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Tikenoğullar i OZ, Peirlinck M, Chubb H, Dubin AM, Kuhl E, Marsden AL. Effects of cardiac growth on electrical dyssynchrony in the single ventricle patient. Comput Methods Biomech Biomed Engin 2024; 27:1011-1027. [PMID: 37314141 PMCID: PMC10719423 DOI: 10.1080/10255842.2023.2222203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
Single ventricle patients, including those with hypoplastic left heart syndrome (HLHS), typically undergo three palliative heart surgeries culminating in the Fontan procedure. HLHS is associated with high rates of morbidity and mortality, and many patients develop arrhythmias, electrical dyssynchrony, and eventually ventricular failure. However, the correlation between ventricular enlargement and electrical dysfunction in HLHS physiology remains poorly understood. Here we characterize the relationship between growth and electrophysiology in HLHS using computational modeling. We integrate a personalized finite element model, a volumetric growth model, and a personalized electrophysiology model to perform controlled in silico experiments. We show that right ventricle enlargement negatively affects QRS duration and interventricular dyssynchrony. Conversely, left ventricle enlargement can partially compensate for this dyssynchrony. These findings have potential implications on our understanding of the origins of electrical dyssynchrony and, ultimately, the treatment of HLHS patients.
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Affiliation(s)
- O. Z. Tikenoğullar i
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - M. Peirlinck
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - H. Chubb
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - A. M. Dubin
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - E. Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - A. L. Marsden
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California, USA
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2
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Hodson DZ, Malla A, Su J. Wide Complex Tachycardia in a 16-year-old with Congenital Heart Disease. Pediatr Rev 2024; 45:358-362. [PMID: 38821901 DOI: 10.1542/pir.2022-005766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 06/02/2024]
Affiliation(s)
| | | | - Jonathan Su
- Division of Pediatric Cardiology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
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Loomba RS, Villarreal EG, Farias JS, Flores S, Wong J. Factors associated with renal oxygen extraction in mechanically ventilated children after the Norwood operation: insights from high fidelity haemodynamic data. Cardiol Young 2024:1-6. [PMID: 38783789 DOI: 10.1017/s1047951124025174] [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: 05/25/2024]
Abstract
BACKGROUND Maintaining the adequacy of systemic oxygen delivery is of utmost importance, particularly in critically ill children. Renal oxygen extraction can be utilised as metric of the balance between systemic oxygen delivery and oxygen consumption. The primary aim of this study was to determine what clinical factors are associated with renal oxygen extraction in children after Norwood procedure. METHODS Mechanically ventilated children who underwent Norwood procedure from 1 September, 2022 to 1 March, 2023 were identified as these patients had data collected and stored with high fidelity by the T3 software. Data regarding haemodynamic values, fluid balance, and airway pressure were collected and analysed using Bayesian regression to determine the association of the individual metrics with renal oxygen extraction. RESULTS A total of 27,270 datapoints were included in the final analyses. The resulting top two models explained had nearly 80% probability of being true and explained over 90% of the variance in renal oxygen extraction. The coefficients for each variable retained in the best were -1.70 for milrinone, -19.05 for epinephrine, 0.129 for mean airway pressure, -0.063 for mean arterial pressure, 0.111 for central venous pressure, 0.093 for arterial saturation, 0.006 for heart rate, -0.025 for respiratory rate, 0.366 for systemic vascular resistance, and -0.032 for systemic blood flow. CONCLUSION Increased milrinone, epinephrine, mean arterial pressure, and systemic blood flow were associated with decreased (improved) renal oxygen extraction, while increased mean airway pressure, central venous pressure, arterial saturation, and systemic vascular resistance were associated with increased (worsened) renal oxygen extraction.
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Affiliation(s)
- Rohit S Loomba
- Advocate Children's Hospital, Chicago, IL, USA
- Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, Mexico
| | | | - Saul Flores
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Joshua Wong
- Advocate Children's Hospital, Chicago, IL, USA
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Zimmerman FJ, Gamboa D. Techniques for Cardiac Resynchronization Therapy in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:447-455. [PMID: 37865518 DOI: 10.1016/j.ccep.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Cardiac resynchronization therapy (CRT) for congenital heart disease has shown promising suucess as an adjunct to medical therapy for heart failure. While cardiac conduction defects and need for ventricular pacing are common in congential heart disease, CRT indications, techniques and long term outcomes have not been well establaished. This is a review of the techniques nad short term outcomes of CRT for the following complex congenital heart disease conditions: single ventricle physiology, systemic right ventricle, and the subpulmonic right ventricle.
