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Prajapati C, Koivumäki J, Pekkanen-Mattila M, Aalto-Setälä K. Sex differences in heart: from basics to clinics. Eur J Med Res 2022; 27:241. [DOI: 10.1186/s40001-022-00880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
AbstractSex differences exist in the structure and function of human heart. The patterns of ventricular repolarization in normal electrocardiograms (ECG) differ in men and women: men ECG pattern displays higher T-wave amplitude and increased ST angle. Generally, women have longer QT duration because of reduced repolarization reserve, and thus, women are more susceptible for the occurrence of torsades de pointes associated with drugs prolonging ventricular repolarization. Sex differences are also observed in the prevalence, penetrance and symptom severity, and also in the prognosis of cardiovascular disease. Generally, women live longer, have less clinical symptoms of cardiac diseases, and later onset of symptoms than men. Sex hormones also play an important role in regulating ventricular repolarization, suggesting that hormones directly influence various cellular functions and adrenergic regulation. From the clinical perspective, sex-based differences in heart physiology are widely recognized, but in daily practice, cardiac diseases are often underdiagnosed and untreated in the women. The underlying mechanisms of sex differences are, however, poorly understood. Here, we summarize sex-dependent differences in normal cardiac physiology, role of sex hormones, and differences in drug responses. Furthermore, we also discuss the importance of human induced pluripotent stem cell-derived cardiomyocytes in further understanding the mechanism of differences in women and men.
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Lazzarini E, Lodrini AM, Arici M, Bolis S, Vagni S, Panella S, Rendon-Angel A, Saibene M, Metallo A, Torre T, Vassalli G, Ameri P, Altomare C, Rocchetti M, Barile L. Stress-induced premature senescence is associated with a prolonged QT interval and recapitulates features of cardiac aging. Theranostics 2022; 12:5237-5257. [PMID: 35836799 PMCID: PMC9274748 DOI: 10.7150/thno.70884] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/11/2022] [Indexed: 01/12/2023] Open
Abstract
Rationale: Aging in the heart is a gradual process, involving continuous changes in cardiovascular cells, including cardiomyocytes (CMs), namely cellular senescence. These changes finally lead to adverse organ remodeling and resulting in heart failure. This study exploits CMs from human induced pluripotent stem cells (iCMs) as a tool to model and characterize mechanisms involved in aging. Methods and Results: Human somatic cells were reprogrammed into human induced pluripotent stem cells and subsequently differentiated in iCMs. A senescent-like phenotype (SenCMs) was induced by short exposure (3 hours) to doxorubicin (Dox) at the sub-lethal concentration of 0.2 µM. Dox treatment induced expression of cyclin-dependent kinase inhibitors p21 and p16, and increased positivity to senescence-associated beta-galactosidase when compared to untreated iCMs. SenCMs showed increased oxidative stress, alteration in mitochondrial morphology and depolarized mitochondrial membrane potential, which resulted in decreased ATP production. Functionally, when compared to iCMs, SenCMs showed, prolonged multicellular QTc and single cell APD, with increased APD variability and delayed afterdepolarizations (DADs) incidence, two well-known arrhythmogenic indexes. These effects were largely ascribable to augmented late sodium current (INaL) and reduced delayed rectifier potassium current (Ikr). Moreover sarcoplasmic reticulum (SR) Ca2+ content was reduced because of downregulated SERCA2 and increased RyR2-mediated Ca2+ leak. Electrical and intracellular Ca2+ alterations were mostly justified by increased CaMKII activity in SenCMs. Finally, SenCMs phenotype was furtherly confirmed by analyzing physiological aging in CMs isolated from old mice in comparison to young ones. Conclusions: Overall, we showed that SenCMs recapitulate the phenotype of aged primary CMs in terms of senescence markers, electrical and Ca2+ handling properties and metabolic features. Thus, Dox-induced SenCMs can be considered a novel in vitro platform to study aging mechanisms and to envision cardiac specific anti-aging approach in humans.
