/ejhf.2400] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022] Open
Abstract
This is the first part of a scientific statement from the Heart Failure Association of the European Society of Cardiology focused upon the pathophysiology of Takotsubo syndrome and is complimentary to the previous HFA Position Statement on Takotsubo syndrome which focused upon clinical management. In part 1 we provide an overview of the pathophysiology of Takotsubo syndrome and fundamental questions to consider. We then review and discuss the central role of catecholamines and the sympathetic nervous system in the pathophysiology, and the direct effects of high surges in catecholamines upon myocardial biology including β-adrenergic receptor signaling, G protein coupled receptor kinases, cardiomyocyte calcium physiology, myofilament physiology, cardiomyocyte gene expression, myocardial electrophysiology and arrhythmogenicity, myocardial inflammation, metabolism and energetics. The integrated effects upon ventricular haemodynamics are discussed and integrated into the pathophysiological model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, A. Cardarelli Hospital, Naples, Italy
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany
| | - Bastian Bruns
- Institute of Experimental Cardiology, Heidelberg University, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany.,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Michele Ciccarelli
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Liam S Couch
- National Heart and Lung Institute, Imperial College, London, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania and University of Medicine Carol Davila, Bucharest, Romania
| | - C Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | | | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, The Netherlands and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology and Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
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25
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Gottlieb LA, Dekker LRC, Coronel R. The Blinding Period Following Ablation Therapy for Atrial Fibrillation: Proarrhythmic and Antiarrhythmic Pathophysiological Mechanisms. JACC Clin Electrophysiol 2021; 7:416-430. [PMID: 33736761 DOI: 10.1016/j.jacep.2021.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) causes heart failure, ischemic strokes, and poor quality of life. The number of patients with AF is estimated to increase to 18 million in Europe in 2050. Pharmacological therapy does not cure AF in all patients. Ablative pulmonary vein isolation is recommended for patients with drug-resistant symptomatic paroxysmal AF but is successful in only about 60%. In patients in whom ablative therapy is successful on the long term, recurrence of AF may occur in the first weeks to months after pulmonary vein ablation. The early recurrence (or delayed cure) of AF is not understood but forms the basis for the generally accepted 3-month blinding (or blanking) period after ablation therapy, which is not included in the evaluation of the eventual success rate of the procedures. The underlying pathophysiological processes responsible for early recurrence and the delayed cure are unknown. The implicit assumption of the blinding period is that the AF mechanism in this period is different from the ablation-targeted AF mechanism (ectopy from the pulmonary veins). In this review, we evaluate the temporary and long-lasting pro- and antiarrhythmic effects of each of the pathophysiological processes and interventions (necrosis, ischemia, oxidative stress, edema, inflammation, autonomic nervous activity, tissue repair, mechanical remodeling, and use of antiarrhythmic drugs) occurring in the blinding period that can modulate AF mechanisms. We propose that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure.
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Affiliation(s)
- Lisa A Gottlieb
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands; Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands.
| | - Ruben Coronel
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
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26
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Newman W, Parry-Williams G, Wiles J, Edwards J, Hulbert S, Kipourou K, Papadakis M, Sharma R, O'Driscoll J. Risk of atrial fibrillation in athletes: a systematic review and meta-analysis. Br J Sports Med 2021; 55:1233-1238. [PMID: 34253538 DOI: 10.1136/bjsports-2021-103994] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE A systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) among athletes compared with non-athlete controls. DESIGN Meta-analysis with heterogeneity analysis and subsequent meta-regression to model covariates were performed. The mode of exercise (endurance and mixed sports) and age were the a priori determined covariates. DATA SOURCES PubMed, MEDLINE, Science Direct, SPORTDiscus and the Cochrane library were searched. ELIGIBILITY CRITERIA Research articles published after 1990 and before 2 December 2020 were included if they reported the number of AF cases in athletes with non-athlete (physically active or inactive) control groups, were case-control or cohort studies and if data allowed calculation of OR. RESULTS The risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p<0.001, Z=4.97). Mode of exercise and risk of AF were moderately correlated (B=0.1259, p=0.0193), with mixed sport conferring a greater risk of AF than endurance sport (B=-0.5476, p=0.0204). Younger (<55 years) athletes were significantly more likely to develop AF compared with older (≥55 years) athletes (B=-0.02293, p<0.001). CONCLUSION Athletes have a significantly greater likelihood of developing AF compared with non-athlete controls, with those participating in mixed sport and younger athletes at the greatest risk. Future studies of AF prevalence in athletes according to specific exercise dose parameters, including training and competition history, may aid further in delineating those at risk.
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Affiliation(s)
- William Newman
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Gemma Parry-Williams
- Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Jonathan Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Jamie Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Sabina Hulbert
- School of Psychology, Politics and Sociology, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Konstantina Kipourou
- Depertment of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Rajan Sharma
- Depertment of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jamie O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK .,Depertment of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
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27
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Goulden CJ, Hagana A, Ulucay E, Zaman S, Ahmed A, Harky A. Optimising risk factors for atrial fibrillation post-cardiac surgery. Perfusion 2021; 37:675-683. [PMID: 34034586 DOI: 10.1177/02676591211019319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postoperative atrial fibrillation (POAF) is an ongoing complication following cardiac surgery, with an incidence of 15%-60%. It is associated with substantial mortality and morbidity, as well increased hospital stays and healthcare costs. The pathogenesis is not fully understood, but the literature suggests that POAF occurs when transient, postoperative triggers act on vulnerable atrial tissue produced by preoperative, procedure-induced and postoperative processes such as inflammation, oxidative stress, autonomic dysfunction and electrophysiological remodelling of the atrial tissues. This sets the stage for arrhythmogenic mechanisms, such as ectopic firing secondary to triggered activity and re-entry mechanisms generating POAF. Preoperative factors include advanced age, sex, ethnicity, cardiovascular risk factors, preoperative drugs, electrocardiogram and echocardiogram abnormalities. Procedural factors include: the use of cardiopulmonary bypass and aortic cross clamp, type of cardiac surgery, use of hypothermia, left ventricular venting, bicaval cannulation and exclusion of the left atrial appendage. Postoperative factors include postoperative drugs, electrolyte and fluid balance and infection. This review explores the pathogenesis of POAF and the contribution of these perioperative factors in the development of POAF. Patients can be risk stratified for targeted treatment and prophylaxis, and how these factors can be attenuated to improve POAF outcomes following cardiac surgery.
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Affiliation(s)
- Christopher J Goulden
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Arwa Hagana
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Edagul Ulucay
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Sadia Zaman
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Amna Ahmed
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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28
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Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, largely associated to morbidity and mortality. Over the past decades, research in appearance and progression of this arrhythmia have turned into significant advances in its management. However, the incidence of AF continues to increase with the aging of the population and many important fundamental and translational underlaying mechanisms remain elusive. Here, we review recent advances in molecular and cellular basis for AF initiation, maintenance and progression. We first provide an overview of the basic molecular and electrophysiological mechanisms that lead and characterize AF. Next, we discuss the upstream regulatory factors conducting the underlying mechanisms which drive electrical and structural AF-associated remodeling, including genetic factors (risk variants associated to AF as transcriptional regulators and genetic changes associated to AF), neurohormonal regulation (i.e., cAMP) and oxidative stress imbalance (cGMP and mitochondrial dysfunction). Finally, we discuss the potential therapeutic implications of those findings, the knowledge gaps and consider future approaches to improve clinical management.
