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Hautamäki M, Järvensivu-Koivunen M, Lyytikäinen LP, Eskola M, Lehtimäki T, Nikus K, Oksala N, Tynkkynen J, Hernesniemi J. The association between GRACE score at admission for myocardial infarction and the incidence of sudden cardiac arrests in long-term follow-up - the MADDEC study. SCAND CARDIOVASC J 2024; 58:2335905. [PMID: 38557164 DOI: 10.1080/14017431.2024.2335905] [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: 09/21/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Background. Sudden cardiac arrest (SCA), often also leading to sudden cardiac death (SCD), is a common complication in coronary artery disease. Despite the effort there is a lack of applicable prediction tools to identify those at high risk. We tested the association between the validated GRACE score and the incidence of SCA after myocardial infarction. Material and methods. A retrospective analysis of 1,985 patients treated for myocardial infarction (MI) between January 1st 2015 and December 31st 2018 and followed until the 31st of December of 2021. The main exposure variable was patients' GRACE score at the point of admission and main outcome variable was incident SCA after hospitalization. Their association was analyzed by subdistribution hazard (SDH) model analysis. The secondary endpoints included SCA in patients with no indication to implantable cardioverter-defibrillator (ICD) device and incident SCD. Results. A total of 1985 patients were treated for MI. Mean GRACE score at baseline was 118.7 (SD 32.0). During a median follow-up time of 5.3 years (IQR 3.8-6.1 years) 78 SCA events and 52 SCDs occurred. In unadjusted analyses one SD increase in GRACE score associated with over 50% higher risk of SCA (SDH 1.55, 95% CI 1.29-1.85, p < 0.0001) and over 40% higher risk for SCD (1.42, 1.12-1.79, p = 0.0033). The associations between SCA and GRACE remained statistically significant even with patients without indication for ICD device (1.57, 1.30-1.90, p < 0.0001) as well as when adjusting with patients LVEF and omitting the age from the GRACE score to better represent the severity of the cardiac event. The association of GRACE and SCD turned statistically insignificant when adjusting with LVEF. Conclusions. GRACE score measured at admission for MI associates with long-term risk for SCA.
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Affiliation(s)
- Markus Hautamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Juho Tynkkynen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
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Tran VH, Lessard D, Parekh J, Tisminetzky MS, Gore JM, Yarzebski J, Granillo E, Nguyen TT, Goldberg R. Ventricular Tachycardia and Hospital Readmission in Patients Discharged From the Hospital After an Acute Myocardial Infarction. CJC Open 2024; 6:781-789. [PMID: 39022163 PMCID: PMC11250869 DOI: 10.1016/j.cjco.2024.02.001] [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: 08/23/2023] [Accepted: 02/09/2024] [Indexed: 07/20/2024] Open
Abstract
Background Although ventricular tachycardia (VT) occurring during hospitalization for an acute myocardial infarction (AMI) increases mortality risk, its relationship with 30-day postdischarge rehospitalization has not been examined. Methods Using data from the Worcester Heart Attack Study, we examined the association between early (during the first 48 hours of admission) and late (after 48 hours from admission) VT with 30-day postdischarge all-cause and cardiovascular disease (CVD)-related rehospitalization while analytically controlling for several demographic and clinical factors. Results The study population consisted of 3534 patients who were hospitalized with an AMI between 2005 and 2015 (average age, 67.2 years; 40.7% women); VT occurred in 452 patients (13.7%), with the majority of instances (81.2%) occurring within 48 hours of admission. The 30-day all-cause rehospitalization rate was 17.3%, with 70.9% of the hospitalizations related to CVD. The odds of rehospitalization were 1.63 times (95% confidence interval [CI] = 0.99-2.69) and 1.12 times (95% CI = 0.83-1.51) higher for patients with AMI who developed late VT and early VT, respectively, compared to patients who did not develop VT. The risk of rehospitalization among patients with late VT was higher (odds ratio = 2.22 (95% CI = 0.79-6.26) in those with ST-segment-elevation AMI, compared to those with non-ST-segment-elevation AMI (odds ratio = 1.45 (95% CI = 0.81-2.57); early VT was not associated with rehospitalization in patients with either AMI subtype. No significant association was present between the occurrence of VT and CVD-related rehospitalization. Conclusions Patients who develop late VT may experience a higher risk of 30-day rehospitalization following hospital discharge for AMI, especially among those with ST-segment-elevation AMI. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Vu Hoang Tran
- Department of Medicine, UMass Memorial Medical Group, Fitchburg, Massachusetts, USA
- Department of Medicine, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jay Parekh
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, New Haven, Connecticut, USA
| | - Mayra S. Tisminetzky
- Department of Medicine, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, New Haven, Connecticut, USA
| | - Joel M. Gore
- Department of Medicine, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jorge Yarzebski
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Edgard Granillo
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tuyet T. Nguyen
- Department of Medicine, College of Health Sciences, Vin University, Hanoi, Vietnam
| | - Robert Goldberg
- Department of Population and Quantitative Health Sciences, Univeristy of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Wang W, Chen M, Guo J, Wang Y, Zhang J. Construction and validation of nomogram model for predicting the risk of ventricular arrhythmia after emergency PCI in patients with acute myocardial infarction. Aging (Albany NY) 2024; 16:8246-8259. [PMID: 38742959 PMCID: PMC11132015 DOI: 10.18632/aging.205815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To make predictions about the risk of MVA (Malignant Ventricular Arrhythmia) after primary PCI (Percutaneous Coronary Intervention) in patients with AMI (Acute Myocardial Infarction) through constructing and validating the Nomogram model. METHODS 311 AMI patients who suffered from emergency PCI in Hefei Second People's Hospital from January 2020 to May 2023 were selected as the training set; 253 patients suffering from the same symptom in Hefei First People's Hospital during the same period were selected as the validation set. Risk factors were further screened by means of multivariate logistic and stepwise regression. The nomogram model was constructed, and then validated by using C-index, ROC curve, decision curve and calibration curve. RESULTS Multivariate logistic analysis revealed that urea, systolic pressure, hypertension, Killip class II-IV, as well as LVEF (Left Ventricular Ejection Fraction) were all unrelated hazards for MVA after emergency PCI for AMI (P<0.05); a risk prediction nomogram model was constructed. The C-index was calculated to evaluate the predictive ability of the model. Result showed that the index of the training and the validation set was 0.783 (95% CI: 0.726-0.84) and 0.717 (95% CI: 0.65-0.784) respectively, which suggested that the model discriminated well. Meanwhile, other tools including ROC curve, calibration curve and decision curve also proved that this nomogram plays an effective role in forecasting the risk for MVA after PCI in AMI patients. CONCLUSIONS The study successfully built the nomogram model and made predictions for the development of MVA after PCI in AMI patients.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230000, Anhui, China
| | - Min Chen
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230000, Anhui, China
| | - Jiongchao Guo
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei 230000, Anhui, China
| | - Yuqi Wang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230000, Anhui, China
| | - Jing Zhang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230000, Anhui, China
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Xu X, Wang Z, Yang J, Fan X, Yang Y. Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord 2024; 24:218. [PMID: 38654151 PMCID: PMC11036585 DOI: 10.1186/s12872-024-03889-w] [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: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The coexistence of cardiac arrhythmias in patients with acute myocardial infarction (AMI) usually exhibits poor prognosis. However, there are few contemporary data available on the burden of cardiac arrhythmias in AMI patients and their impact on in-hospital outcomes. METHODS The present study analyzed data from the China Acute Myocardial Infarction (CAMI) registry involving 23,825 consecutive AMI patients admitted to 108 hospitals from January 2013 to February 2018. Cardiac arrhythmias were defined as the presence of bradyarrhythmias, sustained atrial tachyarrhythmias, and sustained ventricular tachyarrhythmias that occurred during hospitalization. In-hospital outcome was defined as a composite of all-cause mortality, cardiogenic shock, re-infarction, stroke, or heart failure. RESULTS Cardiac arrhythmia was presented in 1991 (8.35%) AMI patients, including 3.4% ventricular tachyarrhythmias, 2.44% bradyarrhythmias, 1.78% atrial tachyarrhythmias, and 0.73% ≥2 kinds of arrhythmias. Patients with arrhythmias were more common with ST-segment elevation myocardial infarction (83.3% vs. 75.5%, P < 0.001), fibrinolysis (12.8% vs. 8.0%, P < 0.001), and previous heart failure (3.7% vs. 1.5%, P < 0.001). The incidences of in-hospital outcomes were 77.0%, 50.7%, 43.5%, and 41.4%, respectively, in patients with ≥ 2 kinds of arrhythmias, ventricular tachyarrhythmias, bradyarrhythmias, and atrial tachyarrhythmias, and were significantly higher in all patients with arrhythmias than those without arrhythmias (48.9% vs. 12.5%, P < 0.001). The presence of any kinds of arrhythmia was independently associated with an increased risk of hospitalization outcome (≥ 2 kinds of arrhythmias, OR 26.83, 95%CI 18.51-38.90; ventricular tachyarrhythmias, OR 8.56, 95%CI 7.34-9.98; bradyarrhythmias, OR 5.82, 95%CI 4.87-6.95; atrial tachyarrhythmias, OR4.15, 95%CI 3.38-5.10), and in-hospital mortality (≥ 2 kinds of arrhythmias, OR 24.44, 95%CI 17.03-35.07; ventricular tachyarrhythmias, OR 13.61, 95%CI 10.87-17.05; bradyarrhythmias, OR 7.85, 95%CI 6.0-10.26; atrial tachyarrhythmias, OR 4.28, 95%CI 2.98-6.16). CONCLUSION Cardiac arrhythmia commonly occurred in patients with AMI might be ventricular tachyarrhythmias, followed by bradyarrhythmias, atrial tachyarrhythmias, and ≥ 2 kinds of arrhythmias. The presence of any arrhythmias could impact poor hospitalization outcomes. REGISTRATION Clinical Trial Registration: Identifier: NCT01874691.