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Affiliation(s)
- Edoardo Lazzarini
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alessandra Maria Lodrini
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, Milano, Italy.,Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Martina Arici
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Sara Bolis
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Cellular and Molecular Cardiology, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Sara Vagni
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Stefano Panella
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Azucena Rendon-Angel
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Melissa Saibene
- Department of Earth and Environmental Sciences, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Alessia Metallo
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Tiziano Torre
- Department of Cardiac Surgery Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giuseppe Vassalli
- Cellular and Molecular Cardiology, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico, Genova, Italy.,Department of Internal Medicine, University of Genova, Genova, Italy
| | - Claudia Altomare
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marcella Rocchetti
- Department of Biotechnology and Biosciences, Università degli Studi di Milano-Bicocca, Milano, Italy.,✉ Corresponding authors: Lucio Barile, PhD. Istituto Cardiocentro Ticino, Laboratories for Translational Research, EOC Via Chiesa 5, 6500 Bellinzona, Switzerland. +41 586667104 ; Marcella Rocchetti, PhD. University of Milano-Bicocca, Dept. of Biotechnology and Biosciences, P.za della Scienza 2, 20126 Milano, Italy. +39 0264483313
| | - Lucio Barile
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy.,✉ Corresponding authors: Lucio Barile, PhD. Istituto Cardiocentro Ticino, Laboratories for Translational Research, EOC Via Chiesa 5, 6500 Bellinzona, Switzerland. +41 586667104 ; Marcella Rocchetti, PhD. University of Milano-Bicocca, Dept. of Biotechnology and Biosciences, P.za della Scienza 2, 20126 Milano, Italy. +39 0264483313
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Liu P, Han D, Sun X, Tan H, Wang Z, Liu C, Zhang Y, Li B, Sun C, Shi R, Li G. Prevalence and risk factors of acquired long QT syndrome in hospitalized patients with chronic kidney disease. J Investig Med 2018; 67:289-294. [PMID: 30367011 DOI: 10.1136/jim-2018-000798] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 12/13/2022]
Abstract
Patients with chronic kidney disease (CKD) have a high risk of fatal arrhythmias. The extended severe corrected QT (QTc) interval is a hallmark of ventricular arrhythmias and sudden cardiac death. The objective of this study was to evaluate the prevalence of acquired long QT syndrome (aLQTS) in hospitalized patients with CKD and search for potential risk factors to improve clinical risk stratification in patients with CKD. Information about patients with CKD was retrospectively collected in our hospital between January 2013 and June 2017. The prevalence of aLQTS in different stages of CKD was evaluated. The common risk factors for QTc prolongation in patients with CKD were compiled, and multivariable logistic regression analysis was used to evaluate how each factor was related to aLQTS in CKD. A total of 804 patients with CKD (299 females, 37.2%) participated in our study. The prevalence of aLQTS among all 804 patients was 56.97%, and the prevalence of QTc prolongation (>500 ms) was 10.07%. Among the elderly, impaired kidney function, hemodialysis, low serum potassium and low left ventricular ejection fraction (LVEF) were associated with QTc prolongation in patients with CKD. The prevalence of aLQTS is much higher and increases with the decline of kidney function in hospitalized patients with CKD, which is related to older age, impaired kidney function, hemodialysis, serum potassium and low LVEF.
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Affiliation(s)
- Peng Liu
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dan Han
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuanzi Sun
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui Tan
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhigang Wang
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Liu
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yali Zhang
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bailin Li
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chaofeng Sun
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Shi
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guoliang Li
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Rabkin SW. Aging effects on QT interval: Implications for cardiac safety of antipsychotic drugs. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:20-5. [PMID: 24748877 PMCID: PMC3981979 DOI: 10.3969/j.issn.1671-5411.2014.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 03/20/2014] [Accepted: 03/22/2014] [Indexed: 11/24/2022]
Abstract
Objectives To explore the effect of aging on cardiac toxicity specifically the interaction of age and antipsychotic drugs to alter the QT interval. Methods The Medline databases were searched using the OvidSP platforms with the search strategy: “QT interval” or “QT” and “age” or “aging”. The entry criteria were: over 10,000 apparently healthy individuals with data on both sexes; QT interval corrected for heart rate (QTc) and an expression of its variance for multiple age decades extending into the older ages. Results QTc increased in duration with increasing age. Considering a modest one SD increment in QTc in the normal population, the addition of Chlorpromazine produced a QTc on average greater than 450 ms for ages 70 years and older. Risperidone, that did not on average alter QTc, would be expected to produce a QTc of 450 ms in persons in their mid 70 years under some circumstances. QTc prolongation > 500 ms with antipsychotic drugs is more likely for persons with QTc initially at the 99th percentile. It may occur with Haloperidol which does not on average alter QTc. Conclusions The range of values for the QT interval in apparently normal older men or women, when combined with the range of expected QT interval changes induced by antipsychotic drugs, can readily be associated with prolonged QTc. Individuals with QTc at the 99th percentile may have serious QTc prolongation with antipsychotic drugs even those that are not usually associated with QTc prolongation.