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29
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Benzoni P, Campostrini G, Landi S, Bertini V, Marchina E, Iascone M, Ahlberg G, Olesen MS, Crescini E, Mora C, Bisleri G, Muneretto C, Ronca R, Presta M, Poliani PL, Piovani G, Verardi R, Di Pasquale E, Consiglio A, Raya A, Torre E, Lodrini AM, Milanesi R, Rocchetti M, Baruscotti M, DiFrancesco D, Memo M, Barbuti A, Dell'Era P. Human iPSC modelling of a familial form of atrial fibrillation reveals a gain of function of If and ICaL in patient-derived cardiomyocytes. Cardiovasc Res 2021; 116:1147-1160. [PMID: 31504264 PMCID: PMC7177512 DOI: 10.1093/cvr/cvz217] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 07/19/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common type of cardiac arrhythmias, whose incidence is likely to increase with the aging of the population. It is considered a progressive condition, frequently observed as a complication of other cardiovascular disorders. However, recent genetic studies revealed the presence of several mutations and variants linked to AF, findings that define AF as a multifactorial disease. Due to the complex genetics and paucity of models, molecular mechanisms underlying the initiation of AF are still poorly understood. Here we investigate the pathophysiological mechanisms of a familial form of AF, with particular attention to the identification of putative triggering cellular mechanisms, using patient's derived cardiomyocytes (CMs) differentiated from induced pluripotent stem cells (iPSCs). METHODS AND RESULTS Here we report the clinical case of three siblings with untreatable persistent AF whose whole-exome sequence analysis revealed several mutated genes. To understand the pathophysiology of this multifactorial form of AF we generated three iPSC clones from two of these patients and differentiated these cells towards the cardiac lineage. Electrophysiological characterization of patient-derived CMs (AF-CMs) revealed that they have higher beating rates compared to control (CTRL)-CMs. The analysis showed an increased contribution of the If and ICaL currents. No differences were observed in the repolarizing current IKr and in the sarcoplasmic reticulum calcium handling. Paced AF-CMs presented significantly prolonged action potentials and, under stressful conditions, generated both delayed after-depolarizations of bigger amplitude and more ectopic beats than CTRL cells. CONCLUSIONS Our results demonstrate that the common genetic background of the patients induces functional alterations of If and ICaL currents leading to a cardiac substrate more prone to develop arrhythmias under demanding conditions. To our knowledge this is the first report that, using patient-derived CMs differentiated from iPSC, suggests a plausible cellular mechanism underlying this complex familial form of AF.
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Affiliation(s)
- Patrizia Benzoni
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Giulia Campostrini
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Sara Landi
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Valeria Bertini
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Eleonora Marchina
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Maria Iascone
- USSD Laboratorio di Genetica Medica, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Gustav Ahlberg
- The Heart Centre, Rigshospitalet, Laboratory for Molecular Cardiology, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Morten Salling Olesen
- The Heart Centre, Rigshospitalet, Laboratory for Molecular Cardiology, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Elisabetta Crescini
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Cristina Mora
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Gianluigi Bisleri
- Department of Surgery, Division of Cardiac Surgery, Queen's University, 99 University Avenue, Kingston, Ontario K7L 3N6, Canada
| | - Claudio Muneretto
- Clinical Department of Cardiovascular Surgery, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Roberto Ronca
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Marco Presta
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Pier Luigi Poliani
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Giovanna Piovani
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Rosanna Verardi
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, viale Europa 11, 25123 Brescia, Italy
| | - Elisa Di Pasquale
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milan, Italy
| | - Antonella Consiglio
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy.,Department of Pathology and Experimental Therapeutics, Bellvitge University Hospital-IDIBELL, 08908 Hospitalet de Llobregat, C/Feixa Larga s/n, 08907 Barcelona, Spain.,Institute of Biomedicine of the University of Barcelona (IBUB), Carrer Baldiri Reixac 15-21, Barcelona 08028, Spain
| | - Angel Raya
- Center of Regenerative Medicine in Barcelona (CMRB), Hospital Duran i Reynals, Hospitalet de Llobregat, 08908 Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Passeig Lluís Companys 23 08010 Barcelona, Spain.,Networking Center of Biomedical Research in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - Eleonora Torre
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, iazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
| | - Alessandra Maria Lodrini
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, iazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
| | - Raffaella Milanesi
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Marcella Rocchetti
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, iazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
| | - Mirko Baruscotti
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Dario DiFrancesco
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Andrea Barbuti
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, 20133 Milan, Italy
| | - Patrizia Dell'Era
- Department of Molecular and Translational Medicine, cFRU lab, Università degli Studi di Brescia, viale Europa 11, 25123 Brescia, Italy
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30
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Diekman CO, Wei N. Circadian Rhythms of Early Afterdepolarizations and Ventricular Arrhythmias in a Cardiomyocyte Model. Biophys J 2020; 120:319-333. [PMID: 33285114 DOI: 10.1016/j.bpj.2020.11.2264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022] Open
Abstract
Sudden cardiac arrest is a malfunction of the heart's electrical system, typically caused by ventricular arrhythmias, that can lead to sudden cardiac death (SCD) within minutes. Epidemiological studies have shown that SCD and ventricular arrhythmias are more likely to occur in the morning than in the evening, and laboratory studies indicate that these daily rhythms in adverse cardiovascular events are at least partially under the control of the endogenous circadian timekeeping system. However, the biophysical mechanisms linking molecular circadian clocks to cardiac arrhythmogenesis are not fully understood. Recent experiments have shown that L-type calcium channels exhibit circadian rhythms in both expression and function in guinea pig ventricular cardiomyocytes. We developed an electrophysiological model of these cells to simulate the effect of circadian variation in L-type calcium conductance. In our simulations, we found that there is a circadian pattern in the occurrence of early afterdepolarizations (EADs), which are abnormal depolarizations during the repolarization phase of a cardiac action potential that can trigger fatal ventricular arrhythmias. Specifically, the model produces EADs in the morning, but not at other times of day. We show that the model exhibits a codimension-2 Takens-Bogdanov bifurcation that serves as an organizing center for different types of EAD dynamics. We also simulated a two-dimensional spatial version of this model across a circadian cycle. We found that there is a circadian pattern in the breakup of spiral waves, which represents ventricular fibrillation in cardiac tissue. Specifically, the model produces spiral wave breakup in the morning, but not in the evening. Our computational study is the first, to our knowledge, to propose a link between circadian rhythms and EAD formation and suggests that the efficacy of drugs targeting EAD-mediated arrhythmias may depend on the time of day that they are administered.
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Affiliation(s)
- Casey O Diekman
- Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, New Jersey; EPSRC Centre for Predictive Modelling in Healthcare, Living Systems Institute, University of Exeter, Exeter, United Kingdom.
| | - Ning Wei
- Department of Mathematics, Purdue University, West Lafayette, Indiana
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31
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Njegic A, Wilson C, Cartwright EJ. Targeting Ca 2 + Handling Proteins for the Treatment of Heart Failure and Arrhythmias. Front Physiol 2020; 11:1068. [PMID: 33013458 PMCID: PMC7498719 DOI: 10.3389/fphys.2020.01068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
Diseases of the heart, such as heart failure and cardiac arrhythmias, are a growing socio-economic burden. Calcium (Ca2+) dysregulation is key hallmark of the failing myocardium and has long been touted as a potential therapeutic target in the treatment of a variety of cardiovascular diseases (CVD). In the heart, Ca2+ is essential for maintaining normal cardiac function through the generation of the cardiac action potential and its involvement in excitation contraction coupling. As such, the proteins which regulate Ca2+ cycling and signaling play a vital role in maintaining Ca2+ homeostasis. Changes to the expression levels and function of Ca2+-channels, pumps and associated intracellular handling proteins contribute to altered Ca2+ homeostasis in CVD. The remodeling of Ca2+-handling proteins therefore results in impaired Ca2+ cycling, Ca2+ leak from the sarcoplasmic reticulum and reduced Ca2+ clearance, all of which contributes to increased intracellular Ca2+. Currently, approved treatments for targeting Ca2+ handling dysfunction in CVD are focused on Ca2+ channel blockers. However, whilst Ca2+ channel blockers have been successful in the treatment of some arrhythmic disorders, they are not universally prescribed to heart failure patients owing to their ability to depress cardiac function. Despite the progress in CVD treatments, there remains a clear need for novel therapeutic approaches which are able to reverse pathophysiology associated with heart failure and arrhythmias. Given that heart failure and cardiac arrhythmias are closely associated with altered Ca2+ homeostasis, this review will address the molecular changes to proteins associated with both Ca2+-handling and -signaling; their potential as novel therapeutic targets will be discussed in the context of pre-clinical and, where available, clinical data.
