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Holkeri A, Eranti A, Haukilahti MAE, Kerola T, Kenttä TV, Tikkanen JT, Rissanen H, Heliövaara M, Knekt P, Junttila MJ, Aro AL, Huikuri HV. Impact of age and sex on the long-term prognosis associated with early repolarization in the general population. Heart Rhythm 2020; 17:621-628. [DOI: 10.1016/j.hrthm.2019.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 10/25/2022]
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Isart FA, Ramos FG, Isart-Infante F. Cardiac Early Repolarization Pattern Anomalies Among Children and Adolescents With and Without Attention-Deficit Hyperactivity Disorder: A Community Observational Study. Glob Pediatr Health 2019; 6:2333794X19828311. [PMID: 30793013 PMCID: PMC6376541 DOI: 10.1177/2333794x19828311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 12/02/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022] Open
Abstract
Our research had 2 aims, first, to determine if electrocardiographic early repolarization pattern anomalies (ERPAs) were more likely present among children and adolescents diagnosed with attention-deficit hyperactivity disorder (ADHD; n = 416) when compared with non-ADHD children (n = 187), and second, to asses if ADHD patients whose parents report severe ADHD psychometric scores were more likely to have ERPA in their surface ECG (electrocardiography) when compared with other ADHD patients with mild to moderate dysfunction or no dysfunction. In our unmatched case-control study, ERPA was recognized when there was an end QRS notch (J wave) or slur on the downslope of a prominent R wave with and without ST-segment elevation and the peak of the notch or J wave (Jp) ≥0.1 mV in ≥2 contiguous leads, excluding V1-V3 anterior lead, and QRS duration (measured in leads in which a notch or slur is absent) <120 ms or ST-segment elevation >0.1 mV in ≥2 contiguous leads, excluding V1-V3, and QRS duration <120 ms. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used to diagnose ADHD. Our data analysis suggested a significant association between ERPA presence and ADHD (n = 603, P = .020). Our logistic regression model suggests that patients with ERPA (n = 167) were 2.778 times more likely to have a diagnosis of ADHD after controlling for age, gender, and ethnicity (95% confidence interval for odds ratio 1.087-7.100, P = .033). Multiple regression models suggested that age, P < .001; gender, P < .001; ERPA, P = .004; and ERPA leads number, P = .022, were significant predictors of global parental ADHD worry scale. Hispanic and black ethnicity were not significant predictors. Consequently, the presence of ERPA should be reported in all ECGs done in children and adolescents for prospective behavioral phenotype and/or arrhythmia risk stratification analysis.
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Affiliation(s)
| | - Faustino G Ramos
- The University of Texas Health Sciences Center at Houston, TX, USA
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Liu X, Shen Y, Xie J, Bao H, Cao Q, Wan R, Xu X, Zhou H, Huang L, Xu Z, Zhu W, Hu J, Cheng X, Hong K. A mutation in the CACNA1C gene leads to early repolarization syndrome with incomplete penetrance: A Chinese family study. PLoS One 2017; 12:e0177532. [PMID: 28493952 PMCID: PMC5426766 DOI: 10.1371/journal.pone.0177532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/28/2017] [Indexed: 01/06/2023] Open
Abstract
Background Early repolarization syndrome (ERS) may be a near-Mendelian or an oligogenic disease; however, no direct evidence has been provided to support this theory. Methods and results We described a large Chinese family with nocturnal sudden cardiac death induced by ERS in most of the young male adults. One missense mutation (p.Q1916R) was found in the major subunit of the L-type calcium channel gene CACNA1C by the direct sequencing of candidate genes. A concomitant gain-of-function variant in the sodium channel gene SCN5A (p.R1193Q) was found to rescue the phenotype of the female CACNA1C-Q1916R mutation carriers, which led to the incomplete penetrance. The functional studies, via the exogenous expression approach, revealed that the CACNA1C-Q1916R mutation led to a decreasing L-type calcium current and the protein expression defect. The decreased calcium current produced by the mutant channel was improved by isoproterenol but exacerbated by testosterone. The effects of CACNA1C-Q1916R mutation and testosterone on cellular electrophysiology were further confirmed by the human ventricular action potential simulation. Conclusions Our results demonstrated that the loss-of-function CACNA1C-Q1916R mutation contributed to ERS-related sudden cardiac death, and the phenotypic incomplete penetrance was modified by the SCN5A-R1193Q variant and sex. These findings suggest that phenotypes of ERS are modified by multiple genetic factors, which supports the theory that ERS may be an oligogenic disease.