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Affiliation(s)
- Simon W Rabkin
- Department of Medicine (Cardiology), University of British Columbia, 9th Floor 2775 Laurel St., Vancouver, B.C., V5Z 1M9, Canada
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Nicolini F, Molardi A, Verdichizzo D, Gallazzi MC, Spaggiari I, Cocconcelli F, Budillon AM, Borrello B, Rivara D, Beghi C, Gherli T. Coronary artery surgery in octogenarians: evolving strategies for the improvement in early and late results. Heart Vessels 2011; 27:559-67. [PMID: 22045151 DOI: 10.1007/s00380-011-0198-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 09/30/2011] [Indexed: 10/16/2022]
Abstract
The purpose of this study was to investigate retrospectively early and late outcomes of coronary artery bypass grafting (CABG) in a large series of octogenarians. We retrospectively reviewed the data of 241 octogenarian patients who underwent CABG between April 2002 and April 2009 at our institution. Mean age was 84.7 ± 1.8 years. Patients affected by concomitant coexistent organic aortic, mitral, or tricuspid valve disease were excluded from the study. Patients with functional secondary ischemic mitral incompetence were included in the study. The majority of the patients were male. Angina pectoris functional class III/IV accounted for 164 patients (68%). Left ventricular ejection fraction ≤35% was diagnosed in 38 patients (15.8%). Early mortality rate was 5.8% (14 patients). Causes of death were cardiac related in 10 patients. Preoperative independent predictors of in-hospital mortality obtained with multivariate analysis were extracardiac arteriopathy, New York Heart Association class III/IV, and previous percutaneous transluminal coronary angioplasty (PTCA). The overall mean follow-up was 41.6 ± 25.9 months (range 1-87.6 months). Among the 222 contacted survivors, there were 16 (7.2%) deaths during the follow-up. The actuarial survival was 91.9% at 1 year and 83.5% at 5 years. On multivariate analysis, time to late death was adversely affected by preoperative extracardiac arteriopathy and previous PTCA. Advanced age alone should not be a deterrent for CABG if it has been determined that the benefits outweigh the potential risk. A careful selection of optimal candidates, based on the evaluation of their systemic comorbidities, appears mandatory in order to obtain the greatest benefit for these high-risk patients.
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Affiliation(s)
- Francesco Nicolini
- Heart Surgery Section, University of Parma Medical School, Via A. Gramsci 14, 43100, Parma, Italy.
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Topal F, Tanindi A, Kurtoglu HG, Akbulut S, Kucukazman M, Topal FE. QT Dispersion is Not Increased in Familial Mediterranean Fever. J Int Med Res 2011; 39:2006-11. [DOI: 10.1177/147323001103900547] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Familial Mediterranean fever (FMF) is an autoimmune disease inherited as an autosomal recessive trait and is characterized by recurrent attacks of fever and sterile polyserositis. This study examined electrocardiographic ventricular repolarization parameters (QT interval and QT dispersion) in 38 FMF patients and 35 healthy controls. The QT interval was measured manually from the onset of QRS to the end of the T wave (return to the TP baseline). QT dispersion was defined as the difference between the maximum and minimum QT values, and corrected QT was calculated according to the Bazett formula. There were no significant differences between FMF patients and healthy control subjects in any parameter of ventricular repolarization; hence QT dispersion was not affected by FMF. Electrocardiographic assessment of QT interval and QT dispersion are, therefore, of little value for the evaluation of cardiac impairment and risk of arrhythmia in FMF patients.
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Affiliation(s)
- F Topal
- Department of Gastroenterology, Cankiri State Hospital, Cankiri, Turkey
| | - A Tanindi
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - HG Kurtoglu
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - S Akbulut
- Department of Gastroenterology, Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital, Istanbul, Turkey
| | - M Kucukazman
- Department of Gastroenterology, Kecioren Education and Research Hospital, Ankara, Turkey
| | - FE Topal
- Department of Emergency Medicine, Cankiri State Hospital, Cankiri, Turkey
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