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Chang Y, Wang X, Tian X, Cao Z, Zhen X, Zhao W, Luo B, Gao Y. Novel indel variation of LTBP4 gene associates with risk of sudden cardiac death in Chinese populations with coronary artery disease. Leg Med (Tokyo) 2024; 69:102437. [PMID: 38547642 DOI: 10.1016/j.legalmed.2024.102437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 07/17/2024]
Abstract
The objective of this study is to investigate whether common genetic variants of the LTBP4 gene are linked to the susceptibility of sudden cardiac death in individuals who have atherosclerotic coronary artery disease (SCD-CAD) in Chinese populations. A total of 208 SCD-CAD cases and 638 controls were included in the analysis, and logistic regression was employed to assess the association between a 4-bp insertion/deletion polymorphism (rs34005443) within LTBP4 and the susceptibility to SCD-CAD among Chinese individuals. Logistic regression analysis demonstrated a notable association between the insertion allele of rs34005443 and an escalated susceptibility to SCD-CAD [odds ratio (OR) = 1.434; 95 % confidence interval:1.14-1.80; P = 1.79 × 10-3]. Genotype-phenotype correlation analysis was performed using Genotype-Tissue expression (GTEx) database and further validated by human myocardium using qPCR. Correlation analysis revealed that LTBP4 expression level was lower in samples with the insertion allele. Furthermore, the dual-luciferase activity assays indicated that rs34005443 may play a regulatory role. Additionally, we predicted 30 transcription factors that are likely to bind to rs34005443 and its highly linked genetic variants via 3DSNP database. Subsequent GO and KEGG analysis indicated that these transcription factors have a significant function in regulating gene expression. Finally, PPI network analysis suggested a tight connection between LTBP4 proteins and TGFβs, highlighting these genes as potential hub genes in the context of SCD-CAD. In summary, our study revealed that rs34005443 might contribute to SCD-CAD susceptibility by regulating LTBP4 expression. These findings revealed that this indel could be a potentially functional marker for molecular diagnosis and risk stratification of SCD-CAD.
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Affiliation(s)
- Yafei Chang
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoshu Wang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Xiaoyi Tian
- School of Public Health, Dalian Medical University, Dalian, China
| | - Zhengjun Cao
- Public Security Bureau of Yancheng, Yancheng, China
| | - Xiaoyuan Zhen
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Wenfeng Zhao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Bin Luo
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China.
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2
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Marrone D, Basso C, Thiene G. Commotio cordis: Another cardiac arrest "sine materia". The 1707 early report and interpretation by G.M. Lancisi. Cardiovasc Pathol 2024; 70:107606. [PMID: 38262503 DOI: 10.1016/j.carpath.2024.107606] [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: 12/22/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').
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Affiliation(s)
- Daniela Marrone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy.
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3
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Kauferstein S, Beckmann BM. [Postmortem genetic analysis following sudden cardiac death : Background, approach, and future]. Herzschrittmacherther Elektrophysiol 2024; 35:31-38. [PMID: 38197940 DOI: 10.1007/s00399-023-00986-9] [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: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Sudden cardiac death (SCD) is defined as an unexpected, nontraumatic death with a possible cardiac or unknown cause. The lowest incidence is observed in infancy and childhood (1 per 100,000), and the incidence is approximately 50 per 100,000 in the middle-aged population, reaching a plateau around the age of 80 (200 per 100,000). While most SCD cases occur in older people with coronary artery disease, there is a predominance of monogenetic and polygenetic diseases in the young. METHODS Postmortem genetic analysis (molecular autopsy) using next-generation sequencing reveals a definite pathogenic genetic alteration, which can explain SCD of young patients in near 20% of the cases. Hence, postmortem genetic analysis has become an important tool to unravel the inheritable cause of death. Furthermore, early identification of a pathogenic genetic sequence variant in the deceased is crucial to reduce risk in relatives due to preventive personalized measures. RESULTS AND CONCLUSION Postmortem genetic analysis forms together with the clinical assessment the basis for early identification of at-risk relatives. A new guideline for the management of ventricular arrhythmias and prevention of sudden death was recently published by the European Society of Cardiology. The new recommendations give genetic testing, also in deceased patients a much higher priority reflecting increasing relevance of genetic testing for diagnostic evaluation, risk stratification and prevention.