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Affiliation(s)
- Alexandra Njegic
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom.,Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Claire Wilson
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom.,Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Elizabeth J Cartwright
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
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32
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Saadeh K, Shivkumar K, Jeevaratnam K. Targeting the β-adrenergic receptor in the clinical management of congenital long QT syndrome. Ann N Y Acad Sci 2020; 1474:27-46. [PMID: 32901453 DOI: 10.1111/nyas.14425] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/10/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023]
Abstract
The long QT syndrome (LQTS) is largely treated pharmacologically with β-blockers, despite the role of sympathetic activity in LQTS being poorly understood. Using the trigger-substrate model of cardiac arrhythmias in this review, we amalgamate current experimental and clinical data from both animal and human studies to explain the mechanism of adrenergic stimulation and blockade on LQT arrhythmic risk and hence assess the efficacy of β-adrenoceptor blockade in the management of LQTS. In LQTS1 and LQTS2, sympathetic stimulation increases arrhythmic risk by enhancing early afterdepolarizations and transmural dispersion of repolarization. β-Blockers successfully reduce cardiac events by reducing these triggers and substrates; however, these effects are less marked in LQTS2 compared with LQTS1. In LQTS3, clinical and experimental investigations of the effects of sympathetic stimulation and β-blocker use have produced contradictory findings, resulting in significant clinical uncertainty. We offer explanations for these contradicting results relating to study sample size, the dose of the β-blocker administered associated with its off-target Na+ channel effects, as well as the type of β-blocker used. We conclude that the antiarrhythmic efficacy of β-blockers is a genotype-specific phenomenon, and hence the use of β-blockers in clinical practice should be genotype dependent.
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Affiliation(s)
- Khalil Saadeh
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Centre, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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33
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Agra-Bermejo RM, Cacho-Antonio C, Rozados-Luis A, Couselo-Seijas M, Fernandez AL, Martinez-Cereijo JM, Bravo SB, Gonzalez-Juanatey JR, Eiras S. CD5L, Macrophage Apoptosis Inhibitor, Was Identified in Epicardial Fat-Secretome and Regulated by Isoproterenol From Patients With Heart Failure. Front Physiol 2020; 11:620. [PMID: 32695009 PMCID: PMC7338428 DOI: 10.3389/fphys.2020.00620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Neurohormonal dysfunction, which can regulate epicardial fat activity, is one of the main promoters of atrial fibrillation (AF) in patients with heart failure (HF). Our aim was to study the epicardial fat mediators for AF in patients with HF and its catecholaminergic regulation. Methods We have included 29 patients with HF who underwent cardiac surgery and were followed up for 5 years. Released proteins by epicardial adipose tissue (EAT) after isoproterenol treatment were identified by nano-high-performance liquid chromatography (HPLC) and triple time-of-flight (TOF) analysis. Common and differential identified proteins in groups of patients with AF before and after surgery were determined by the FunRich tool. Plasma and epicardial fat biopsy proteins were quantified by western blot. Results Our results identified 17 common released proteins by EAT, after isoproterenol treatment, from HF patients who suffered AF or developed new-onset AF during follow-up. Mostly, they were involved on inflammatory response and extracellular matrix. One of them was CD5L, a macrophage apoptosis inhibitor. Its secretion by isoproterenol treatment was validated on western blot. The CD5L levels on epicardial fat were also higher in the group of male patients who present or develop AF (0.44 ± 0.05 vs. 0.18 ± 0.15; p < 0.016). However, there were no differences regarding plasma levels. Conclusion Our results suggest the role of epicardial fat CD5L as a mediator of AF and its possible paracrine effect by catecholaminergic activity.
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Affiliation(s)
- Rosa M Agra-Bermejo
- Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.,Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Carla Cacho-Antonio
- Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Adriana Rozados-Luis
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marinela Couselo-Seijas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel L Fernandez
- CIBERCV, Madrid, Spain.,Heart Surgery Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - J M Martinez-Cereijo
- Heart Surgery Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - S B Bravo
- Proteomic Unit, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose R Gonzalez-Juanatey
- Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.,Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Sonia Eiras
- CIBERCV, Madrid, Spain.,Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
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34
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Olshansky B, Muldowney J. Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension. Am J Cardiol 2020; 125:1582-1593. [PMID: 32204870 DOI: 10.1016/j.amjcard.2020.01.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 12/17/2022]
Abstract
Neurogenic orthostatic hypotension (nOH), a drop in blood pressure upon standing resulting from autonomic malfunction, may cause debilitating symptoms that can affect independence in daily activities and quality-of-life. nOH may also be associated with cardiovascular comorbidities (e.g., supine hypertension, heart failure, diabetes, and arrhythmias), making treatment decisions complicated and requiring management that should be based on a patient's cardiovascular profile. Additionally, drugs used to treat the cardiovascular disorders (e.g., vasodilators, β-blockers) can exacerbate nOH and concomitant symptoms. When orthostatic symptoms are severe and not effectively managed with nonpharmacologic strategies (e.g., water ingestion, abdominal compression), droxidopa or midodrine may be effective. Droxidopa may be less likely than midodrine to exacerbate supine hypertension, based on conclusions of a limited meta-analysis. In conclusion, treating nOH in patients with cardiovascular conditions requires a balance between symptom relief and minimizing adverse outcomes.
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35
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Couffignal C, Amour J, Ait-Hamou N, Cholley B, Fellahi JL, Duval X, Costa De Beauregard Y, Nataf P, Dilly MP, Provenchère S, Montravers P, Mentré F, Longrois D. Timing of β-Blocker Reintroduction and the Occurrence of Postoperative Atrial Fibrillation after Cardiac Surgery: A Prospective Cohort Study. Anesthesiology 2020; 132:267-279. [PMID: 31939841 DOI: 10.1097/aln.0000000000003064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of β-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. METHODS This multicenter prospective French cohort study included patients on β-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of β-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of β-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). RESULTS Of 663 patients, β-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of β-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. CONCLUSIONS β-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) β-blocker reintroduction after cardiac surgery.