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Affiliation(s)
- Xu Xu
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhao Wang
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jingang Yang
- , Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Yuejin Yang
- , Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kuang S, Chan YH, Wong S, Khoo SM. Obstructive sleep apnoea and nocturnal atrial fibrillation in patients with ischaemic heart disease. Singapore Med J 2024:00077293-990000000-00091. [PMID: 38363738 DOI: 10.4103/singaporemedj.smj-2021-293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/11/2022] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Arrhythmias, especially atrial fibrillation (AF) and ventricular arrhythmias, are independent risk factors of mortality in patients with ischaemic heart disease (IHD). While there is a growing body of evidence that suggests an association between obstructive sleep apnoea (OSA) and cardiac arrhythmias, evidence on this relationship in patients with IHD has been scant and inconsistent. We hypothesised that in patients with IHD, severe OSA is associated with an increased risk of nocturnal arrhythmias. METHODS We studied 103 consecutive patients with IHD who underwent an overnight polysomnography. Exposed subjects were defined as patients who had an apnoea-hypopnoea index (AHI) ≥30/h (severe OSA), and nonexposed subjects were defined as patients who had an AHI <30/h (nonsevere OSA). All electrocardiograms (ECGs) were interpreted by the Somte ECG analysis software and confirmed by a physician blinded to the presence or absence of exposure. Arrhythmias were categorised as supraventricular and ventricular. Arrhythmia subtypes (ventricular, atrial and conduction delay) were analysed as dichotomous outcomes using multiple logistic regression models. RESULTS Atrial fibrillation and AF/flutter (odds ratio 13.5, 95% confidence interval 1.66-109.83; P = 0.003) were found to be more common in the severe OSA group than in the nonsevere OSA group. This association remained significant after adjustment for potential confounders. There was no significant difference in the prevalence of ventricular and conduction delay arrhythmias between the two groups. CONCLUSION In patients with IHD, there was a significant association between severe OSA and nocturnal AF/flutter. This underscores the need to evaluate for OSA in patients with IHD, as it may have important implications on clinical outcomes.
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Affiliation(s)
- Silin Kuang
- University Medicine Cluster, National University Health System, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Serene Wong
- Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore
- Fast and Chronic Programs, Alexandra Hospital, National University Health System, Singapore
| | - See Meng Khoo
- Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore
- Fast and Chronic Programs, Alexandra Hospital, National University Health System, Singapore
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Tanguay A, Lebon J, Hébert D. Early prediction of ventricular fibrillation using electrocardiographic characteristics in prehospital suspected ST-segment elevation myocardial infarction: a case-control study. CAN J EMERG MED 2023; 25:728-735. [PMID: 37572268 DOI: 10.1007/s43678-023-00565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/23/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec. METHODS We performed a matched case-control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF-) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development. RESULTS Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55-31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04-14.82), and STE in V2-V6 (OR 3.8, 95% CI 1.21-11.74) were electrocardiographic predictors of VF. We also observed that STD in V3-V5 (OR 6.5, 95% CI 1.42-29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80-21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01-22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33-13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13-4.06) and 3 (OR 11.6, 95% CI 3.22-41.66) predictors showed significant association with VF. CONCLUSIONS In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads.
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Affiliation(s)
- Alain Tanguay
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada
- Centre de Recherche du CISSS Chaudières-Appalaches, Lévis, QC, Canada
| | - Johann Lebon
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada.
- Centre de Recherche du CISSS Chaudières-Appalaches, Lévis, QC, Canada.
| | - Denise Hébert
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada
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Ray L, Geier C, DeWitt KM. Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 2: Ventricular and bradyarrhythmias. Am J Health Syst Pharm 2023; 80:1123-1136. [PMID: 37235971 DOI: 10.1093/ajhp/zxad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE This is the second article in a 2-part series reviewing the pathophysiology and treatment considerations for arrhythmias. Part 1 of the series discussed aspects related to treating atrial arrhythmias. Here in part 2, the pathophysiology of ventricular arrhythmias and bradyarrhythmias and current evidence on treatment approaches are reviewed. SUMMARY Ventricular arrhythmias can arise suddenly and are a common cause of sudden cardiac death. Several antiarrhythmics may be effective in management of ventricular arrhythmias, but there is robust evidence to support the use of only a few of these agents, and such evidence was largely derived from trials involving patients with out-of-hospital cardiac arrest. Bradyarrhythmias range from asymptomatic mild prolongation of nodal conduction to severe conduction delays and impending cardiac arrest. Vasopressors, chronotropes, and pacing strategies require careful attention and titration to minimize adverse effects and patient harm. CONCLUSION Ventricular arrhythmias and bradyarrhythmias can be consequential and require acute intervention. As experts in pharmacotherapy, acute care pharmacists can participate in providing high-level intervention by aiding in diagnostic workup and medication selection.
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Affiliation(s)
- Lance Ray
- Denver Health and Hospital Authority, Denver, CO, and Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Curtis Geier
- San Francisco General Hospital, San Francisco, CA, USA
| | - Kyle M DeWitt
- University of Vermont Medical Center, Burlington, VT, USA
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Basara G, Bahcecioglu G, Ren X, Zorlutuna P. An Experimental and Numerical Investigation of Cardiac Tissue-Patch Interrelation. J Biomech Eng 2023; 145:081004. [PMID: 37337466 PMCID: PMC10321148 DOI: 10.1115/1.4062736] [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: 11/21/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Tissue engineered cardiac patches have great potential as a regenerative therapy for myocardial infarction. Yet, the mutual interaction of cardiac patches with healthy tissue has not been completely understood. Here, we investigated the impact of acellular and cellular patches on a beating two-dimensional (2D) cardiac cell layer, and the effect of the beating of this layer on the cells encapsulated in the patch. We cultured human-induced pluripotent stem cell-derived cardiomyocytes (iCMs) on a coverslip and placed gelatin methacryloyl hydrogel alone or with encapsulated iCMs to create acellular and cellular patches, respectively. When the acellular patch was placed on the cardiac cell layer, the beating characteristics and Ca+2 handling properties reduced, whereas placing the cellular patch restored these characteristics. To better understand the effects of the cyclic contraction and relaxation induced by the beating cardiac cell layer on the patch placed on top of it, a simulation model was developed, and the calculated strain values were in agreement with the values measured experimentally. Moreover, this dynamic culture induced by the beating 2D iCM layer on the iCMs encapsulated in the cellular patch improved their beating velocity and frequency. Additionally, the encapsulated iCMs were observed to be coupled with the underlying beating 2D iCM layer. Overall, this study provides a detailed investigation on the mutual relationship of acellular/cellular patches with the beating 2D iCM layer, understanding of which would be valuable for developing more advanced cardiac patches.
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Affiliation(s)
- Gozde Basara
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, 225 Multidisciplinary Research Building, Notre Dame, IN 46556
| | - Gokhan Bahcecioglu
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, 108B Multidisciplinary Research Building, Notre Dame, IN 46556
| | - Xiang Ren
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556
| | - Pinar Zorlutuna
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556; Department of Chemical and Biomolecular Engineering, University of Notre Dame, 143 Multidisciplinary Research Building, Notre Dame, IN 46556
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Lozano O, Marcos P, Salazar-Ramirez FDJ, Lázaro-Alfaro AF, Sobrevia L, García-Rivas G. Targeting the mitochondrial Ca 2+ uniporter complex in cardiovascular disease. Acta Physiol (Oxf) 2023; 237:e13946. [PMID: 36751976 DOI: 10.1111/apha.13946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Cardiovascular diseases (CVDs), the leading cause of death worldwide, share in common mitochondrial dysfunction, in specific a dysregulation of Ca2+ uptake dynamics through the mitochondrial Ca2+ uniporter (MCU) complex. In particular, Ca2+ uptake regulates the mitochondrial ATP production, mitochondrial dynamics, oxidative stress, and cell death. Therefore, modulating the activity of the MCU complex to regulate Ca2+ uptake, has been suggested as a potential therapeutic approach for the treatment of CVDs. Here, the role and implications of the MCU complex in CVDs are presented, followed by a review of the evidence for MCU complex modulation, genetically and pharmacologically. While most approaches have aimed within the MCU complex for the modulation of the Ca2+ pore channel, the MCU subunit, its intra- and extra- mitochondrial implications, including Ca2+ dynamics, oxidative stress, post-translational modifications, and its repercussions in the cardiac function, highlight that targeting the MCU complex has the translational potential for novel CVDs therapeutics.
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Affiliation(s)
- Omar Lozano
- Cátedra de Cardiología y Medicina Vascular, School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
- Biomedical Research Center, Hospital Zambrano-Hellion, TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico
- The Institute for Obesity Research, Tecnologico de Monterrey, Monterrey, Mexico
| | - Patricio Marcos
- Cátedra de Cardiología y Medicina Vascular, School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Felipe de Jesús Salazar-Ramirez
- Cátedra de Cardiología y Medicina Vascular, School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Anay F Lázaro-Alfaro
- Cátedra de Cardiología y Medicina Vascular, School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Luis Sobrevia
- The Institute for Obesity Research, Tecnologico de Monterrey, Monterrey, Mexico
- Cellular and Molecular Physiology Laboratory, Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Queensland, Australia
| | - Gerardo García-Rivas
- Cátedra de Cardiología y Medicina Vascular, School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
- Biomedical Research Center, Hospital Zambrano-Hellion, TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico
- The Institute for Obesity Research, Tecnologico de Monterrey, Monterrey, Mexico
- Center of Functional Medicine, Hospital Zambrano-Hellion, TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico
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Bianco HT, Povoa R, Izar MC, Alves CMR, Barbosa AHP, Bombig MTN, Gonçalves I, Luna B, Aguirre AC, Moraes PIDM, Almeida D, Moreira FT, Povoa FF, Stefanini E, Caixeta AM, Bacchin AS, Moisés VA, Fonseca FA. Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors. Arq Bras Cardiol 2022; 119:691-702. [PMID: 36453760 PMCID: PMC9750212 DOI: 10.36660/abc.20211055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/15/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. OBJECTIVES To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. METHODS Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. RESULTS Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. CONCLUSION Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.