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Affiliation(s)
- Frank J Zimmerman
- Advocate Children's Heart Institute, 4440 West 95th Street, Oak Lawn, IL 60453, USA.
| | - David Gamboa
- Advocate Children's Heart Institute, 4440 West 95th Street, Oak Lawn, IL 60453, USA
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Berger M, Kumowski N, Straw S, Verket M, Marx N, Witte KK, Schütt K. Clinical implications and risk factors for QRS prolongation over time in heart failure patients. Clin Res Cardiol 2023; 112:312-322. [PMID: 36378295 PMCID: PMC9898415 DOI: 10.1007/s00392-022-02122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND QRS prolongation is an established prognostic marker in heart failure (HF). In contrast, the role of QRS width progression over time has been incompletely explored. The current study investigates the role of QRS width progression over time on clinical status and identifies underlying predictors. METHODS Datasets of ≥ 2 consecutive visits from 100 attendees to our HF clinic between April and August 2021 were analysed for changes in QRS complex duration. RESULTS In total 240 datasets were stratified into tertiles based on change in QRS duration (mm/month) (1st tertile: - 1.65 [1.50] 'regression'; 2nd tertile 0.03 [0.19] 'stable', 3rd tertile 3.57 [10.11] 'progression'). The incidence of the combined endpoint HF hospitalisation and worsening of symptomatic heart failure was significantly higher in the group with QRS width progression (3rd tertile) compared with the stable group (2nd tertile; log-rank test: p = 0.013). These patients were characterised by higher plasma NT-pro-BNP levels (p = 0.008) and higher heart rate (p = 0.007). A spline-based prediction model identified patients at risk of QRS width progression when NT-pro-BNP and heartrate were > 837 pg/ml and > 83/bpm, respectively. These markers were independent of guideline-directed medical HF therapy. Patients beyond both thresholds had a 14-fold increased risk of QRS width progression compared to those with neither or either alone (HR: 14.2 [95% 6.9 - 53.6]; p < 0.0001, p for interaction = 0.016). CONCLUSIONS This pilot study demonstrates that QRS width progression is associated with clinical deterioration of HF. NTproBNP plasma levels and heart rate indicate patients at risk QRS width progression, independently of HF therapy.
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Affiliation(s)
- Martin Berger
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nina Kumowski
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Sam Straw
- grid.9909.90000 0004 1936 8403Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Marlo Verket
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus K. Witte
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Katharina Schütt
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
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Márquez-González H, Hernández-Vásquez JG, Del Valle-Lom M, Yáñez-Gutiérrez L, Klünder-Klünder M, Almeida-Gutiérrez E, Koretzky SG. Failures of the Fontan System in Univentricular Hearts and Mortality Risk in Heart Transplantation: A Systematic Review and Meta-Analysis. Life (Basel) 2021; 11:1363. [PMID: 34947894 PMCID: PMC8709145 DOI: 10.3390/life11121363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 02/07/2023] Open
Abstract
The Fontan procedure (FP) is the standard surgical treatment for Univentricular heart diseases. Over time, the Fontan system fails, leading to pathologies such as protein-losing enteropathy (PLE), plastic bronchitis (PB), and heart failure (HF). FP should be considered as a transitional step to the final treatment: heart transplantation (HT). This systematic review and meta-analysis aims to establish the risk of death following HT according to the presence of FP complications. There was a total of 691 transplanted patients in the 18 articles, immediate survival 88% (n = 448), survival from 1 to 5 years of 78% (n = 427) and survival from 5.1 to 10 years of 69% (n = 208), >10 years 61% (n = 109). The relative risk (RR) was 1.12 for PLE (95% confidence interval [CI] = 0.89-1.40, p = 0.34), 1.03 for HF (0.7-1.51, p = 0.88), 0.70 for Arrhythmias (0.39-1.24, p = 0.22), 0.46 for PB (0.08-2.72, p = 0.39), and 5.81 for CKD (1.70-19.88, p = 0.005). In patients with two or more failures, the RR was 1.94 (0.99-3.81, p = 0.05). After FP, the risk of death after HT is associated with CKD and with the presence of two or more failures.
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Affiliation(s)
- Horacio Márquez-González
- Department of Clinical Research, Federico Gómez Children’s Hospital, Mexico City 06720, Mexico; (H.M.-G.); (J.G.H.-V.); (M.D.V.-L.); (M.K.-K.)
- Centro Médico Nacional Siglo XXI, IMSS, Department Congenital Heart Diseases, Mexico City 06720, Mexico; (L.Y.-G.); (E.A.-G.)
| | - Jose Gustavo Hernández-Vásquez
- Department of Clinical Research, Federico Gómez Children’s Hospital, Mexico City 06720, Mexico; (H.M.-G.); (J.G.H.-V.); (M.D.V.-L.); (M.K.-K.)
| | - Montserrat Del Valle-Lom
- Department of Clinical Research, Federico Gómez Children’s Hospital, Mexico City 06720, Mexico; (H.M.-G.); (J.G.H.-V.); (M.D.V.-L.); (M.K.-K.)
| | - Lucelli Yáñez-Gutiérrez
- Centro Médico Nacional Siglo XXI, IMSS, Department Congenital Heart Diseases, Mexico City 06720, Mexico; (L.Y.-G.); (E.A.-G.)
| | - Miguel Klünder-Klünder
- Department of Clinical Research, Federico Gómez Children’s Hospital, Mexico City 06720, Mexico; (H.M.-G.); (J.G.H.-V.); (M.D.V.-L.); (M.K.-K.)
| | - Eduardo Almeida-Gutiérrez
- Centro Médico Nacional Siglo XXI, IMSS, Department Congenital Heart Diseases, Mexico City 06720, Mexico; (L.Y.-G.); (E.A.-G.)