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Affiliation(s)
- Camille Couffignal
- From the Department of Biostatistics, Bichat-Claude Bernard Hospital, AP-HP.Nord, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (C.C., F.M.) University of Paris, IAME, UMR1137, Paris, France (C.C., X.D., F.M.) INSERM, IAME, UMR 1137, Paris, France (C.C., X.D., F.M.) Clinical Investigation Center, CIC-1425, AP-HP, INSERM, Paris, France (X.D., Y.C.D.B.) Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, APHP, Sorbonne University, UPMC University, Paris 06, UMR INSERM 1166, IHU ICAN, Paris, France (J.A., N.A.-H.) Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, APHP Paris-Ouest, University of Paris, Paris, France (B.C.) Department of Anesthesia and Intensive Care, Hôpital Cardiologique Louis Pradel, IHU OPERA Inserm U1060/Faculté de Médecine Lyon Est, University Claude Bernard Lyon 1, Lyon, France (J.-L.F.) Department of Cardiac Surgery, Bichat-Claude Bernard Hospital, AP-HP.Nord, APHP, Paris, France (P.N.) Department of Anesthesia and Intensive Care, Bichat-Claude Bernard Hospital, AP-HP.Nord, APHP, Paris, France (M.-P.D., S.P., P.M., D.L.) University of Paris, Paris, France (P.M., D.L.)
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36
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Postoperative Atrial Fibrillation Following Cardiac Surgery: From Pathogenesis to Potential Therapies. Am J Cardiovasc Drugs 2020; 20:19-49. [PMID: 31502217 DOI: 10.1007/s40256-019-00365-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery which can lead to high rates of morbidity and mortality, an enhanced length of hospital stay, and an increased cost of care. POAF is postulated to be a multifactorial phenomenon; however, some major pathogeneses have been proposed, including inflammatory pathways, oxidative stress, and autonomic dysfunction. Genetic studies also showed that inflammatory pathways, beta-1 adrenoreceptor variants, G protein-coupled receptor kinase 5 gene variants, and non-coding single-nucleotide polymorphisms in the 4q25 chromosomal locus are involved in this phenomenon. Moreover, several predisposing factors lead to the development of POAF, consisting of pre-, intra-, and postoperative contributors. The main predisposing factors comprise age, prior history of major cardiovascular risk factors, and ischemia-reperfusion injury during surgery. The management of POAF is based on the usual therapies used for non-surgical AF, including medications for either rate control or rhythm control in hemodynamically unstable patients. The perioperative administration of β-blockers and some antiarrhythmic agents has been recommended in major international guidelines. In addition, upstream therapies consisting of colchicine, magnesium, statins, and antioxidants have attenuated the incidence of POAF; however, some uncomfortable side effects developed in large randomized trials. The use of anticoagulation has also resulted in less mortality in patients with POAF at higher risk of thromboembolic events. Despite these recommendations, the actual regimen for the prevention of POAF remains controversial. In this review, we highlight the pathogenesis, predisposing factors, and potential therapeutic options for the management of patients at risk for or with POAF following cardiac surgery.
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37
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van Ouwerkerk AF, Bosada FM, van Duijvenboden K, Hill MC, Montefiori LE, Scholman KT, Liu J, de Vries AAF, Boukens BJ, Ellinor PT, Goumans MJTH, Efimov IR, Nobrega MA, Barnett P, Martin JF, Christoffels VM. Identification of atrial fibrillation associated genes and functional non-coding variants. Nat Commun 2019; 10:4755. [PMID: 31628324 PMCID: PMC6802215 DOI: 10.1038/s41467-019-12721-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/19/2019] [Indexed: 12/31/2022] Open
Abstract
Disease-associated genetic variants that lie in non-coding regions found by genome-wide association studies are thought to alter the functionality of transcription regulatory elements and target gene expression. To uncover causal genetic variants, variant regulatory elements and their target genes, here we cross-reference human transcriptomic, epigenomic and chromatin conformation datasets. Of 104 genetic variant regions associated with atrial fibrillation candidate target genes are prioritized. We optimize EMERGE enhancer prediction and use accessible chromatin profiles of human atrial cardiomyocytes to more accurately predict cardiac regulatory elements and identify hundreds of sub-threshold variants that co-localize with regulatory elements. Removal of mouse homologues of atrial fibrillation-associated regions in vivo uncovers a distal regulatory region involved in Gja1 (Cx43) expression. Our analyses provide a shortlist of genes likely affected by atrial fibrillation-associated variants and provide variant regulatory elements in each region that link genetic variation and target gene regulation, helping to focus future investigations.
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Affiliation(s)
- Antoinette F van Ouwerkerk
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Fernanda M Bosada
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Karel van Duijvenboden
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Matthew C Hill
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, 77030, USA
| | | | - Koen T Scholman
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Jia Liu
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Cell Biology and Genetics, Center for Anti-ageing and Regenerative Medicine, Shenzhen Key Laboratory for Anti-ageing and Regenerative Medicine, Shenzhen University Medical School, Shenzhen University, Nanhai Ave, 3688, Shenzhen, China
- Netherlands Heart Institute, Holland Heart House, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands
| | - Antoine A F de Vries
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Netherlands Heart Institute, Holland Heart House, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands
| | - Bastiaan J Boukens
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovasular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Marie José T H Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Center, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - Igor R Efimov
- Department of Biomedical Engineering, George Washington University, Washington, DC, USA
| | - Marcelo A Nobrega
- Department of Human Genetics, The University of Chicago, Chicago, USA
| | - Phil Barnett
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - James F Martin
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Heart Institute, Houston, TX, 77030, USA
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam University Medical Centers, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.
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38
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Thomas AM, Cabrera CP, Finlay M, Lall K, Nobles M, Schilling RJ, Wood K, Mein CA, Barnes MR, Munroe PB, Tinker A. Differentially expressed genes for atrial fibrillation identified by RNA sequencing from paired human left and right atrial appendages. Physiol Genomics 2019; 51:323-332. [PMID: 31172864 PMCID: PMC6732415 DOI: 10.1152/physiolgenomics.00012.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation is a significant worldwide contributor to cardiovascular morbidity and mortality. Few studies have investigated the differences in gene expression between the left and right atrial appendages, leaving their characterization largely unexplored. In this study, differential gene expression was investigated in atrial fibrillation and sinus rhythm using left and right atrial appendages from the same patients. RNA sequencing was performed on the left and right atrial appendages from five sinus rhythm (SR) control patients and five permanent AF case patients. Differential gene expression in both the left and right atrial appendages was analyzed using the Bioconductor package edgeR. A selection of differentially expressed genes, with relevance to atrial fibrillation, were further validated using quantitative RT-PCR. The distribution of the samples assessed through principal component analysis showed distinct grouping between left and right atrial appendages and between SR controls and AF cases. Overall 157 differentially expressed genes were identified to be downregulated and 90 genes upregulated in AF. Pathway enrichment analysis indicated a greater involvement of left atrial genes in the Wnt signaling pathway whereas right atrial genes were involved in clathrin-coated vesicle and collagen formation. The differing expression of genes in both left and right atrial appendages indicate that there are different mechanisms for development, support and remodeling of AF within the left and right atria.