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Affiliation(s)
- Henrique Tria Bianco
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Rui Povoa
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Claudia Maria Rodrigues Alves
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Henrique Pereira Barbosa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Maria Teresa Nogueira Bombig
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Iran Gonçalves
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Bráulio Luna
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Ana Caroline Aguirre
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Pedro Ivo de Marqui Moraes
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Dirceu Almeida
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Flávio Tocci Moreira
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Fernando Focaccia Povoa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Edson Stefanini
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Mendes Caixeta
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Amanda S. Bacchin
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Valdir Ambrósio Moisés
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Francisco A.H. Fonseca
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
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11
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Chyrchel M, Gallina T, Januszek R, Szafrański O, Gębska M, Surdacki A. The Reduction of Left Ventricle Ejection Fraction after Multi-Vessel PCI during Acute Myocardial Infarction as a Predictor of Major Adverse Cardiac Events in Long-Term Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013160. [PMID: 36293739 PMCID: PMC9603361 DOI: 10.3390/ijerph192013160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Revascularisation strategy in patients with multi-vessel coronary disease and acute myocardial infarction (AMI) remains challenging. One of the potential treatment options is complete percutaneous revascularisation during index hospitalisation. This strategy could positively influence left ventricle ejection fraction (LVEF). AIM To investigate the long-term changes in LVEF and clinical outcome among patients with AMI after complete coronary revascularisation (CCR). METHODS Records of 171 patients with a diagnosis of AMI and multi-vessel coronary artery disease (CAD) on index angiography, in whom CCR was performed as a staged procedure during initial hospitalisation, were analysed. Clinical data were collected from in-hospital medical records and discharge letters. Cardiac ultrasound (CU), with particular assessment of LVEF, was performed one day before discharge. Follow-up (FU) CU was collected from the out-patient department at least six months ± one week after discharge. Follow-up data, including major adverse cardiac events (MACE), were collected during follow-up visits by telephone. Depending on the LVEF change during the follow-up period, patients were divided into two groups. Patients with a decrease in the LVEF (D-LVEF group) were compared with patients with no changes (preserved) or improvement regarding LVEF (P/I-LVEF). RESULTS The median duration of the follow-up was 19 months (14-24 months). The median change in LVEF during observation was -5.0p% (IQR (-7.0)-(-2.75p.%)) in the D-LVEF group and +4.0% (IQR 1.0-5.0p%) in the P/I-LVEF group. Among patients in the P/I-LVEF group, there was a sub-group of patients with no change in LVEF (28 patients), and one demonstrating improvement in LVEF (104 patients). In the subgroup of patients with improved LVEF, the median change in LVEF was 4.5p% (IQR 2-6.25p%). Among patients with decreasing LVEF, there was a significantly higher risk of MACE (15 vs. 2.3%, p = 0.031), especially non-fatal AMI (10 vs. 0%, p = 0.017). We found the following among predictors concerning increased risk of MACE occurrence: urgent PCI (p = 0.004), hospitalisations regardless of cause (p = 0.028), EF worsening (p = 0.025), fasting glucose serum concentration (p = 0.024) and fasting triglyceride serum concentration (p = 0.027). CONCLUSIONS Complete revascularisation (CR) at baseline (one stage) in patients with AMI and multi-vessel disease is associated with LVEF improvement and MACE rate reduction. Patients with worse LVEF have poor clinical outcome and a higher rate of MACE.
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Affiliation(s)
- Michał Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Tomasz Gallina
- Student Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Oskar Szafrański
- Student Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Monika Gębska
- Department of Cardiology, District Hospital, ul. Jagiellońska 36, 97-500 Radomsko, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
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12
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Cesaro A, Gragnano F, Paolisso P, Bergamaschi L, Gallinoro E, Sardu C, Mileva N, Foà A, Armillotta M, Sansonetti A, Amicone S, Impellizzeri A, Esposito G, Morici N, Oreglia JA, Casella G, Mauro C, Vassilev D, Galie N, Santulli G, Pizzi C, Barbato E, Calabrò P, Marfella R. In-hospital arrhythmic burden reduction in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: Insights from the SGLT2-I AMI PROTECT study. Front Cardiovasc Med 2022; 9:1012220. [PMID: 36237914 PMCID: PMC9551177 DOI: 10.3389/fcvm.2022.1012220] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 01/05/2023] Open
Abstract
Background Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) have shown significant cardiovascular benefits in patients with and without type 2 diabetes mellitus (T2DM). They have also gained interest for their potential anti-arrhythmic role and their ability to reduce the occurrence of atrial fibrillation (AF) and ventricular arrhythmias (VAs) in T2DM and heart failure patients. Objectives To investigate in-hospital new-onset cardiac arrhythmias in a cohort of T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-i vs. other oral anti-diabetic agents (non-SGLT2-i users). Methods Patients from the SGLT2-I AMI PROTECT registry (NCT05261867) were stratified according to the use of SGLT2-i before admission for AMI, divided into SGLT2-i users vs. non-SGLT2-i users. In-hospital outcomes included the occurrence of in-hospital new-onset cardiac arrhythmias (NOCAs), defined as a composite of new-onset AF and sustained new-onset ventricular tachycardia (VT) and/or ventricular fibrillation (VF) during hospitalization. Results The study population comprised 646 AMI patients categorized into SGLT2-i users (111 patients) and non-SGLT2-i users (535 patients). SGLT2-i users had a lower rate of NOCAs compared with non-SGLT2-i users (6.3 vs. 15.7%, p = 0.010). Moreover, SGLT2-i was associated with a lower rate of AF and VT/VF considered individually (p = 0.032). In the multivariate logistic regression model, after adjusting for all confounding factors, the use of SGLT2-i was identified as an independent predictor of the lower occurrence of NOCAs (OR = 0.35; 95%CI 0.14-0.86; p = 0.022). At multinomial logistic regression, after adjusting for potential confounders, SGLT2-i therapy remained an independent predictor of VT/VF occurrence (OR = 0.20; 95%CI 0.04-0.97; p = 0.046) but not of AF occurrence. Conclusions In T2DM patients, the use of SGLT2-i was associated with a lower risk of new-onset arrhythmic events during hospitalization for AMI. In particular, the primary effect was expressed in the reduction of VAs. These findings emphasize the cardioprotective effects of SGLT2-i in the setting of AMI beyond glycemic control. Trial registration Data are part of the observational international registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov, identifier: NCT05261867.
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Affiliation(s)
- Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli', Naples, Italy,Division of Cardiology, A.O.R.N. “Sant'Anna e San Sebastiano”, Caserta, Italy,*Correspondence: Arturo Cesaro
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli', Naples, Italy,Division of Cardiology, A.O.R.N. “Sant'Anna e San Sebastiano”, Caserta, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Emanuele Gallinoro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli', Naples, Italy,Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Niya Mileva
- Cardiology Clinic, “Alexandrovska” University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Giuseppe Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy,Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jacopo Andrea Oreglia
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | | | - Nazzareno Galie
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy,Department of Medicine (Division of Cardiology) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, NY, United States
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli', Naples, Italy,Division of Cardiology, A.O.R.N. “Sant'Anna e San Sebastiano”, Caserta, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy,Mediterranea Cardiocentro, Naples, Italy
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Chen X, Zhao X, Wu H, Li L, Yang D, Si Y, Wang F, He Y, Shou J, Jiang Y, Chu W, Zhou B, Zeng C, Wang WE. Association of Nonalcoholic Fatty Liver Disease with Ventricular Tachycardia and Sinus Arrest in Patients with Non-ST-Segment Elevation Myocardial Infarction. Int Heart J 2022; 63:814-820. [PMID: 36104232 DOI: 10.1536/ihj.22-113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is an emerging driver of cardiac arrhythmias. However, the relationship between NAFLD and malignant arrhythmia in non-ST-segment elevation myocardial infarction (NSTEMI) patients is still unclear.In this study, 358 NSTEMI inpatients were enrolled. They all received 24-hour Holter monitoring after percutaneous coronary intervention. All inpatients were divided into two groups: the non-NAFLD group (236 cases, 65.9%) and the NAFLD group (122 cases, 34.1%). Compared with the non-NAFLD group, the NAFLD group had a significantly higher incidence of PVCs/hour > 5 (premature ventricular complexes, 32.0% versus 9.3%, P < 0.001), ventricular tachycardia (VT, 22.1% versus 5.9%, P < 0.001), and sinus arrest (SA, 7.4% versus 1.3%, P = 0.002). We found that NAFLD was closely associated with the occurrence of VT [unadjusted odds ratio (OR) 4.507, 95% confidence interval (CI) 2.263-8.974, P < 0.001] and SA (OR 6.186, 95%CI 1.643-23.291, P = 0.007). After adjusting for age, sex, body mass index, and other confounding factors, the above differences were still statistically significant (VT: OR 4.808, 95%CI 2.254-10.253, P < 0.001; SA: OR 9.589, 95%CI 2.027-45.367, P = 0.004).NAFLD is associated with the occurrence of VT and SA in NSTEMI patients. It indicates that NAFLD might be a risk factor for malignant arrhythmias in post-NSTEMI patients.
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Affiliation(s)
- Xiaokang Chen
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Xiaofang Zhao
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Hao Wu
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Liangpeng Li
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Dezhong Yang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Yueqiao Si
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Feng Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Yanji He
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Jialing Shou
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Yuanyuan Jiang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Wei Chu
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Bingqing Zhou
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Wei Eric Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
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14
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Su XL, Wang SH, Komal S, Cui LG, Ni RC, Zhang LR, Han SN. The caspase-1 inhibitor VX765 upregulates connexin 43 expression and improves cell-cell communication after myocardial infarction via suppressing the IL-1β/p38 MAPK pathway. Acta Pharmacol Sin 2022; 43:2289-2301. [PMID: 35132192 PMCID: PMC9433445 DOI: 10.1038/s41401-021-00845-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/15/2021] [Indexed: 02/04/2023] Open
Abstract
Connexin 43 (Cx43) is the most important protein in the gap junction channel between cardiomyocytes. Abnormalities of Cx43 change the conduction velocity and direction of cardiomyocytes, leading to reentry and conduction block of the myocardium, thereby causing arrhythmia. It has been shown that IL-1β reduces the expression of Cx43 in astrocytes and cardiomyocytes in vitro. However, whether caspase-1 and IL-1β affect connexin 43 after myocardial infarction (MI) is uncertain. In this study we investigated the effects of VX765, a caspase-1 inhibitor, on the expression of Cx43 and cell-to-cell communication after MI. Rats were treated with VX765 (16 mg/kg, i.v.) 1 h before the left anterior descending artery (LAD) ligation, and then once daily for 7 days. The ischemic heart was collected for histochemical analysis and Western blot analysis. We showed that VX765 treatment significantly decreased the infarct area, and alleviated cardiac dysfunction and remodeling by suppressing the NLRP3 inflammasome/caspase-1/IL-1β expression in the heart after MI. In addition, VX765 treatment markedly raised Cx43 levels in the heart after MI. In vitro experiments were conducted in rat cardiac myocytes (RCMs) stimulated with the supernatant from LPS/ATP-treated rat cardiac fibroblasts (RCFs). Pretreatment of the RCFs with VX765 (25 μM) reversed the downregulation of Cx43 expression in RCMs and significantly improved intercellular communication detected using a scrape-loading/dye transfer assay. We revealed that VX765 suppressed the activation of p38 MAPK signaling in the heart tissue after MI as well as in RCMs stimulated with the supernatant from LPS/ATP-treated RCFs. Taken together, these data show that the caspase-1 inhibitor VX765 upregulates Cx43 expression and improves cell-to-cell communication in rat heart after MI via suppressing the IL-1β/p38 MAPK pathway.
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Affiliation(s)
- Xue-Ling Su
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China
| | - Shu-Hui Wang
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China
| | - Sumra Komal
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China
| | - Liu-Gen Cui
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China
| | - Rui-Cong Ni
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China
| | - Li-Rong Zhang
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China.
| | - Sheng-Na Han
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, China.