| | - Solange Gabriela Koretzky
- Department of Clinical Research, Nacional de Cardiología “Ignacio Chávez”, Mexico City 14080, Mexico
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Buendía-Fuentes F, Gordon-Ramírez B, Subirà LD, Merás P, Gallego P, González A, Prieto-Arévalo R, Segura T, Rodríguez-Puras MJ, Montserrat S, Sarnago-Cebada F, Alonso-García A, Oliver JM, Rueda-Soriano J. LONG TERM OUTCOMES OF ADULTS WITH SINGLE VENTRICLE PHYSIOLOGY NOT UNDERGOING FONTAN REPAIR: A MULTICENTRE EXPERIENCE. Can J Cardiol 2021; 38:1111-1120. [PMID: 34118376 DOI: 10.1016/j.cjca.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND To describe long-term survival and cardiovascular events in adult patients with single ventricle physiology (SVP) without Fontan palliation, focusing on predictors of mortality and comparing groups according to their cardiovascular physiology. METHODS Multicentre, observational and retrospective study including adult patients with SVP without Fontan palliation since their first adult clinic visit. The cohort was subdivided into three groups. (Eisenmenger - Restricted Pulmonary flow - Aortopulmonary shunt) Death was considered the main endpoint. Other clinical outcomes occurring during follow-up were considered as secondary endpoints. RESULTS 146 patients, mean age 32.5±11.1 years were analysed. Over a mean follow-up of 7.3 ± 4.1 years, 33 patients (22.6%) died. Survival was 86% and 74% at 5 and 10 years, respectively. Right ventricular morphology was not associated with higher mortality. Four variables at baseline were related to a higher mortality (at least moderate AV valve regurgitation, platelet count <150 × 10 3 /mm 3 , GFR <60 ml/min/1.73m 2 and QRS >120ms). 34.2% of patients were admitted to the hospital due to heart failure, and 7.5% received a heart transplant. Other cardiovascular outcomes were also frequent (atrial arrhythmias: 19.2%, stroke: 15.1%, pacemaker/ICD: 6.2%/2.7%). CONCLUSIONS Adult patients with SVP who had not undergone Fontan exhibit a high mortality rate and frequent major cardiovascular events. At least moderate AV valve regurgitation, thrombocytopenia, renal dysfunction and QRS duration >120 ms at baseline visit allow identification of a cohort of patients at higher risk of mortality.
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Affiliation(s)
- Francisco Buendía-Fuentes
- ACHD Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe. CIBERCV, Valencia, Spain
| | - Blanca Gordon-Ramírez
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau. Department of Cardiology. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Laura Dos Subirà
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau. Department of Cardiology. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain; CIBERCV. Barcelona, Spain.
| | - Pablo Merás
- ACHD Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pastora Gallego
- ACHD Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio. Instituto de BioMedicina de Sevilla. CIBERCV, Sevilla, Spain
| | - Ana González
- ACHD Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arévalo
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - Teresa Segura
- ACHD Unit, Department of Cardiology, Hospital Universitario 12 Octubre, Madrid, Spain
| | - María J Rodríguez-Puras
- ACHD Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio. Instituto de BioMedicina de Sevilla. CIBERCV, Sevilla, Spain
| | - Silvia Montserrat
- ACHD Unit, Department of Cardiology, Hospital Clinic Barcelona. Institut clinic Cardiovascular. IDIBAPS. CIBERCV. Barcelona, Spain
| | | | - Andrés Alonso-García
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - José M Oliver
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - Joaquín Rueda-Soriano
- ACHD Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe. CIBERCV, Valencia, Spain
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A genome-wide association and polygenic risk score study on abnormal electrocardiogram in a Chinese population. Sci Rep 2021; 11:4669. [PMID: 33633301 PMCID: PMC7907205 DOI: 10.1038/s41598-021-84135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/12/2021] [Indexed: 11/21/2022] Open
Abstract
Electrocardiography is a common and widely-performed medical examination based on the measurement and evaluation of electrocardiogram (ECG) to assess the up-to-date cardiac rhythms and thus suggest the health conditions of cardiovascular system and on a larger level the individual’s wellness. Abnormal ECG assessment from the detection of abnormal heart rhythms may have clinical implications including blood clots in formation, ongoing heart attack, coronary artery blockage, etc. Past genetic-phenotypic research focused primarily on the physical parameters of ECG but not the medical evaluation. To unbiasedly uncover the underlying links of genetic variants with normal vs. abnormal ECG assessment, a genome-wide association study (GWAS) is carried out in a 1006-participant cohort of Chinese population effectively genotyped for 243487 single nucleotide polymorphisms (SNPs). Both age and sex are influential factors, and six novel SNPs are identified for potential association with abnormal ECG. With the selected SNPs, a polygenic risk score (PRS) differentiates the case–control subgroups, and correlates well with increased risk of abnormal ECG. The findings are reproduced in an independent validation cohort. The derived PRS may function as a potential biomarker for prospectively screening the high-risk subgroup of heart issues in the Chinese population.
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