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Affiliation(s)
- Alison M Thomas
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Claudia P Cabrera
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Malcolm Finlay
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Kulvinder Lall
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Muriel Nobles
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Kristie Wood
- Barts and London Genome Centre, School of Medicine and Dentistry, Blizard Institute, London, United Kingdom
| | - Charles A Mein
- Barts and London Genome Centre, School of Medicine and Dentistry, Blizard Institute, London, United Kingdom
| | - Michael R Barnes
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew Tinker
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Kettlewell S, Saxena P, Dempster J, Colman MA, Myles RC, Smith GL, Workman AJ. Dynamic clamping human and rabbit atrial calcium current: narrowing I CaL window abolishes early afterdepolarizations. J Physiol 2019; 597:3619-3638. [PMID: 31093979 PMCID: PMC6767690 DOI: 10.1113/jp277827] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/13/2019] [Indexed: 11/08/2022] Open
Abstract
Key points Early‐afterdepolarizations (EADs) are abnormal action potential oscillations and a known cause of cardiac arrhythmias. Ventricular EADs involve reactivation of a Ca2+ current (ICaL) in its ‘window region’ voltage range. However, electrical mechanisms of atrial EADs, a potential cause of atrial fibrillation, are poorly understood. Atrial cells were obtained from consenting patients undergoing heart surgery, as well as from rabbits. ICaL was blocked with nifedipine and then a hybrid patch clamp/mathematical‐modelling technique, ‘dynamic clamping’, was used to record action potentials at the same time as injecting an artificial, modifiable, ICaL (ICaL,D‐C). Progressively widening the ICaL,D‐C window region produced EADs of various types, dependent on window width. EAD production was strongest upon moving the activation (vs. inactivation) side of the window. EADs were then induced by a different method: increasing ICaL,D‐C amplitude and/or K+ channel‐blockade (4‐aminopyridine). Narrowing of the ICaL,D‐C window by ∼10 mV abolished these EADs. Atrial ICaL window narrowing is worthy of further testing as a potential anti‐atrial fibrillation drug mechanism.
Abstract Atrial early‐afterdepolarizations (EADs) may contribute to atrial fibrillation (AF), perhaps involving reactivation of L‐type Ca2+ current (ICaL) in its window region voltage range. The present study aimed (i) to validate the dynamic clamp technique for modifying the ICaL contribution to atrial action potential (AP) waveform; (ii) to investigate the effects of widening the window ICaL on EAD‐propensity; and (iii) to test whether EADs from increased ICaL and AP duration are supressed by narrowing the window ICaL. ICaL and APs were recorded from rabbit and human atrial myocytes by whole‐cell‐patch clamp. During AP recording, ICaL was inhibited (3 µm nifedipine) and replaced by a dynamic clamp model current, ICaL,D‐C (tuned to native ICaL characteristics), computed in real‐time (every 50 µs) based on myocyte membrane potential. ICaL,D‐C‐injection restored the nifedipine‐suppressed AP plateau. Widening the window ICaL,D‐C, symmetrically by stepwise simultaneous equal shifts of half‐voltages (V0.5) of ICaL,D‐C activation (negatively) and inactivation (positively), generated EADs (single, multiple or preceding repolarization failure) in a window width‐dependent manner, as well as AP alternans. A stronger EAD‐generating effect resulted from independently shifting activation V0.5 (asymmetrical widening) than inactivation V0.5; for example, a 15 mV activation shift produced EADs in nine of 17 (53%) human atrial myocytes vs. 0 of 18 from inactivation shift (P < 0.05). In 11 rabbit atrial myocytes in which EADs were generated either by increasing the conductance of normal window width ICaL,D‐C or subsequent 4‐aminopyridine (2 mm), window ICaL,D‐C narrowing (10 mV) abolished EADs of all types (P < 0.05). The present study validated the dynamic clamp for ICaL, which is novel in atrial cardiomyocytes, and showed that EADs of various types are generated by widening (particularly asymmetrically) the window ICaL, as well as abolished by narrowing it. Window ICaL narrowing is a potential therapeutic mechanism worth pursuing in the search for improved anti‐AF drugs. Early‐afterdepolarizations (EADs) are abnormal action potential oscillations and a known cause of cardiac arrhythmias. Ventricular EADs involve reactivation of a Ca2+ current (ICaL) in its ‘window region’ voltage range. However, electrical mechanisms of atrial EADs, a potential cause of atrial fibrillation, are poorly understood. Atrial cells were obtained from consenting patients undergoing heart surgery, as well as from rabbits. ICaL was blocked with nifedipine and then a hybrid patch clamp/mathematical‐modelling technique, ‘dynamic clamping’, was used to record action potentials at the same time as injecting an artificial, modifiable, ICaL (ICaL,D‐C). Progressively widening the ICaL,D‐C window region produced EADs of various types, dependent on window width. EAD production was strongest upon moving the activation (vs. inactivation) side of the window. EADs were then induced by a different method: increasing ICaL,D‐C amplitude and/or K+ channel‐blockade (4‐aminopyridine). Narrowing of the ICaL,D‐C window by ∼10 mV abolished these EADs. Atrial ICaL window narrowing is worthy of further testing as a potential anti‐atrial fibrillation drug mechanism.
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Affiliation(s)
- Sarah Kettlewell
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Priyanka Saxena
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - John Dempster
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Rachel C Myles
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Godfrey L Smith
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Antony J Workman
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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Carter-Storch R, Dahl JS, Christensen NL, Pecini R, Søndergård EV, Øvrehus KA, Møller JE. Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation. Interact Cardiovasc Thorac Surg 2019; 29:378-385. [PMID: 30977792 DOI: 10.1093/icvts/ivz094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/03/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractOBJECTIVESPostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. However, knowledge on the rate of long-term atrial fibrillation (LTAF) after POAF remains unclear. We investigated predictors of POAF in patients with aortic stenosis undergoing surgical aortic valve replacement, and assessed the rate of LTAF during follow-up.METHODSWe prospectively included 96 adult patients with severe aortic stenosis undergoing surgical aortic valve replacement. Patients with previous atrial fibrillation (AF) were excluded. Patients underwent echocardiography, cardiac computed tomography and magnetic resonance imaging immediately prior to surgery. Surgical aortic clamp time and postoperative C-reactive protein (CRP) were documented. POAF was defined as AF recorded within 7 days of surgery. Through chart review, patients were followed up for documented episodes of LTAF occurring more than 7 days after surgery.RESULTSPOAF occurred in 51 patients (53%). It was associated with larger preoperative echocardiographic left atrial volume index (44 ± 12 vs 37 ± 8 ml/m2, P = 0.004), longer aortic clamp time [80 (70–102) vs 72 (62–65) min, P = 0.04] and higher CRP on first postoperative day [80 (64–87) vs 65 (44–83) mg/l, P = 0.001]. Multivariable logistic regression revealed that left atrial volume index [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13; P = 0.005] and postoperative CRP (OR 1.03, 95% CI 1.01–1.05; P = 0.006) were the only independent predictors of POAF. During 695 days (25th–75th percentile: 498–859 days) of follow-up, LTAF occurred in 11 patients of whom 10 were in the POAF group (hazard ratio 9.4, 95% CI 1.2–74; P = 0.03).CONCLUSIONSPOAF is predicted by left atrial volume index and postoperative CRP. Patients with POAF have a 9-fold increase risk of developing symptomatic LTAF during follow-up.Clinical trial registration numberClinicalTrials.gov (NCT02316587).