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15
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Huang TC, Lin SJ, Chen CJ, Jhuo SJ, Chang CW, Lin SC, Chi NY, Chou LF, Tai LH, Liu YH, Lin TH, Liao WS, Kao PH, Cheng MC, Hsu PC, Lee CS, Lin YH, Lee HC, Lu YH, Yen HW, Lin TH, Su HM, Lai WT, Dai CY, Lee CH, Chen PS, Lin SF, Tsai WC. Skin Sympathetic Nerve Activity and Ventricular Arrhythmias in Acute Coronary Syndrome. Heart Rhythm 2022; 19:1613-1619. [PMID: 35525422 DOI: 10.1016/j.hrthm.2022.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is major cause of ventricular arrhythmias (VA) and sudden death. neuECG is a non-invasive method to simultaneously measure skin sympathetic nerve activity (SKNA) and electrocardiogram (ECG). OBJECTIVE To test the hypotheses that (1) ACS increases the average SKNA (aSKNA), (2) the magnitude of aSKNA elevation is associated with VA during ACS and (3) there is a gender difference of aSKNA in patients without and with ACS. METHODS We prospectively studied 128 ACS and 165 control participants. The neuECG was recorded with electrocardiogram (ECG) Lead I configuration at baseline, during mental math stress and during recovery (5-min each). All recordings were done in the morning. RESULTS In control group, women have higher aSKNA (μV) than men at baseline (0.82±0.25 vs 0.73±0.20, p=0.009) but not during mental stress (1.21±0.36 vs 1.16±0.36, p=0.394), suggesting women had lower sympathetic reserve. In comparison, ACS is associated with equally elevated aSKNA (μV) in women vs men at baseline (1.14±0.33 vs 1.04±0.35, p=0.531), during mental stress (1.46±0.32 vs 1.33 ±0.37, p=0.113) and during recovery (1.30±0.33 1.11±0.30, p=0.075). After adjusting for age and gender, the adjusted odds ratio for VA including ventricular tachycardia and fibrillation is 1.23 (95% confidence interval 1.05-1.44) for each 0.1 μV elevation of aSKNA. The aSKNA is positively correlated with plasma norepinephrine level. CONCLUSIONS ACS is associated with elevated aSKNA and the magnitude of aSKNA elevation is associated with occurrences of VA. Women have higher aSKNA and lower SKNA reserve than men in control but not in ACS patients.
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Affiliation(s)
- Tien-Chi Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shin-Jing Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chang-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shih-Jie Jhuo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Wei Chang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ching Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Nai-Yu Chi
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Fang Chou
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Hsin Tai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsueh Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Han Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Sheng Liao
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Heng Kao
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mu-Chun Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ye-Hsu Lu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shien-Fong Lin
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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16
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Elliott MK, Costa CM, Whitaker J, Gemmell P, Mehta VS, Sidhu BS, Gould J, Williams SE, O'Neill M, Razavi R, Niederer S, Bishop MJ, Rinaldi CA. Effect of scar and pacing location on repolarization in a porcine myocardial infarction model. Heart Rhythm O2 2022; 3:186-195. [PMID: 35496454 PMCID: PMC9043407 DOI: 10.1016/j.hroo.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background The effect of chronic ischemic scar on repolarization is unclear, with conflicting results from human and animal studies. An improved understanding of electrical remodeling within scar and border zone tissue may enhance substrate-guided ablation techniques for treatment of ventricular tachycardia. Computational modeling studies have suggested increased dispersion of repolarization during epicardial, but not endocardial, left ventricular pacing, in close proximity to scar. However, the effect of endocardial pacing near scar in vivo is unknown. Objective The purpose of this study was to investigate the effect of scar and pacing location on local repolarization in a porcine myocardial infarction model. Methods Six model pigs underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging followed by electroanatomic mapping of the left ventricular endocardium. LGE-CMR images were registered to the anatomic shell and scar defined by LGE. Activation recovery intervals (ARIs), a surrogate for action potential duration, and local ARI gradients were calculated from unipolar electrograms within areas of late gadolinium enhancement (aLGE) and healthy myocardium. Results There was no significant difference between aLGE and healthy myocardium in mean ARI (304.20 ± 19.44 ms vs 300.59 ± 19.22 ms; P = .43), ARI heterogeneity (23.32 ± 11.43 ms vs 24.85 ± 12.99 ms; P = .54), or ARI gradients (6.18 ± 2.09 vs 5.66 ± 2.32 ms/mm; P = .39). Endocardial pacing distance from scar did not affect ARI gradients. Conclusion Our findings suggest that changes in ARI are not an intrinsic property of surviving myocytes within scar, and endocardial pacing close to scar does not affect local repolarization.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Caroline Mendonca Costa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Philip Gemmell
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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17
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Basara G, Saeidi-Javash M, Ren X, Bahcecioglu G, Wyatt BC, Anasori B, Zhang Y, Zorlutuna P. Electrically conductive 3D printed Ti 3C 2T x MXene-PEG composite constructs for cardiac tissue engineering. Acta Biomater 2022; 139:179-189. [PMID: 33352299 PMCID: PMC8213874 DOI: 10.1016/j.actbio.2020.12.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023]
Abstract
Tissue engineered cardiac patches have great potential as a therapeutic treatment for myocardial infarction (MI). However, for successful integration with the native tissue and proper function of the cells comprising the patch, it is crucial for these patches to mimic the ordered structure of the native extracellular matrix and the electroconductivity of the human heart. In this study, a new composite construct that can provide both conductive and topographical cues for human induced pluripotent stem cell derived cardiomyocytes (iCMs) is developed for cardiac tissue engineering applications. The constructs are fabricated by 3D printing conductive titanium carbide (Ti3C2Tx) MXene in pre-designed patterns on polyethylene glycol (PEG) hydrogels, using aerosol jet printing, at a cell-level resolution and then seeded with iCMs and cultured for one week with no signs of cytotoxicity. The results presented in this work illustrate the vital role of 3D-printed Ti3C2Tx MXene on aligning iCMs with a significant increase in MYH7, SERCA2, and TNNT2 expressions, and with an improved synchronous beating as well as conduction velocity. This study demonstrates that 3D printed Ti3C2Tx MXene can potentially be used to create physiologically relevant cardiac patches for the treatment of MI. STATEMENT OF SIGNIFICANCE: As cardiovascular diseases and specifically myocardial infarction (MI) continue to be the leading cause of death worldwide, it is critical that new clinical interventions be developed. Tissue engineered cardiac patches have shown significant potential as clinical therapeutics to promote recovery following MI. Unfortunately, current constructs lack the ordered structure and electroconductivity of native human heart. In this study, we engineered a composite construct that can provide both conductive and topographical cues for human induced pluripotent stem cell derived cardiomyocytes. By 3D printing conductive Ti3C2Tx MXene in pre-designed patterns on polyethylene glycol hydrogels, using aerosol jet printing, at a cell-level resolution, we developed tissue engineered patches that have the potential for providing a new clinical therapeutic to combat cardiovascular disease.
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Affiliation(s)
- Gozde Basara
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Mortaza Saeidi-Javash
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Xiang Ren
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Gokhan Bahcecioglu
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Brian C. Wyatt
- Integrated Nanosystems Development Institute and Department of Mechanical and Energy Engineering, Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Babak Anasori
- Integrated Nanosystems Development Institute and Department of Mechanical and Energy Engineering, Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Yanliang Zhang
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Pinar Zorlutuna
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA,Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA,Corresponding author: Pinar Zorlutuna, , Address: 143 Multidisciplinary Research Building, University of Notre Dame, Notre Dame, IN 46556, Phone no: +1 574 631 8543, Fax no: +1 574 631 8341
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18
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Wang S, Li J, Sun L, Cai J, Wang S, Zeng L, Sun S. Application of machine learning to predict the occurrence of arrhythmia after acute myocardial infarction. BMC Med Inform Decis Mak 2021; 21:301. [PMID: 34724938 PMCID: PMC8560220 DOI: 10.1186/s12911-021-01667-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early identification of the occurrence of arrhythmia in patients with acute myocardial infarction plays an essential role in clinical decision-making. The present study attempted to use machine learning (ML) methods to build predictive models of arrhythmia after acute myocardial infarction (AMI). Methods A total of 2084 patients with acute myocardial infarction were enrolled in this study. (All data is available on Github: https://github.com/wangsuhuai/AMI-database1.git). The primary outcome is whether tachyarrhythmia occurred during admission containing atrial arrhythmia, ventricular arrhythmia, and supraventricular tachycardia. All data is randomly divided into a training set (80%) and an internal testing set (20%). Apply three machine learning algorithms: decision tree, random forest (RF), and artificial neural network (ANN) to learn the training set to build a model, then use the testing set to evaluate the prediction performance, and compare it with the model built by the Global Registry of Acute Coronary Events (GRACE) risk variable set. Results Three ML models predict the occurrence of tachyarrhythmias after AMI. After variable selection, the artificial neural network (ANN) model has reached the highest accuracy rate, which is better than the model constructed using the Grace variable set. After applying SHapley Additive exPlanations (SHAP) to make the model interpretable, the most important features are abnormal wall motion, lesion location, bundle branch block, age, and heart rate. Among them, RBBB (odds ratio [OR]: 4.21; 95% confidence interval [CI]: 2.42–7.02), ≥ 2 ventricular walls motion abnormal (OR: 3.26; 95% CI: 2.01–4.36) and right coronary artery occlusion (OR: 3.00; 95% CI: 1.98–4.56) are significant factors related to arrhythmia after AMI. Conclusions We used advanced machine learning methods to build prediction models for tachyarrhythmia after AMI for the first time (especially the ANN model that has the best performance). The current study can supplement the current AMI risk score, provide a reliable evaluation method for the clinic, and broaden the new horizons of ML and clinical research. Trial registration Clinical Trial Registry No.: ChiCTR2100041960. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01667-8.
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Affiliation(s)
- Suhuai Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jingjie Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Lin Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Jianing Cai
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shihui Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Linwen Zeng
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shaoqing Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
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19
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Jong J, Packard RRS. 18F-FDG PET imaging of myocardial inflammation and viability following experimental infarction and anti-inflammatory treatment with compound MCC950. J Nucl Cardiol 2021; 28:2358-2360. [PMID: 32333277 DOI: 10.1007/s12350-020-02104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jeremy Jong
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 17-054A, Los Angeles, CA, 90095, USA
| | - René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 17-054A, Los Angeles, CA, 90095, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA.
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20
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Cernica D, Benedek I, Polexa S, Tolescu C, Benedek T. 3D Printing-A Cutting Edge Technology for Treating Post-Infarction Patients. Life (Basel) 2021; 11:910. [PMID: 34575059 PMCID: PMC8468787 DOI: 10.3390/life11090910] [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: 07/05/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 02/06/2023] Open
Abstract
The increasing complexity of cardiovascular interventions requires advanced peri-procedural imaging and tailored treatment. Three-dimensional printing technology represents one of the most significant advances in the field of cardiac imaging, interventional cardiology or cardiovascular surgery. Patient-specific models may provide substantial information on intervention planning in complex cardiovascular diseases, and volumetric medical imaging from CT or MRI can be translated into patient-specific 3D models using advanced post-processing applications. 3D printing and additive manufacturing have a great variety of clinical applications targeting anatomy, implants and devices, assisting optimal interventional treatment and post-interventional evaluation. Although the 3D printing technology still lacks scientific evidence, its benefits have been shown in structural heart diseases as well as for treatment of complex arrhythmias and corrective surgery interventions. Recent development has enabled transformation of conventional 3D printing into complex 3D functional living tissues contributing to regenerative medicine through engineered bionic materials such hydrogels, cell suspensions or matrix components. This review aims to present the most recent clinical applications of 3D printing in cardiovascular medicine, highlighting also the potential for future development of this revolutionary technology in the medical field.