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Affiliation(s)
- Xin Liu
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yang Shen
- Jiangxi Province Key Laboratory of Molecular Medicine, Nanchang, China
| | - Jinyan Xie
- Jiangxi Province Key Laboratory of Molecular Medicine, Nanchang, China
| | - Huihui Bao
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing Cao
- Jiangxi Province Key Laboratory of Molecular Medicine, Nanchang, China
| | - Rong Wan
- Jiangxi Province Key Laboratory of Molecular Medicine, Nanchang, China
| | - Xiaoming Xu
- Department of Forensic Medicine, Medical College of Nanchang University, Nanchang, China
| | - Hui Zhou
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lin Huang
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhenyan Xu
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinzhu Hu
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoshu Cheng
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kui Hong
- Department of Cardiovascular medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Province Key Laboratory of Molecular Medicine, Nanchang, China
- * E-mail:
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Cheng YJ, Lin XX, Ji CC, Chen XM, Liu LJ, Tang K, Wu SH. Role of Early Repolarization Pattern in Increasing Risk of Death. J Am Heart Assoc 2016; 5:JAHA.116.003375. [PMID: 27671315 PMCID: PMC5079012 DOI: 10.1161/jaha.116.003375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background An early repolarization pattern (ERP) has been hypothesized to be arrhythmogenic in experimental studies, but the prognostic significance of the ERP in the general population is controversial. We performed a meta‐analysis to examine the link between ERP and the risk of sudden cardiac arrest (SCA), cardiac death, and death from any cause. Methods and Results We performed a literature search using MEDLINE (January 1, 1966 to July 31, 2015) and EMBASE (January 1, 1980 to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Sixteen studies involving 334 524 subjects were identified. Compared with those without ERP, subjects with ERP experienced significantly increased risk for developing SCA (RR 2.18; 95% CI 1.29–3.68), cardiac death (RR 1.48; 95% CI 1.06–2.07), and death from any cause (RR 1.21; 95% CI 1.02–1.42), respectively. The increased risk was present predominantly in Asians and whites but not in African Americans. ERP with J‐point elevation in inferior leads, notching configuration, and horizontal or descending ST segment connote higher risk. ERP was associated with an absolute risk increase of 139.6 (95% CI 130.3–149.3) additional SCAs per 100 000 person‐years and responsible for 7.3% (95% CI 1.9–15.2) of SCA in the general population. Conclusions ERP is associated with significant increased risk for SCA, cardiac death, and death from any cause. Future studies should focus on understanding the exact mechanisms for the arrhythmia risk and developing reliable tools for risk stratification.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Xiong Lin
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xu-Miao Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li-Juan Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Tang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Lohrmann GM, Peters F, Srivathsan K, Essop MR, Mookadam F. Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization. Am J Cardiol 2016; 118:765-70. [PMID: 27381667 DOI: 10.1016/j.amjcard.2016.06.006] [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: 02/13/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 02/08/2023]
Abstract
Electrocardiographic abnormalities, and specifically early repolarization (ER) patterns, are increasingly found to be common variants in healthy populations free of heart disease or risk factors. Data are sparse in subjects of African descent, for which no increase in adverse cardiovascular outcomes have been demonstrated. A database of healthy disease-free adult volunteers of sub-Saharan African descent had 12 lead electrocardiograms (ECGs) and transthoracic echocardiograms performed. Statistical tests were then performed on the data to elicit associations; 396 volunteers (63.1% women) with a mean age of 37.4 years met the inclusion and exclusion criteria. An abnormal ECG was identified in 50.5% of volunteers, largely because of underlying ST elevation at the J point (ER), left ventricular hypertrophy (LVH) by voltage criteria, and T-wave inversion. Men were more likely to have abnormal ECGs (odds ratio [OR] 1.75; p <0.001), axes (OR 2.05; p = 0.023), display LVH by Sokolow-Lyon voltage criteria (OR 5.45; p <0.001), and have ER patterns (OR 11.61; p <0.001). Additionally, younger adults were also more likely to display LVH by voltage criteria and ER patterns. Volunteers with LVH by ECG had 5.7% higher LV mass indexes (p = 0.047). An abnormal ECG was not associated with a reduced left ventricular ejection fraction or diastolic dysfunction. ECG abnormalities, especially ER patterns, in black adults of Sub-Saharan descent are common, occurring in half of the normal adults.
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Walsh BM, Smith SW. "Persistent Juvenile" T-Wave Pattern May Not Be Persistent: Case Series and Literature Review. J Emerg Med 2015; 49:e165-72. [PMID: 26409676 DOI: 10.1016/j.jemermed.2015.06.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND T-wave inversions (TWI) can signify serious pathology, but may also represent a benign variant. One such variant has been termed the "persistent juvenile" T-wave pattern (PJTWP). It is characterized by TWI in the right precordium, and has been understood to represent an arrested stage of the normal electrocardiographic evolution from childhood. CASE REPORT A series of four African-American (AA) women, ages 20 to 43 years, presented to the Emergency Department, and were found to have right precordial TWI that was absent on prior electrocardiograms. The diagnostic evaluation did not reveal acute cardiopulmonary causes for these new TWIs. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The "persistent" juvenile pattern may not be actually persistent in the individual patient. In an appropriate patient, such as a young AA woman, where acute cardiopulmonary disease has been reasonably ruled out, the finding of new right precordial TWI should not preclude the diagnosis of PJTWP.