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Affiliation(s)
- Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- OPEN Odense Patient Data Explorative Network
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Redi Pecini
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Eva V Søndergård
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- OPEN Odense Patient Data Explorative Network
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Colman MA, Saxena P, Kettlewell S, Workman AJ. Description of the Human Atrial Action Potential Derived From a Single, Congruent Data Source: Novel Computational Models for Integrated Experimental-Numerical Study of Atrial Arrhythmia Mechanisms. Front Physiol 2018; 9:1211. [PMID: 30245635 PMCID: PMC6137999 DOI: 10.3389/fphys.2018.01211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: The development of improved diagnosis, management, and treatment strategies for human atrial fibrillation (AF) is a significant and important challenge in order to improve quality of life for millions and reduce the substantial social-economic costs of the condition. As a complex condition demonstrating high variability and relation to other cardiac conditions, the study of AF requires approaches from multiple disciplines including single-cell experimental electrophysiology and computational modeling. Models of human atrial cells are less well parameterized than those of the human ventricle or other mammal species, largely due to the inherent challenges in patch clamping human atrial cells. Such challenges include, frequently, unphysiologically depolarized resting potentials and thus injection of a compensatory hyperpolarizing current, as well as detecting certain ion currents which may be disrupted by the cell isolation process. The aim of this study was to develop a laboratory specific model of human atrial electrophysiology which reproduces exactly the conditions of isolated-cell experiments, including testing of multiple experimental interventions. Methods: Formulations for the primary ion currents characterized by isolated-cell experiments in the Workman laboratory were fit directly to voltage-clamp data; the fast sodium-current was parameterized based on experiments relating resting membrane potential to maximal action potential upstroke velocity; compensatory hyperpolarizing current was included as a constant applied current. These formulations were integrated with three independent human atrial cell models to provide a family of novel models. Extrapolated intact-cell models were developed through removal of the hyperpolarizing current and introduction of terminal repolarization potassium currents. Results: The isolated-cell models quantitatively reproduced experimentally measured properties of excitation in both control and pharmacological and dynamic-clamp interventions. Comparison of isolated and intact-cell models highlighted the importance of reproducing this cellular environment when comparing experimental and simulation data. Conclusion: We have developed a laboratory specific model of the human atrial cell which directly reproduces the experimental isolated-cell conditions and captures human atrial excitation properties. The model may be particularly useful for directly relating model to experiment, and offers a complementary tool to the available set of human atrial cell models with specific advantages resulting from the congruent input data source.
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Affiliation(s)
- Michael A Colman
- Leeds Computational Physiology Lab, School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Priyanka Saxena
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sarah Kettlewell
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Antony J Workman
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Wu Q, Qu J, Yin Y, Wang A, Cheng W, Duan R, Zhang B. Morning hypertension is a risk factor of macrovascular events following cerebral infarction: A retrospective study. Medicine (Baltimore) 2018; 97:e12013. [PMID: 30142846 PMCID: PMC6113038 DOI: 10.1097/md.0000000000012013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/30/2018] [Indexed: 12/04/2022] Open
Abstract
This study aimed to investigate risk factors (such as morning hypertension, drug compliance, and biochemical parameters) of macrovascular events after cerebral infarction.This was a retrospective study of patients with cerebral infarction admitted between May 2015 and April 2016 at the Fengxian Branch, 6th People's Hospital of Shanghai. They were divided into the macrovascular events and control groups according to the diagnosis of macrovascular events following cerebral infarction.Among the 702 patients included for analysis, 122 patients were with macrovascular events and 580 were without macrovascular events (controls). Morning hypertension (P = .01), dyslipidemia (P = .007), atrial fibrillation (P = .039), carotid artery plaque (P = .014), inflammatory infection (P = .005), high homocysteine (P = .032), antithrombotic compliance (P < .001), statins compliance (P < .001), morning diastolic blood pressure (P < .001), morning systolic blood pressure (P < .001), and morning heart rate (morHR) (P = .033) were associated with macrovascular events. Multivariable analysis showed that morning hypertension (P = .021, odds ratio [OR] = 1.753, 95% confidence interval [CI] [1.088, 2.826]), dyslipidemia (P = .021, OR = 1.708, 95% CI [1.085, 2.687]), and inflammatory infection (P = .031, OR = 2.263, 95% CI [1.078, 4.752]) were independent risk factors for macrovascular events, while antithrombotic compliance (P < .001, OR = 0.488, 95% CI [0.336, 0.709]), statin compliance (P = .02, OR = 0.64, 95% CI [0.44, 0.931]), and morHR (P = .027, OR = 0.977, 95% CI [0.958, 0.997]) were independent protective factors against macrovascular events. Atrial fibrillation showed a tendency to be associated with macrovascular events (P = .077, OR = 1.531, 95% CI [0.955, 2.454]).Morning hypertension, dyslipidemia, and inflammatory infection may increase the risk of macrovascular events following cerebral infarction. Improving morning blood pressure management and drug compliance (antithrombotic drugs and statins) may reduce the risk of macrovascular events following cerebral infarction.
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Lackermair K, Clauss S, Voigt T, Klier I, Summo C, Hildebrand B, Nickel T, Estner HL, Kääb S, Wakili R, Wilbert-Lampen U. Alteration of Endothelin 1, MCP-1 and Chromogranin A in patients with atrial fibrillation undergoing pulmonary vein isolation. PLoS One 2017; 12:e0184337. [PMID: 28886122 PMCID: PMC5590904 DOI: 10.1371/journal.pone.0184337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The relation between arrhythmias and stress is known. The aim of our current study was to elucidate whether plasma levels of previously described stress parameters are altered in highly symptomatic patients with atrial fibrillation (AF) per se and in patients undergoing ablation therapy by pulmonary vein isolation (PVI). METHODS 96 patients with AF undergoing PVI were recruited. Plasma levels of Endothelin-1 (ET-1), MCP-1 and Chromogranin-A (CGA) were measured before and three months after ablation completed with clinical follow-up with respect to AF recurrence. Additionally, we examined 40 healthy age- and sex-matched volunteers as a reference. RESULTS Symptomatic AF patients showed increased levels of ET-1 compared to healthy controls (2.62pg/ml vs. 1.57pg/ml; p<0.01). Baseline levels of ET-1 were higher in patients presenting with AF after PVI (2.96pg/ml vs. 2.57pg/ml;p = 0.02). The temporal comparison revealed decreased ET-1 levels in patients without (2.57pg/ml vs. 2.33pg/ml; p<0.01) and unchanged ET-1 levels in patients with AF after PVI. Baseline MCP-1 was increased in AF patients vs. controls (268pg/ml vs. 227 pg/ml; p = 0.03). Both groups, with and without AF after PVI, showed an increase of MCP-1 compared to baseline (268pg/ml vs. 349pg/ml;p<0.01; 281pg/ml vs. 355pg/ml;p = 0.03). CGA was lower in AF patients compared to healthy controls (13.8ng/ml vs. 25.6ng/ml;p<0.01). Over time patients without AF after PVI showed an increase of CGA (14.2ng/ml vs. 20.7ng/ml;p<0.01). No change was observed in patients with AF after PVI. CONCLUSION Our study demonstrated dysregulated levels of ET-1, MCP-1 and CGA in symptomatic AF patients. We could demonstrate an association between ET-1 to presence or absence of AF. Furthermore, we could show that a decrease of ET-1 as well as an increase of CGA after PVI, representing a trend towards control cohort levels, were both associated with restoration of sinus rhythm. These results provide new insights into the role of stress-related biomarkers in AF and AF treatment by ablation therapy.