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Affiliation(s)
- Daniel Cernica
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Imre Benedek
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Stefania Polexa
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Cosmin Tolescu
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodal Cardiovascular Imaging, Cardio Med Medical Center, 540124 Targu Mures, Romania; (D.C.); (I.B.); (C.T.); (T.B.)
- Cardiology Department, University of Medicine, Pharmacy, Sciences and Technologies “George Emil Palade”, 540142 Targu Mures, Romania
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21
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Abstract
Conduction disorders and arrhythmias remain difficult to treat and are increasingly prevalent owing to the increasing age and body mass of the general population, because both are risk factors for arrhythmia. Many of the underlying conditions that give rise to arrhythmia - including atrial fibrillation and ventricular arrhythmia, which frequently occur in patients with acute myocardial ischaemia or heart failure - can have an inflammatory component. In the past, inflammation was viewed mostly as an epiphenomenon associated with arrhythmia; however, the recently discovered inflammatory and non-canonical functions of cardiac immune cells indicate that leukocytes can be arrhythmogenic either by altering tissue composition or by interacting with cardiomyocytes; for example, by changing their phenotype or perhaps even by directly interfering with conduction. In this Review, we discuss the electrophysiological properties of leukocytes and how these cells relate to conduction in the heart. Given the thematic parallels, we also summarize the interactions between immune cells and neural systems that influence information transfer, extrapolating findings from the field of neuroscience to the heart and defining common themes. We aim to bridge the knowledge gap between electrophysiology and immunology, to promote conceptual connections between these two fields and to explore promising opportunities for future research.
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22
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Byhamre ML, Araghi M, Alfredsson L, Bellocco R, Engström G, Eriksson M, Galanti MR, Jansson JH, Lager A, Lundberg M, Östergren PO, Pedersen NL, Trolle Lagerros Y, Ye W, Wennberg P, Magnusson C. Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies. Int J Epidemiol 2021; 49:2041-2050. [PMID: 33347584 PMCID: PMC7825961 DOI: 10.1093/ije/dyaa197] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project. METHODS We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use. RESULTS Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount. CONCLUSIONS Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
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Affiliation(s)
- Marja Lisa Byhamre
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics, and Statistics, Umeå University, Umeå, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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23
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Kavsur R, Becher MU, Nassan W, Sedaghat A, Aksoy A, Schrickel JW, Nickenig G, Tiyerili V. CHA 2DS 2-VASC score predicts coronary artery disease progression and mortality after ventricular arrhythmia in patients with implantable cardioverter-defibrillator. IJC HEART & VASCULATURE 2021; 34:100802. [PMID: 34095451 PMCID: PMC8165543 DOI: 10.1016/j.ijcha.2021.100802] [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: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
AIM The CHA2DS2-VASC score has expanded its use beyond the initial purpose of predicting the risk of stroke in patients with atrial fibrillation. We aimed to investigate the value of the CHA2DS2-VASC score as a risk assessment tool to predict relevant coronary artery disease (CAD) leading to percutaneous coronary intervention (PCI), and all-cause mortality after detected ventricular arrhythmia (VA) in patients with an Implantable Cardioverter-Defibrillator (ICD). METHODS A total of 183 ICD-patients who underwent coronary angiography after VA were included and classified according to their CHA2DS2-VASC score in a low(1-3), intermediate(4-5) and high(6-8) score group. We evaluated the predictive value of CHA2DS2-VASC score for the presence of relevant CAD leading to percutaneous coronary intervention (PCI), as well as late all-cause mortality. RESULTS A total of 60 patients (32.8%) had significant CAD and underwent successful PCI. After adjustment for relevant parameters such as ischemic cardiomyopathy, angina pectoris, left ventricular ejection fraction, CHA2DS2-VASC score remained the only independent predictor of CAD leading to PCI [HR 1.73 (1.07-2.80)]. The Area under curve was 0.64 (0.56-72, p = 0.002). Kaplan-Meier analysis and log-rank showed an increased three-year mortality of ICD-patients with an intermediate or high score after VA (p = 0.003). Multivariate cox-regression analysis revealed that CHA2DS2-VASC score was also independently associated with all-cause mortality following adjustment for clinically relevant variables (HR 2.20, 1.17-4.14). CONCLUSIONS CHA2DS2-VASC score can be a predictor of CAD leading to PCI in ICD-patients after VA. ICD-Patients with a high score have an increased risk for reduced three-year all-cause mortality after VA.
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Key Words
- AF, Atrial fibrillation
- CABG, Coronary artery bypass graft
- CAD, Coronary artery disease
- CK-MB, Creatine Kinase MB Isoenzyme
- Coronary angiography
- Coronary artery disease
- ICD, Implantable Cardioverter-Defibrillator
- Implantable Cardioverter Defibrillator
- LDL, Low-Density Lipoprotein
- LVEF, Left Ventricular Ejection Fraction
- PCI, Percutaneous Coronary Intervention
- VA, Ventricular Arrhythmia
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
- Ventricular fibrillation
- Ventricular tachycardia
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Affiliation(s)
- Refik Kavsur
- Corresponding author at: Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | | | - Welat Nassan
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Sedaghat
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jan Wilko Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Pretorius D, Kahn-Krell AM, Lou X, Fast VG, Berry JL, Kamp TJ, Zhang J. Layer-By-Layer Fabrication of Large and Thick Human Cardiac Muscle Patch Constructs With Superior Electrophysiological Properties. Front Cell Dev Biol 2021; 9:670504. [PMID: 33937272 PMCID: PMC8086556 DOI: 10.3389/fcell.2021.670504] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023] Open
Abstract
Engineered cardiac tissues fabricated from human induced pluripotent stem cells (hiPSCs) show promise for ameliorating damage from myocardial infarction, while also restoring function to the damaged left ventricular (LV) myocardium. For these constructs to reach their clinical potential, they need to be of a clinically relevant volume and thickness, and capable of generating synchronous and forceful contraction to assist the pumping action of the recipient heart. Design prerequisites include a structure thickness sufficient to produce a beneficial contractile force, prevascularization to overcome diffusion limitations and sufficient structural development to allow for maximal cell communication. Previous attempts to meet these prerequisites have been hindered by lack of oxygen and nutrient transport due to diffusion limits (100–200 μm) resulting in necrosis. This study employs a layer-by-layer (LbL) fabrication method to produce cardiac tissue constructs that meet these design prerequisites and mimic normal myocardium in form and function. Thick (>2 mm) cardiac tissues created from hiPSC-derived cardiomyocytes, -endothelial cells (ECs) and -fibroblasts (FBs) were assessed, in vitro, over a 4-week period for viability (<6% necrotic cells), cell morphology and functionality. Functional performance assessment showed enhanced t-tubule network development, gap junction communication as well as previously unseen, physiologically relevant conduction velocities (CVs) (>30 cm/s). These results demonstrate that LbL fabrication can be utilized successfully to create prevascularized, functional cardiac tissue constructs from hiPSCs for potential therapeutic applications.
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Affiliation(s)
- Danielle Pretorius
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Asher M Kahn-Krell
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Xi Lou
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vladimir G Fast
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joel L Berry
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Timothy J Kamp
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, WI, United States
| | - Jianyi Zhang
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
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Alqarni F, Alsaadi M, Karem F. MR image analysis of ex-vivo mouse model of heart ischemia. Saudi J Biol Sci 2021; 28:1990-1998. [PMID: 33732084 PMCID: PMC7938144 DOI: 10.1016/j.sjbs.2020.12.054] [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: 07/10/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Myocardial infarction is one of the major causes of death and disability. Various diagnostic modalities used to investigate cardiac ischaemia. Advances in Magnetic Resonance Imaging technology has opened up new horizons for investigating the cardiac function and quantifying any pathology that may be present. Aims The present study was designed to quantify the cardiac area at risk and infarction reperfusion areas using the mismatch of iron oxide contrast and gadolinium (Gd) contrast imaging (MRIs) and to test if a combination of T1, T2, and iron oxide T2* contrasts will distinguish the infarction and AAR zones. Methods A well-established mouse model was used to induced cardiac ischaemia and reperfusion. Six mice models’ hearts were harvested and processed according to various protocols. MI was induced through ligation technique for five mice, and one was kept as normal control. MR imaging and Reperfusion were performed using a Three-dimensional gradient-echo fast low angle shot (3DFLASH) and three-dimensional multi-slice multi-echo sequence (3DMSME). Generation of T1 and T2 maps, image post-processing including segmentation and mismatch measurement and drawing of the area of interest. Results The edematous myocardium had significant high signal intensity in 3DMSME with variable echo time (14, 28, 42 ms). The combination of 3DFLASH and 3DMSME at an echo time of 42 ms was statistically significant, detecting the AAR more accurately. Both T1 and T2 sequences had the potential to determine the AAR zone. The infarct area has significantly high signal intensity compared to normal areas (p = 0.04 for the T1 map and p = 0.01 for the T2 map). Conclusions The study demonstrated that Cardiac MRI was a valuable technology to investigate infarct areas and zones that are at risk.