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Affiliation(s)
- Brooks M Walsh
- Department of Emergency Medicine, Bridgeport Hospital, Bridgeport, Connecticut
| | - Stephen W Smith
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, Minnesota
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Spears DA, Gollob MH. Genetics of inherited primary arrhythmia disorders. APPLICATION OF CLINICAL GENETICS 2015; 8:215-33. [PMID: 26425105 PMCID: PMC4583121 DOI: 10.2147/tacg.s55762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A sudden unexplained death is felt to be due to a primary arrhythmic disorder when no structural heart disease is found on autopsy, and there is no preceding documentation of heart disease. In these cases, death is presumed to be secondary to a lethal and potentially heritable abnormality of cardiac ion channel function. These channelopathies include congenital long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, and short QT syndrome. In certain cases, genetic testing may have an important role in supporting a diagnosis of a primary arrhythmia disorder, and can also provide prognostic information, but by far the greatest strength of genetic testing lies in the screening of family members, who may be at risk. The purpose of this review is to describe the basic genetic and molecular pathophysiology of the primary inherited arrhythmia disorders, and to outline a rational approach to genetic testing, management, and family screening.
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Affiliation(s)
- Danna A Spears
- Division of Cardiology - Electrophysiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Michael H Gollob
- Division of Cardiology - Electrophysiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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Brosnan MJ, Kumar S, LaGerche A, Brown A, Stewart S, Kalman JM, Prior DL. Early repolarization patterns associated with increased arrhythmic risk are common in young non-Caucasian Australian males and not influenced by athletic status. Heart Rhythm 2015; 12:1576-83. [PMID: 25839111 DOI: 10.1016/j.hrthm.2015.03.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early repolarization (ER) with a horizontal ST segment (ST-h) and high-amplitude J waves in the inferior leads is associated with an increased risk of cardiac arrhythmic death. The effect of ethnicity and athletic status on this increased-risk ER pattern has not been established. Aboriginal Australian/Torres Strait Islander and Pacific Islander/Maori (non-Caucasian [non-C]) subjects are well represented in Australian sport; however, the patterns and prevalence of ER in these populations are unknown. OBJECTIVE The purpose of this study was to assess the prevalence and effect of athletic activity on ER patterns in young non-C and Caucasian (C) subjects. METHODS Twelve-lead ECGs of 726 male athletes (23.8% non-C) and 170 male controls (45.9% non-C) aged 16-40 years were analyzed for the presence of ER, defined as J-point elevation (J wave, QRS slur, or discrete ST elevation) ≥0.1 mV in ≥2 inferior (II, III, aVF) or lateral (I, aVL,V4-V6) leads. ST morphology was coded as horizontal (ST-h) or ascending (ST-a). "Increased-risk ER" was defined as inferior ER with ST-h and J waves >2 mV. RESULTS Regardless of athletic status, ER and increased-risk ER were more prevalent in non-C than in C subjects (53.8% vs 32% and 7.6% vs 1.2%, respectively, P <.0001). Whereas lower heart rate, larger QRS voltage, and shorter QRS duration were predictors of ER, non-C ethnicity was the only independent predictor of increased-risk ER (odds ratio 17.621, 95% confidence interval 4.98-62.346, P < .0001). CONCLUSION ER patterns associated with increased arrhythmic risk are more common in young non-C than C subjects and were not influenced by athletic status. The long-term clinical significance of ER in these populations is yet to be determined.
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Affiliation(s)
- Maria J Brosnan
- Department of Cardiology, St. Vincent׳s Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Saurabh Kumar
- Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Andre LaGerche
- Department of Cardiology, St. Vincent׳s Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Alex Brown
- School of Population Health, University of South Australia, Adelaide, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - David L Prior
- Department of Cardiology, St. Vincent׳s Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
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Mizusawa Y, Bezzina CR. Early repolarization pattern: its ECG characteristics, arrhythmogeneity and heritability. J Interv Card Electrophysiol 2014; 39:185-92. [PMID: 24532112 DOI: 10.1007/s10840-013-9870-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/30/2013] [Indexed: 12/19/2022]
Abstract
Early repolarization (ER) has been accepted as a benign ECG variant for decades. Two seminal studies challenged this notion and have demonstrated that ER pattern is associated with an increased risk of arrhythmic and cardiac mortality in patients with idiopathic ventricular fibrillation (IVF) and in the general population. Recent clinical studies demonstrate its varying impact as an arrhythmogenic substrate on different diseases. For example, in ER syndrome, a primary electrical disease, ER appears as a major arrhythmogenic substrate for development of VF whereas in patients with coronary artery disease, an ER pattern may exist as a silent substrate, increasing the risk of VF during episodes of cardiac ischaemia. Due to the high prevalence of an ER pattern in the general population and a low VF event rate, it remains challenging to differentiate a malignant ER pattern from a benign form. Recent research suggests that a J-wave amplitude of more than 0.1 mV combined with a descending/horizontal ST segment may constitute a malignant ER pattern. Further studies are however necessary to evaluate its prognostic value for cardiac and arrhythmic death in the general population as well as in cases with a malignant ER pattern. While genetic testing has revealed putative causal DNA variants in sporadic cases, the lack of co-segregation with the disease in affected families suggests that ER syndrome is not monogenic but is likely a complex disorder influenced by multiple genetic as well as environmental factors.
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Affiliation(s)
- Yuka Mizusawa
- AMC Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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