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Affiliation(s)
- K. Lackermair
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - S. Clauss
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - T. Voigt
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - I. Klier
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - C. Summo
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - B. Hildebrand
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - T. Nickel
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - H. L. Estner
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - S. Kääb
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
| | - R. Wakili
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
- * E-mail:
| | - U. Wilbert-Lampen
- Department of Medicine I, Klinikum Grosshadern, University of Munich (LMU), Munich, Germany
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Anderson EJ, Efird JT, Kiser AC, Crane PB, O'Neal WT, Ferguson TB, Alwair H, Carter K, Williams JM, Gehi AK, Kypson AP. Plasma Catecholamine Levels on the Morning of Surgery Predict Post-Operative Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:1456-1465. [PMID: 29430523 DOI: 10.1016/j.jacep.2017.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to determine whether plasma catecholamines and monoamine oxidase-B (MOA-B) are associated with post-operative atrial fibrillation (POAF) in patients undergoing elective cardiac surgery. BACKGROUND Although intra- and post-operative adrenergic tone has been demonstrated to be an causative factor for POAF, the role and association of pre-operative plasma catecholamines remains unclear. METHODS Prior to administration of anesthesia on the morning of surgery, blood samples were obtained from 324 patients undergoing nonemergent coronary artery bypass graft and/or aortic valve surgery with cardiopulmonary bypass at East Carolina Heart Institute. The concentrations of norepinephrine (NE), dopamine (DA), epinephrine (EPI), and enzyme MAO-B were assessed in platelet-rich plasma. A log-binomial regression model was used to determine the association between quartiles of these variables and POAF. RESULTS Levels of NE (p = 0.0006) and EPI (p = 0.047) in the 4th quartile [Formula: see text] were positively associated with POAF, whereas DA (p = 0.0034) levels in the 4th quartile [Formula: see text] were inversely associated with POAF. Adjusting for age, heart failure (HF), and history of atrial fibrillation, the composite pre-operative (adrenergic) plasma marker [Formula: see text] was associated with a 4-fold increased occurrence of POAF (adjusted p = 0.0001). No association between plasma MAO-B and POAF was observed. CONCLUSIONS Our results suggest that pre-operative adrenergic tone is an important factor underlying POAF. This information provides evidence that assessment of plasma catecholamines may be a low-cost method that is easy to implement for predicting which patients are likely to develop POAF. More investigation in a multicentric setting is needed to validate our results.
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Affiliation(s)
- Ethan J Anderson
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa.,Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Jimmy T Efird
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina.,Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina.,Office of the Dean of Research, College of Nursing, East Carolina University, Greenville, North Carolina.,Center for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andy C Kiser
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Patricia B Crane
- Office of the Dean of Research, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Hazaim Alwair
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kendal Carter
- Center for Epidemiology and Outcomes Research, East Carolina Heart Institute, Greenville, North Carolina
| | - J Mark Williams
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Anil K Gehi
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan P Kypson
- REX Cardiac Surgical Specialists, University of North Carolina Health Care, Raleigh, North Carolina
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Quan D, Zurcher K. Reversible atrial fibrillation following Crotalinae envenomation. J Venom Anim Toxins Incl Trop Dis 2017; 23:16. [PMID: 28331489 PMCID: PMC5359800 DOI: 10.1186/s40409-017-0108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Cardiotoxicity is a documented complication of Crotalinae envenomation. Reported cardiac complications following snake envenomation have included acute myocardial infarction, electrocardiogram abnormalities and arrhythmias. Few reports exist describing arrhythmia induced by viper envenomation and to our knowledge none describe arrhythmia induced by Crotalinae envenomation. This report concerns the first known case of atrial fibrillation precipitated by rattlesnake bite. Case presentation A 73-year-old Caucasian man with a past medical history of hypertension, hyperlipidemia, type 1 diabetes mellitus, and a baseline first-degree atrioventricular block presented to the emergency department following a rattlesnake bite to his left lower leg. He developed pain and swelling in his left leg two-hour post-envenomation and subsequently received four vials of Crotalidae polyvalent immune fab (ovine). At three-hour post-envenomation following transfer to the intensive care unit, an electrocardiogram revealed new-onset atrial fibrillation. An amiodarone drip was started and the patient successfully converted to normal sinus rhythm approximately six hours after he was found to be in atrial fibrillation. A transthoracic echocardiogram revealed mild concentric left ventricular hypertrophy and an ejection fraction of 72%. He was discharged the following day with no hematological abnormalities and a baseline first-degree atrioventricular block. Conclusion This is the first documented case of reversible atrial fibrillation precipitated by Crotalinae envenomation. In patients with pertinent risk factors for developing atrial fibrillation, physicians should be aware of the potential for this arrhythmia. Direct toxic effects of venom or structural and electrophysiological cardiovascular abnormalities may predispose snakebite patients to arrhythmia, warranting extended and attentive cardiac monitoring.
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Affiliation(s)
- Dan Quan
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 East Roosevelt Road, Phoenix, AZ 85008 USA.,Department of Emergency Medicine, University of Arizona College of Medicine - Phoenix, 550 East Van Buren Street, Phoenix, AZ 85004 USA
| | - Kenneth Zurcher
- University of Arizona College of Medicine - Phoenix, 550 East Van Buren Street, Phoenix, AZ 85004 USA
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Limongelli G, Masarone D, Maddaloni V, Rubino M, Fratta F, Cirillo A, Ludovica SB, Pacileo R, Fusco A, Coppola GR, Pisacane F, Bossone E, Calabrò P, Calabrò R, Russo MG, Pacileo G. Genetics of Takotsubo Syndrome. Heart Fail Clin 2017; 12:499-506. [PMID: 27638020 DOI: 10.1016/j.hfc.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Takotsubo syndrome (TTS) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. A genetic predisposition has been suggested based on the few familial TTS cases. Conflicting results have been published regarding the role of functional polymorphisms in relevant candidate genes, such as α1-, β1-, and β2-adrenergic receptors; G protein-coupled receptor kinase 5; and estrogen receptors. Further research is required to help clarify the role of genetic susceptibility in TTS.
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Affiliation(s)
- Giuseppe Limongelli
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy.
| | - Daniele Masarone
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Valeria Maddaloni
- Genomic and Cellular Lab, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Marta Rubino
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Fiorella Fratta
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Annapaola Cirillo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Spinelli Barrile Ludovica
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Roberta Pacileo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Adelaide Fusco
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Guido Ronald Coppola
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Francesca Pisacane
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Cardiology Division, Heart Department, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, via De Marinis, Cava de" Tirreni (SA) 84013, Italy
| | - Paolo Calabrò
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Raffaele Calabrò
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Maria Giovanna Russo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
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Yaylali YT, Saricopur A, Yurtdas M, Senol H, Gokoz-Dogu G. Atrial Function in Patients with Breast Cancer After Treatment with Anthracyclines. Arq Bras Cardiol 2016; 107:411-419. [PMID: 27812678 PMCID: PMC5137385 DOI: 10.5935/abc.20160146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/29/2016] [Indexed: 12/27/2022] Open
Abstract