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Affiliation(s)
- Faiz Alqarni
- Medical Imaging Department, King Saud Medical City, Riyadh 12746, Saudi Arabia.,Centre of Advanced Imaging, University of Queensland, Brisbane, St Lucia, QLD 4072, Australia
| | - Mohammed Alsaadi
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, PO Box 422, Alkharj 11942, Saudi Arabia
| | - Fayka Karem
- Medical Imaging Department, King Saud Medical City, Riyadh 12746, Saudi Arabia.,Al Azhar University, Faculty of Medicine for Girls, Radiology and Medical Imaging Department, P.O Box: 1175,Cario, Egypt
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MD1 Depletion Predisposes to Ventricular Arrhythmias in the Setting of Myocardial Infarction. Heart Lung Circ 2020; 30:869-881. [PMID: 33257269 DOI: 10.1016/j.hlc.2020.09.938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Myeloid differentiation protein 1 (MD1) is expressed in the human heart and is a negative regulator of Toll-like receptor 4 (TLR4) signalling. MD1 exerts anti-arrhythmic effects. AIM The aim of this study was to determine the role of MD1 in myocardial infarction (MI)-related ventricular arrhythmias (VAs). METHOD Myocardial infarction was induced by surgical ligation of the left anterior coronary artery in MD1 knockout (KO) mice and their wild-type littermates. Myocardial infarction-induced vulnerability to VAs and its underlying mechanisms were evaluated. RESULTS Myeloid differentiation protein 1 was downregulated in the MI mice. Myeloid differentiation protein 1 deficiency decreased post-MI left ventricular (LV) function and increased the infarct size. The MI mice exhibited prolonged action potential duration (APD), enhanced APD alternans thresholds, and a higher incidence of VAs. Myocardial infarction-induced LV fibrosis and inflammation decreased the expression levels of Kv4.2, Kv4.3, Kv1.5, and Kv2.1, increased Cav1.2 expression, and disturbed Ca2+ handling protein expression. These MI-induced adverse effects were further exacerbated in KO mice. Mechanistically, MD1 deletion markedly enhanced the activation of the TLR4/calmodulin-dependent protein kinase II (CaMKII) signalling pathway in post-MI mice. CONCLUSIONS Myeloid differentiation protein 1 deletion increases the vulnerability to VAs in post-MI mice. This is mainly caused by the aggravated maladaptive LV fibrosis and inflammation and interference with the expressions of ion channels and Ca2+ handling proteins, which is related to enhanced activation of the TLR4/CaMKII signalling pathway.
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Tapa S, Wang L, Francis Stuart SD, Wang Z, Jiang Y, Habecker BA, Ripplinger CM. Adrenergic supersensitivity and impaired neural control of cardiac electrophysiology following regional cardiac sympathetic nerve loss. Sci Rep 2020; 10:18801. [PMID: 33139790 PMCID: PMC7608682 DOI: 10.1038/s41598-020-75903-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
Myocardial infarction (MI) can result in sympathetic nerve loss in the infarct region. However, the contribution of hypo-innervation to electrophysiological remodeling, independent from MI-induced ischemia and fibrosis, has not been comprehensively investigated. We present a novel mouse model of regional cardiac sympathetic hypo-innervation utilizing a targeted-toxin (dopamine beta-hydroxylase antibody conjugated to saporin, DBH-Sap), and measure resulting electrophysiological and Ca2+ handling dynamics. Five days post-surgery, sympathetic nerve density was reduced in the anterior left ventricular epicardium of DBH-Sap hearts compared to control. In Langendorff-perfused hearts, there were no differences in mean action potential duration (APD80) between groups; however, isoproterenol (ISO) significantly shortened APD80 in DBH-Sap but not control hearts, resulting in a significant increase in APD80 dispersion in the DBH-Sap group. ISO also produced spontaneous diastolic Ca2+ elevation in DBH-Sap but not control hearts. In innervated hearts, sympathetic nerve stimulation (SNS) increased heart rate to a lesser degree in DBH-Sap hearts compared to control. Additionally, SNS produced APD80 prolongation in the apex of control but not DBH-Sap hearts. These results suggest that hypo-innervated hearts have regional super-sensitivity to circulating adrenergic stimulation (ISO), while having blunted responses to SNS, providing important insight into the mechanisms of arrhythmogenesis following sympathetic nerve loss.
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Affiliation(s)
- Srinivas Tapa
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Lianguo Wang
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Samantha D Francis Stuart
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Zhen Wang
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Yanyan Jiang
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, OR, USA
| | - Crystal M Ripplinger
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA.
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Pechmajou L, Marijon E, Varenne O, Dumas F, Beganton F, Jost D, Lamhaut L, Lecarpentier E, Loeb T, Agostinucci JM, Sideris G, Riant E, Baudinaud P, Hagege A, Bougouin W, Spaulding C, Cariou A, Jouven X, Karam N. Impact of Coronary Lesion Stability on the Benefit of Emergent Percutaneous Coronary Intervention After Sudden Cardiac Arrest. Circ Cardiovasc Interv 2020; 13:e009181. [PMID: 32895006 DOI: 10.1161/circinterventions.119.009181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI. METHODS Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions. RESULTS Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, P=0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, P=1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42-3.09], P<0.001), contrary to PCI of stable lesions (odds ratio, 0.92 [95% CI. 0.44-1.87], P=0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions. CONCLUSIONS Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram.
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Affiliation(s)
- Louis Pechmajou
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Eloi Marijon
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Olivier Varenne
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department (O.V.), Cochin Hospital, Paris, France
| | - Florence Dumas
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Emergency Department (F.D.), Cochin Hospital, Paris, France
| | - Frankie Beganton
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.)
| | | | - Lionel Lamhaut
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,SAMU 75, Necker Hospital, Paris, France (L.L.)
| | | | - Thomas Loeb
- SAMU 92, Raymond Poincaré Hospital, Garches, France (T.L.)
| | | | - Georgios Sideris
- Cardiology Department, Lariboisiere Hospital, Paris, France (G.S.)
| | - Elisabeth Riant
- Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Pierre Baudinaud
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Albert Hagege
- Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Wulfran Bougouin
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.)
| | - Christian Spaulding
- Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Alain Cariou
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Intensive Care Unit (A.C.), Cochin Hospital, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
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Kang J, Zheng C, Park KW, Park J, Rhee T, Lee HS, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction. J Clin Med 2020; 9:jcm9010232. [PMID: 31952345 PMCID: PMC7019798 DOI: 10.3390/jcm9010232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/26/2023] Open
Abstract
The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF.
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Amin M, Kella D, Killu AM, Padmanabhan D, Hodge DO, Golafshar MA, Chamberlain AM, Lee JZ, Shen WK, Friedman PA, Asirvatham SJ, Roger VL, Gersh BJ, Mulpuru SK. Sudden cardiac arrest and ventricular arrhythmias following first type I myocardial infarction in the contemporary era. J Cardiovasc Electrophysiol 2019; 30:2869-2876. [PMID: 31588605 PMCID: PMC8276850 DOI: 10.1111/jce.14218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/18/2019] [Accepted: 10/02/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Myocardial infarction (MI) is associated with an increase in subsequent heart failure (HF), recurrent ischemic events, sudden cardiac arrest, and ventricular arrhythmias (SCA-VA). The primary objective of the study to determine the role of intercurrent HF and ischemic events on the development of SCA-VA following first type I MI. METHODS AND RESULTS A retrospective cohort study of patients experiencing first type 1 MI in Olmsted County, Minnesota (2002-2012) was conducted by identifying patients using the medical records linkage system (Rochester epidemiology project). Patients aged ≥18 years were followed from the time of MI till death or 31 July, 2017. Intercurrent HF and ischemic events were the primary exposures following MI and their association with outcome SCA-VA was assessed. Eight hundred and sixty-seven patients (mean age was 63 ± 14.5 years; 69% male; 49.8% ST-elevation myocardial infarction) who had their first type I MI during the study period were included. Majority of acute MI patients were revascularized using percutaneous coronary intervention and bypass surgery (628 [72.43%] and 87 [10.03%] respectively). During a mean follow-up of 7.69 ± 4.17 years, HF, recurrent ischemic events and SCA-VA occurred in 155 (17.9%), 245 (28.3%), and 40 (4.61%) patients respectively. Low ejection fraction (adjusted hazard ratio [HR] 0.95; 95% confidence interval [CI], 0.93-0.98; P < .001), intercurrent HF (adjusted HR 3.11; 95% CI, 1.39-6.95; P = .006) and recurrent ischemic events (adjusted HR 3.47; 95% CI, 1.68-7.18; P < .001) were associated with subsequent SCA-VA. CONCLUSION SCA-VA occurred in a small proportion of patients after MI and is associated with intercurrent HF and recurrent ischemic events.
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Affiliation(s)
- Mustapha Amin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Danesh Kella
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ammar M. Killu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Justin Z. Lee
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Paul A. Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Véronique L. Roger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Department of Epidemiology, Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Siva K. Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
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Ahmed TAN, Abdel‐Nazeer AA, Hassan AKM, Hasan‐Ali H, Youssef AA. Electrocardiographic measures of ventricular repolarization dispersion and arrhythmic outcomes among ST elevation myocardial infarction patients with pre-infarction angina undergoing primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol 2019; 24:e12637. [PMID: 30737993 PMCID: PMC6931689 DOI: 10.1111/anec.12637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/06/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Arrhythmias are considered one of the major causes of death in ST elevation myocardial infarction (STEMI), particularly in the early in-hospital phase. Pre-infarction angina (PIA) has been suggested to have a protective role. OBJECTIVES To study the difference in acute electrocardiographic findings between STEMI patients with and without PIA and to assess the in-hospital arrhythmias in both groups. MATERIAL AND METHODS We prospectively enrolled 238 consecutive patients with STEMI. Patients were divided into two groups: those with or without PIA. ECG data recorded and analyzed included ST-segment resolution (STR) at 90 min, corrected QT interval (QTc) and dispersion (QTD), T-peak-to-T-end interval (Tp-Te), and dispersion and Tp-Te/QT ratio. In-hospital ventricular arrhythmias encountered in both groups were recorded. Predictors of in-hospital arrhythmias were assessed among different clinical and electrocardiographic parameters. RESULTS Of the 238 patients included, 42 (17%) had PIA and 196 (83%) had no PIA. Patients with PIA had higher rates of STR (p < 0.0001), while patients with no PIA had higher values of QTc (p = 0.006), QTD (p = 0.001), Tp-Te interval (p = 0.001), Tp-Te dispersion (p < 0.0001), and Tp-Te/QT ratio (p = 0.01) compared to those with angina preceding their incident infarction (PIA). This was reflected into significantly higher rates of in-hospital arrhythmias among patients with no PIA (20% vs. 7%, p = 0.04). Furthermore, longer Tp-Te interval and higher Tp-Te/QT ratio independently predicted in-hospital ventricular arrhythmias. CONCLUSION Pre-infarction angina patients had better electrocardiographic measures of repolarization dispersion and encountered significantly less arrhythmic events compared to patients who did not experience PIA.