Background: Atrial electromechanical delay (EMD) is used to predict atrial fibrillation, measured by echocardiography. Objectives: The aim of this study was to assess atrial EMD and mechanical function after anthracycline-containing chemotherapy. Methods: Fifty-three patients with breast cancer (48 ± 8 years old) who received 240 mg/m2of Adriamycin, 2400 mg/m2 of cyclophosphamide, and 960 mg/m2 of paclitaxel were included in this retrospective study, as were 42 healthy subjects (47 ± 9 years old). Echocardiographic measurements were performed 11 ± 7 months (median 9 months) after treatment with anthracyclines. Results: Left intra-atrial EMD (11.4 ± 6.0 vs. 8.1 ± 4.9, p=0.008) and inter-atrial EMD (19.7 ± 7.4 vs. 14.7 ± 6.5, p=0.001) were prolonged; LA passive emptying volume and fraction were decreased (p=0.0001 and p=0.0001); LA active emptying volume and fraction were increased (p=0.0001 and p=0.0001); Mitral A velocity (0.8 ± 0.2 vs. 0.6 ± 0.2, p=0.0001) and mitral E-wave deceleration time (201.2 ± 35.6 vs. 163.7 ± 21.8, p=0.0001) were increased; Mitral E/A ratio (1.0 ± 0.3 vs. 1.3 ± 0.3, p=0.0001) and mitral Em (0.09 ± 0.03 vs. 0.11 ± 0.03, p=0.001) were decreased; Mitral Am (0.11 ± 0.02 vs. 0.09 ± 0.02, p=0.0001) and mitral E/Em ratio (8.8 ± 3.2 vs. 7.6 ± 2.6, p=0.017) were increased in the patients. Conclusions: In patients with breast cancer after anthracycline therapy: Left intra-atrial, inter-atrial electromechanical intervals were prolonged. Diastolic function was impaired. Impaired left ventricular relaxation and left atrial electrical conduction could be contributing to the development of atrial arrhythmias. Fundamento: Atraso eletromecânico atrial (AEA) é utilizado para prever fibrilação atrial, medido pela ecocardiografia. Objetivos: O propósito deste estudo era verificar o AEA e a função mecânica após quimioterapia com antraciclinas. Métodos: Cinquenta e três pacientes com câncer de mama (48 ± 8 anos) que receberam 240 mg/m2 de adriamicina, 2400 mg/m2 de ciclofosfamida, e 960 mg/m2 de paclitaxel foram incluídas neste estudo retrospectivo, além de 42 indivíduos saudáveis (47 ± 9 anos). Medidas ecocardiográficas foram realizadas por aproximadamente 11 ± 7 meses (média de 9 meses) após tratamento com antraciclinas. Resultados: AEA esquerdo intra-atrial (11,4 ± 6,0 vs. 8,1 ± 4,9, p=0,008) e AEA interarterial (19,7 ± 7,4 vs. 14,7 ± 6,5, p=0,001) foram prolongados; Volume de esvaziamento passivo e fracionamento de AE diminuíram (p=0,0001 e p=0,0001); Volume de esvaziamento ativo e fracionamento de AE (p=0,0001 e p=0,0001); Tempo de aceleração mitral A (0,8 ± 0,2 vs. 0,6 ± 0,2, p=0,0001) e de desaceleração de onda-E mitral (201,2 ± 35,6 vs. 163,7 ± 21,8, p=0,0001) aumentarão; Razão mitral E/A (1,0 ± 0,3 vs. 1,3 ± 0,3, p=0,0001) e mitral Em (0,09 ± 0,03 vs. 0,11 ± 0,03, p=0,001) diminuíram; Razão mitral Am (0,11 ± 0,02 vs. 0,09 ± 0,02, p=0,0001) e mitral E/Em (8,8 ± 3,2 vs. 7,6 ± 2,6, p=0,017) aumentaram nos pacientes. Conclusões: Em pacientes com câncer de mama após terapia com antraciclina: intervalos eletromecânicos intra-atriais esquerdos, intra-atriais foram prolongados. A função diastólica foi prejudicada. O relaxamento ventricular esquerdo foi prejudicado, e a condução elétrica atrial esquerda pode estar contribuindo para o desenvolvimento de arritmias atriais.
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Affiliation(s)
| | - Ahmet Saricopur
- Pamukkale University Faculty of Medicine, Cardiology Denizli; - Turkey
| | | | - Hande Senol
- Pamukkale University Dept of Biostatistics; - Turkey
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Weber S, Meyer-Roxlau S, El-Armouche A. Role of protein phosphatase inhibitor-1 in cardiac beta adrenergic pathway. J Mol Cell Cardiol 2016; 101:116-126. [PMID: 27639308 DOI: 10.1016/j.yjmcc.2016.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 01/08/2023]
Abstract
Phosphoproteomic studies have shown that about one third of all cardiac proteins are reversibly phosphorylated, affecting virtually every cellular signaling pathway. The reversibility of this process is orchestrated by the opposing enzymatic activity of kinases and phosphatases. Conversely, imbalances in subcellular protein phosphorylation patterns are a hallmark of many cardiovascular diseases including heart failure and cardiac arrhythmias. While numerous studies have revealed excessive beta-adrenergic signaling followed by deregulated kinase expression or activity as a major driver of the latter cardiac pathologies, far less is known about the beta-adrenergic regulation of their phosphatase counterparts. In fact, most of the limited knowledge stems from the detailed analysis of the endogenous inhibitor of the protein phosphatase 1 (I-1) in cellular and animal models. I-1 acts as a nodal point between adrenergic and putatively non-adrenergic cardiac signaling pathways and is able to influence widespread cellular functions of protein phosphatase 1 which are contributing to cardiac health and disease, e.g. Ca2+ handling, sarcomere contractility and glucose metabolism. Finally, nearly all of these studies agree that I-1 is a promising drug target on the one hand but the outcome of its pharmacological regulation maybe extremely context-dependent on the other hand, thus warranting for careful interpretation of past and future experimental results. In this respect we will: 1) comprehensively review the current knowledge about structural, functional and regulatory properties of I-1 within the heart 2) highlight current working hypothesis and potential I-1 mediated disease mechanisms 3) discuss state-of-the-art knowledge and future prospects of a potential therapeutic strategy targeting I-1 by restoring the balance of cardiac protein phosphorylation.
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Affiliation(s)
- Silvio Weber
- Department of Pharmacology and Toxicology, Medical Faculty, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.
| | - Stefanie Meyer-Roxlau
- Department of Pharmacology and Toxicology, Medical Faculty, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, Medical Faculty, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.
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Mitrić G, Udy A, Bandeshe H, Clement P, Boots R. Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:90. [PMID: 27038791 PMCID: PMC4818931 DOI: 10.1186/s13054-016-1252-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
Background Atrial fibrillation is a common rhythm disturbance in the general medical-surgical intensive care unit. Amiodarone is a popular drug in this setting but evidence to inform clinical practice remains scarce. We aimed to identify whether variation in the clinical use of amiodarone was associated with recurrent atrial fibrillation. Methods This was a retrospective audit of 177 critically ill patients who developed new-onset atrial fibrillation after admission to a tertiary level medical-surgical trauma intensive care unit. Patterns of amiodarone prescription (including dosage schedule and duration) were assessed in relation to recurrence of atrial fibrillation during the intensive care unit stay. Known recurrence risk factors, such as inotrope administration, cardiac disease indices, Charlson Comorbidity Index, magnesium concentrations, fluid balance, and potassium concentrations, were also included in adjusted analysis using forward stepwise logistic regression modelling. Results The cohort had a median (interquartile range) age of 69 years (60–75), Acute Physiology and Chronic Health Evalution II score of 22 (17–28) and Charlson Comorbidity Index of 2 (1–4). A bolus dose of amiodarone followed by infusion (P = 0.02), in addition to continuing amiodarone infusion through to discharge from the intensive care unit (P < 0.001), were associated with less recurrent dysrhythmia. Recurrence after successful treatment was associated with ceasing amiodarone while an inotrope infusion continued (P < 0.001), and was more common in patients with a prior history of congestive cardiac failure (P = 0.04), and a diagnosis of systemic inflammatory response syndrome (P = 0.02). Conclusions Amiodarone should be administered as a bolus dose followed immediately with an infusion when treating atrial fibrillation in the medical-surgical intensive care unit. Consideration should be given to continuing amiodarone infusions in patients on inotropes until they are ceased.
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Affiliation(s)
- Goran Mitrić
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Prahran, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Prahran, Melbourne, VIC, Australia
| | - Hiran Bandeshe
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Pierre Clement
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Rob Boots
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia. .,Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia.
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Lomivorotov VV, Efremov SM, Pokushalov EA, Karaskov AM. New-Onset Atrial Fibrillation After Cardiac Surgery: Pathophysiology, Prophylaxis, and Treatment. J Cardiothorac Vasc Anesth 2016; 30:200-16. [DOI: 10.1053/j.jvca.2015.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 01/13/2023]
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