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Affiliation(s)
- Tarek A. N. Ahmed
- Department of Cardiovascular MedicineAsyut University HospitalAsyutEgypt
| | | | - Ayman K. M. Hassan
- Department of Cardiovascular MedicineAsyut University HospitalAsyutEgypt
| | - Hosam Hasan‐Ali
- Department of Cardiovascular MedicineAsyut University HospitalAsyutEgypt
| | - Amr A. Youssef
- Department of Cardiovascular MedicineAsyut University HospitalAsyutEgypt
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Dursun İ, Taşcanov MB. Akut ST elevasyonlu miyokard enfarktüslü hastalarda aritmiler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.444433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Twenty-five year trends (1986-2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular fibrillation complicating acute myocardial infarction. Am Heart J 2019; 208:1-10. [PMID: 30471486 DOI: 10.1016/j.ahj.2018.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of ventricular tachycardia (VT) and ventricular fibrillation (VF) among patients hospitalized with acute myocardial infarction (AMI) have not been recently examined. METHODS We used data from 11,825 patients hospitalized with AMI at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. Multivariable adjusted logistic regression modeling was used to examine trends in hospital IRs and CFRs of VT and VF complicating AMI. RESULTS The median age of the study population was 71 years, 57.9% were men, and 94.7% were white. The hospital IRs declined from 14.3% in 1986/1988 to 10.5% in 2009/2011 for VT and from 8.2% to 1.7% for VF. The in-hospital CFRs declined from 27.7% to 6.9% for VT and from 49.6% to 36.0% for VF between 1986/1988 and 2009/2011, respectively. The IRs of both early (<48 hours) and late VT and VF declined over time, with greater declines in those of late VT and VF. The incidence rates of VT declined similarly for patients with either an ST-segment elevation myocardial infarction (STEMI) or non-STEMI, whereas they only declined in those with VF and a STEMI. CONCLUSIONS The hospital IRs and CHRs of VT and VF complicating AMI have declined over time, likely because of changes in acute monitoring and treatment practices. Despite these encouraging trends, efforts remain needed to identify patients at risk for these serious ventricular arrhythmias so that preventive and treatment strategies might be implemented as necessary.
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Kobayashi Y, Tanno K, Ueno A, Fukamizu S, Murata H, Watanabe N, Sasaki T, Yamamoto T, Takayama M, Nagao K. In-Hospital Electrical Storm in Acute Myocardial Infarction ― Clinical Background and Mechanism of the Electrical Instability ―. Circ J 2018; 83:91-100. [DOI: 10.1253/circj.cj-18-0785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshinori Kobayashi
- Tokyo CCU Network Scientific Committee
- Cardiology Division, Tokai University Hachioji-Hospital
| | | | - Akira Ueno
- Tokyo CCU Network Scientific Committee
- Cardiology Division, Tokai University Hachioji-Hospital
| | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee
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Albanese M, Alpaslan K, Ouarrak T, Merguet P, Schneider S, Schöls W. In-hospital major arrhythmias, arrhythmic death and resuscitation after successful primary percutaneous intervention for acute transmural infarction: a retrospective single-centre cohort study. BMC Cardiovasc Disord 2018; 18:116. [PMID: 29898675 PMCID: PMC6001058 DOI: 10.1186/s12872-018-0851-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transmural acute myocardial infarction (AMI) is associated with a high risk for ventricular arrhythmia before, during and after treatment. Consequently, it is recommended that patients diagnosed with transmural AMI be monitored in a cardiac care unit (CCU) so life-threatening arrhythmias can be treated promptly. We examined the incidence and timing of in-hospital malignant ventricular arrhythmias, sudden cardiac or arrhythmic death (SCD/AD) and resuscitation requirements in patients with transmural AMI recovering from percutaneous coronary intervention (PCI) undertaken within 12 h of symptom onset and without antecedent thrombolysis. METHODS This was a retrospective cohort study using the Duisburg Heart Center (Germany) cardiac patient registry. In total, 975 patients met the inclusion criteria. The composite endpoint was post-PCI ventricular fibrillation or tachycardia, SCD/AD or requirement for resuscitation. We compared the demographic and clinical characteristics of patients who met the composite endpoint with those who did not, recorded the timing of endpoint episodes, and used multivariable logistic regression analysis to identify factors associated with the endpoint criteria. RESULTS There was no significant difference in the length of CCU or hospital stay between the groups. In-hospital mortality was 6.5%, and the composite endpoint was met in 7.4% of cases. Malignant ventricular tachyarrhythmia occurred in 2.8% of the patients, and SCD/AD occurred in 0.3% of the cases. There was a biphasic temporal distribution of endpoint events; specifically, 76.7% occurred < 96 h after symptom onset, and 12.6% occurred 240-360 h after symptom onset. Multivariable regression analysis identified positive associations between an endpoint episode and the following: age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05] per year); left ventricular ejection fraction (LVEF) < 30% (OR 3.66, 95% CI 1.91-6.99); peak serum creatine phosphokinase concentration (OR 1.01, 95% CI 1.00-1.02 per 100 U/dl); leucocytosis (OR 1.86, 95% CI 1.04-3.32), and coronary thrombus (OR 1.85, 95% CI 1.04-3.27). CONCLUSIONS Most post-PCI malignant ventricular arrhythmias, SCD/AD and resuscitation episodes occurred within 96 h of transmural AMI (76.7%). A substantial minority (12.6%) of these events arose 240-360 h after symptom onset. Further study is needed to establish the influence of age, LVEF < 30%, peak serum creatine phosphokinase concentration, leucocytosis and coronary thrombus on post-PCI outcomes after transmural AMI.
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Affiliation(s)
- Marco Albanese
- Herzzentrum Duisburg, Gerrickstr. 21, D-47137, Duisburg, Germany. .,Klinik für Kardiologie und Angiologie, Herzzentrum Duisburg, Gerrickstr. 21, 47137, Duisburg, Germany. .,Present address: Herzzentrum Hirslanden Zentralschweiz, Klinik St. Anna, St. Anna Str. 32, CH-6006, Luzern, Switzerland.
| | - Korhan Alpaslan
- Herzzentrum Duisburg, Gerrickstr. 21, D-47137, Duisburg, Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79 - Haus, MD-67063, Ludwigshafen a. Rh, Germany
| | - Peter Merguet
- Herzzentrum Duisburg, Gerrickstr. 21, D-47137, Duisburg, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79 - Haus, MD-67063, Ludwigshafen a. Rh, Germany
| | - Wolfgang Schöls
- Herzzentrum Duisburg, Gerrickstr. 21, D-47137, Duisburg, Germany
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Overexpression of Cx43 in cells of the myocardial scar: Correction of post-infarct arrhythmias through heterotypic cell-cell coupling. Sci Rep 2018; 8:7145. [PMID: 29739982 PMCID: PMC5940892 DOI: 10.1038/s41598-018-25147-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Ventricular tachycardia (VT) is the most common and potentially lethal complication following myocardial infarction (MI). Biological correction of the conduction inhomogeneity that underlies re-entry could be a major advance in infarction therapy. As minimal increases in conduction of infarcted tissue markedly influence VT susceptibility, we reasoned that enhanced propagation of the electrical signal between non-excitable cells within a resolving infarct might comprise a simple means to decrease post-infarction arrhythmia risk. We therefore tested lentivirus-mediated delivery of the gap-junction protein Connexin 43 (Cx43) into acute myocardial lesions. Cx43 was expressed in (myo)fibroblasts and CD45+ cells within the scar and provided prominent and long lasting arrhythmia protection in vivo. Optical mapping of Cx43 injected hearts revealed enhanced conduction velocity within the scar, indicating Cx43-mediated electrical coupling between myocytes and (myo)fibroblasts. Thus, Cx43 gene therapy, by direct in vivo transduction of non-cardiomyocytes, comprises a simple and clinically applicable biological therapy that markedly reduces post-infarction VT.
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Meta-analysis of T-wave indices for risk stratification in myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 14:776-779. [PMID: 29581718 PMCID: PMC5863057 DOI: 10.11909/j.issn.1671-5411.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Yu Z, Chen Z, Wu Y, Chen R, Li M, Chen X, Qin S, Liang Y, Su Y, Ge J. Electrocardiographic parameters effectively predict ventricular tachycardia/fibrillation in acute phase and abnormal cardiac function in chronic phase of ST-segment elevation myocardial infarction. J Cardiovasc Electrophysiol 2018; 29:756-766. [PMID: 29399929 DOI: 10.1111/jce.13453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ziqing Yu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
- Shanghai Medical College; Fudan University; Shanghai PR China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Yuan Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Ruizhen Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
- Department of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
- Department of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai PR China
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Jackman CP, Ganapathi AM, Asfour H, Qian Y, Allen BW, Li Y, Bursac N. Engineered cardiac tissue patch maintains structural and electrical properties after epicardial implantation. Biomaterials 2018; 159:48-58. [PMID: 29309993 DOI: 10.1016/j.biomaterials.2018.01.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/17/2017] [Accepted: 01/01/2018] [Indexed: 12/22/2022]
Abstract
Functional cardiac tissue engineering holds promise as a candidate therapy for myocardial infarction and heart failure. Generation of "strong-contracting and fast-conducting" cardiac tissue patches capable of electromechanical coupling with host myocardium could allow efficient improvement of heart function without increased arrhythmogenic risks. Towards that goal, we engineered highly functional 1 cm × 1 cm cardiac tissue patches made of neonatal rat ventricular cells which after 2 weeks of culture exhibited force of contraction of 18.0 ± 1.4 mN, conduction velocity (CV) of 32.3 ± 1.8 cm/s, and sustained chronic activation when paced at rates as high as 8.7 ± 0.8 Hz. Patches transduced with genetically-encoded calcium indicator (GCaMP6) were implanted onto adult rat ventricles and after 4-6 weeks assessed for action potential conduction and electrical integration by two-camera optical mapping of GCaMP6-reported Ca2+ transients in the patch and RH237-reported action potentials in the recipient heart. Of the 13 implanted patches, 11 (85%) engrafted, maintained structural integrity, and conducted action potentials with average CVs and Ca2+ transient durations comparable to those before implantation. Despite preserved graft electrical properties, no anterograde or retrograde conduction could be induced between the patch and host cardiomyocytes, indicating lack of electrical integration. Electrical properties of the underlying myocardium were not changed by the engrafted patch. From immunostaining analyses, implanted patches were highly vascularized and expressed abundant electromechanical junctions, but remained separated from the epicardium by a non-myocyte layer. In summary, our studies demonstrate generation of highly functional cardiac tissue patches that can robustly engraft on the epicardial surface, vascularize, and maintain electrical function, but do not couple with host tissue. The lack of graft-host electrical integration is therefore a critical obstacle to development of efficient tissue engineering therapies for heart repair.
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Affiliation(s)
| | - Asvin M Ganapathi
- Duke University Medical Center, Department of General Surgery, Durham, NC, USA
| | - Huda Asfour
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Ying Qian
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Brian W Allen
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Yanzhen Li
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
| | - Nenad Bursac
- Duke University, Department of Biomedical Engineering, Durham, NC, USA.
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Prognostic implication of early ventricular fibrillation among patients with ST elevation myocardial infarction. Coron Artery Dis 2017; 28:570-576. [DOI: 10.1097/mca.0000000000000532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Fisser C, Marcinek A, Hetzenecker A, Debl K, Luchner A, Sterz U, Priefert J, Zeman F, Kohler M, Maier LS, Buchner S, Arzt M. Association of sleep-disordered breathing and disturbed cardiac repolarization in patients with ST-segment elevation myocardial infarction. Sleep Med 2017; 33:61-67. [DOI: 10.1016/j.sleep.2017.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
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Hundahl LA, Tfelt-Hansen J, Jespersen T. Rat Models of Ventricular Fibrillation Following Acute Myocardial Infarction. J Cardiovasc Pharmacol Ther 2017; 22:514-528. [PMID: 28381093 DOI: 10.1177/1074248417702894] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A number of animal models have been designed in order to unravel the underlying mechanisms of acute ischemia-induced arrhythmias and to test compounds and interventions for antiarrhythmic therapy. This is important as acute myocardial infarction (AMI) continues to be the major cause of sudden cardiac death, and we are yet to discover safe and effective treatments of the lethal arrhythmias occurring in the acute setting. Animal models therefore continue to be relevant for our understanding and treatment of acute ischemic arrhythmias. This review discusses the applicability of the rat as a model for ventricular arrhythmias occurring during the acute phase of AMI. It provides a description of models developed, advantages and disadvantages of rats, as well as an overview of the most important interventions investigated and the relevance for human pathophysiology.
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Affiliation(s)
- Laura A Hundahl
- 1 Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- 2 Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Jespersen
- 1 Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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43
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2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death. J Am Coll Cardiol 2017; 69:712-744. [DOI: 10.1016/j.jacc.2016.09.933] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Al-Khatib SM, Yancy CW, Solis P, Becker L, Benjamin EJ, Carrillo RG, Ezekowitz JA, Fonarow GC, Kantharia BK, Kleinman M, Nichol G, Varosy PD. 2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2017; 10:e000022. [DOI: 10.1161/hcq.0000000000000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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45
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Bhar-Amato J, Davies W, Agarwal S. Ventricular Arrhythmia after Acute Myocardial Infarction: 'The Perfect Storm'. Arrhythm Electrophysiol Rev 2017; 6:134-139. [PMID: 29018522 DOI: 10.15420/aer.2017.24.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Ventricular tachyarrhythmias (VAs) commonly occur early in ischaemia, and remain a common cause of sudden death in acute MI. The thrombolysis and primary percutaneous coronary intervention era has resulted in the modification of the natural history of an infarct and subsequent VA. Presence of VA could independently influence mortality in patients recovering from MI. Appropriate risk assessment and subsequent treatment is warranted in these patients. The prevention and treatment of haemodynamically significant VA in the post-infarct period and of sudden cardiac death remote from the event remain areas of ongoing study.
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Affiliation(s)
- Justine Bhar-Amato
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
| | - William Davies
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
| | - Sharad Agarwal
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
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46
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Blais C, Rochette L. Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2016; 35:184-93. [PMID: 26674188 DOI: 10.24095/hpcdp.35.10.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Of all cardiovascular causes of mortality, coronary heart disease (CHD) remains the leading cause of death. Our objectives were to establish trends in the prevalence and incidence of CHD in the province of Quebec, and to determine the proportion of CHD mortality that had no previous CHD diagnosis. METHODS Trends in prevalence, incidence and mortality were examined with a population-based study using the Quebec Integrated Chronic Disease Surveillance System, which links several health administrative databases. Data are presented using two case definitions for Quebecers aged 20 years and over: 1) a validated definition, and 2) CHD causes of death codes added to estimate the proportion of deaths that occurred without any previous CHD diagnosis as a proxy for sudden cardiac death (SCD). RESULTS In 2012/2013, the crude prevalence of CHD was 9.4% with the first definition (593 000 people). Between 2000/2001 and 2012/2013, the age-standardized prevalence increased by 14%, although it has been decreasing slightly since 2009/2010. Age-standardized incidence and mortality rates decreased by 46% and 26% respectively, and represented a crude rate of 6.9 per 1000 and 5.2% in 2012/2013. The proportion identified only by CHD mortality, our SCD proxy, was only significant for the incident cases (0.38 per 1000 in 2009/2010) and declined over the study period. CONCLUSION The prevalence of CHD has tended to decrease in recent years, and incidence and mortality have been declining in Quebec. Most CHD mortality occurs in previously diagnosed patients and only a small proportion of incident cases were not previously identified.
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Affiliation(s)
- C Blais
- Institut national de santé publique du Québec, Québec, Quebec, Canada.,Faculté de pharmacie, Université Laval, Québec, Quebec, Canada
| | - L Rochette
- Institut national de santé publique du Québec, Québec, Quebec, Canada
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47
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Kandzari DE, Perumal R, Bhatt DL. Frequency and Implications of Ischemia Prior to Ventricular Tachyarrhythmia in Patients Treated With a Wearable Cardioverter Defibrillator Following Myocardial Infarction. Clin Cardiol 2016; 39:399-405. [PMID: 27341494 DOI: 10.1002/clc.22544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/12/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Autopsy studies imply that recurrent myocardial infarction (MI) accounts for the majority of sudden death early after acute MI, rather than primary arrhythmia. However, diagnosis of recurrent MI by autopsy is challenging and excludes electrocardiographic data to adjudicate arrhythmic causes. We examined the frequency of ischemia prior to treated ventricular tachycardia/fibrillation (VT/VF) and outcomes in patients using the wearable cardioverter defibrillator (WCD) following acute MI. HYPOTHESIS Primary arrhythmia, rather than ischemia, is a frequent contributor to sudden death following MI. METHODS All patients treated for VT/VF over a 6-year period while wearing a WCD following acute MI with advanced left ventricular dysfunction (ejection fraction ≤35%) were included. Patients with ST-segment changes ≥0.1 mV before VT/VF were classified ischemic. Demographics and clinical outcomes were compared between those with ischemia-mediated vs primary arrhythmia. RESULTS Among 273 patients fulfilling study criteria, 15.4% had ischemia prior to VT/VF. Clinical and WCD use characteristics did not significantly differ between ischemic and primary VT/VF groups. Termination of VT/VF by WCD treatment approximated 96% in both groups. Survival 24 hours post-treatment was 88% and 84% (P = 0.54) for patients with and without ischemic VT/VF, respectively. Furthermore, 30-day cumulative survival for those with and without ischemic VT/VF was 77% and 70%, respectively (P = 0.57). CONCLUSIONS Ischemia is an infrequent cause of VT/VF following MI, contradicting previous study conclusions that recurrent MI is responsible for most post-MI sudden death. Etiology of VT/VF, however, did not influence defibrillation success or survival, which was high for both groups.
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Affiliation(s)
- David E Kandzari
- Interventional Cardiology Research, Piedmont Heart Institute, Atlanta, Georgia
| | - Ramu Perumal
- Medical Affairs, ZOLL Medical Corporation, Pittsburgh, Pennsylvania
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts
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Wang H, Xi Y, Zheng Y, Wang X, Cooney AJ. Generation of electrophysiologically functional cardiomyocytes from mouse induced pluripotent stem cells. Stem Cell Res 2016; 16:522-30. [PMID: 26972055 DOI: 10.1016/j.scr.2016.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 01/08/2023] Open
Abstract
Induced pluripotent stem (iPS) cells can efficiently differentiate into the three germ layers similar to those formed by differentiated embryonic stem (ES) cells. This provides a new source of cells in which to establish preclinical allogeneic transplantation models. Our iPS cells were generated from mouse embryonic fibroblasts (MEFs) transfected with the Yamanaka factors, the four transcription factors (Oct4, Sox2, Klf4 and c-Myc), without antibiotic selection or MEF feeders. After the formation of embryoid bodies (EBs), iPS cells spontaneously differentiated into Flk1-positive cardiac progenitors and cardiomyocytes expressing cardiac-specific markers such as alpha sarcomeric actinin (α-actinin), cardiac alpha myosin heavy chain (α-MHC), cardiac troponin T (cTnT), and connexin 43 (CX43), as well as cardiac transcription factors Nk2 homebox 5 (Nkx2.5) and gata binding protein 4 (gata4). The electrophysiological activity of iPS cell-derived cardiomyocytes (iPS-CMs) was detected in beating cell clusters with optical mapping and RH237 a voltage-sensitive dye, and in single contracting cells with patch-clamp technology. Incompletely differentiated iPS cells formed teratomas when transplanted into a severe combined immunodeficiency (SCID) mouse model of myocardial infarction. Our results show that somatic cells can be reprogrammed into pluripotent stem cells, which in turn spontaneously differentiate into electrophysiologically functional mature cardiomyocytes expressing cardiac-specific makers, and that these cells can potentially be used to repair myocardial infarction (MI) in the future.
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Affiliation(s)
- Hongran Wang
- Department of Pediatrics, Dell Pediatric Research Institute, University of Texas at Austin Dell Medical School, 1400 Barbara Jordan Blvd., Austin, TX 78723, USA
| | - Yutao Xi
- Electrophysiology Research Laboratory, Texas Heart Institute, Houston, TX 77030, USA
| | - Yi Zheng
- Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV 89557, USA
| | - Xiaohong Wang
- Stem Cell Center, Texas Heart Institute, Houston, TX 77030, USA
| | - Austin J Cooney
- Department of Pediatrics, Dell Pediatric Research Institute, University of Texas at Austin Dell Medical School, 1400 Barbara Jordan Blvd., Austin, TX 78723, USA.
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50
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Jabbari R, Risgaard B, Fosbøl EL, Scheike T, Philbert BT, Winkel BG, Albert CM, Glinge C, Ahtarovski KA, Haunsø S, Køber L, Jørgensen E, Pedersen F, Tfelt-Hansen J, Engstrøm T. Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2015; 116:678-85. [PMID: 26150175 DOI: 10.1016/j.amjcard.2015.05.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
We aimed to assess the risk factors and outcome of ventricular fibrillation (VF) before and during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction. From 1999 to 2012, we consecutively enrolled 5,373 patients with ST-segment elevation myocardial infarction. In total, 410 of the patients had VF before and 88 had VF during PPCI. During a mean follow-up of 4.2 years, 1,196 subjects died. A logistic regression model identified younger age, anterior infarct, Killip class >I at admission, and a preprocedural Thrombolysis In Myocardial Infarction flow grade of 0 to I to be significantly associated with VF before PPCI, whereas inferior infarct, a preprocedural Thrombolysis In Myocardial Infarction flow grade of 0 to I, and Killip class >I at admission were significantly associated with VF during PPCI. All-cause mortality was evaluated using the Cox regression model. Compared with the patients without VF, those with VF before or during PPCI had a significantly increased 30-day mortality, with an adjusted hazard ratio = 3.40 (95% confidence interval 1.70 to 6.70) and 4.20 (95% confidence interval 1.30 to 13.30), respectively. Importantly, there was no tendency of 30-day mortality difference between VF before and during PPCI (p = 0.170). In patients with VF before or during PPCI who survived for at least 30 days, there was no increase in the long-term mortality. In conclusion, our data suggest that 30-day mortality is the same for patients with VF before PPCI compared with VF during PPCI, and the occurrence of VF before or during PPCI was associated with increased 30-day mortality but not with long-term mortality.
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