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Affiliation(s)
- Silke Kauferstein
- Institut für Rechtsmedizin, Zentrum für plötzlichen Herztod und familiäre Arrhythmiesyndrome, Universitätsklinikum Frankfurt, Kennedyallee 104, 60590, Frankfurt, Deutschland.
- Partner Site Rhein-Main, DZHK (German Centre for Cardiovascular Research), Frankfurt, Deutschland.
| | - Britt-Maria Beckmann
- Institut für Rechtsmedizin, Zentrum für plötzlichen Herztod und familiäre Arrhythmiesyndrome, Universitätsklinikum Frankfurt, Kennedyallee 104, 60590, Frankfurt, Deutschland
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4
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Thiene G. Autopsy and sudden death. Eur Heart J Suppl 2023; 25:C118-C129. [PMID: 37125299 PMCID: PMC10132616 DOI: 10.1093/eurheartjsupp/suad014] [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] [Indexed: 05/02/2023]
Abstract
Our story dates back in the late 70s, when a series of juvenile sudden death (SD) occurred in the Veneto region, north east of Italy. A successful application for a prospective study on young people dying suddenly (<35-year-old, sudden infant death syndrome excluded) was submitted to the regional health authorities, thus implementing a network of collaboration with local anatomic and forensic pathologists, to collect all such events and to gather demographic data. The project is still in progress, and since then, we studied hundreds of consecutive juvenile SD cases, allowing to identify the culprit diseases in the various organs and cardiac structures (aorta, coronary arteries, myocardium, valves, and conduction system). The long-standing Veneto region experience clearly shows that autopsy still plays a pivotal role in the study and prevention of SD and should be carried out regularly. With time, the investigation of SD moved from the classic post-mortem study to molecular autopsy, especially in cases of SD with structurally normal heart. Sudden death prevention in the young has to be faced by an interdisciplinary team, including pathologists, cardiologists, sport physicians, and geneticists, the clinicopathologic correlation method still being the polar star. The game in the fight against SD is still played in the anatomical theatre, the place where 'death enjoys to save lives'.
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Genetically determined cardiomyopathies at autopsy: the pivotal role of the pathologist in establishing the diagnosis and guiding family screening. Virchows Arch 2023; 482:653-669. [PMID: 36897369 PMCID: PMC10067659 DOI: 10.1007/s00428-023-03523-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
Cardiomyopathies (CMP) comprise a heterogenous group of diseases affecting primarily the myocardium, either genetic and/or acquired in origin. While many classification systems have been proposed in the clinical setting, there is no internationally agreed pathological consensus concerning the diagnostic approach to inherited CMP at autopsy. A document on autopsy diagnosis of CMP is needed because the complexity of the pathologic backgrounds requires proper insight and expertise. In cases presenting with cardiac hypertrophy and/or dilatation/scarring with normal coronary arteries, a suspicion of inherited CMP must be considered, and a histological examination is essential. Establishing the actual cause of the disease may require a number of tissue-based and/or fluid-based investigations, be it histological, ultrastructural, or molecular. A history of illicit drug use must be looked for. Sudden death is frequently the first manifestation of disease in case of CMP, especially in the young. Also, during routine clinical or forensic autopsies, a suspicion of CMP may arise based on clinical data or pathological findings at autopsy. It is thus a challenge to make a diagnosis of a CMP at autopsy. The pathology report should provide the relevant data and a cardiac diagnosis which can help the family in furthering investigations, including genetic testing in case of genetic forms of CMP. With the explosion in molecular testing and the concept of the molecular autopsy, the pathologist should use strict criteria in the diagnosis of CMP, and helpful for clinical geneticists and cardiologists who advise the family as to the possibility of a genetic disease.
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Martinez-Barrios E, Sarquella-Brugada G, Perez-Serra A, Fernandez-Falgueras A, Cesar S, Alcalde M, Coll M, Puigmulé M, Iglesias A, Ferrer-Costa C, del Olmo B, Picó F, Lopez L, Fiol V, Cruzalegui J, Hernandez C, Arbelo E, Díez-Escuté N, Cerralbo P, Grassi S, Oliva A, Toro R, Brugada J, Brugada R, Campuzano O. Reevaluation of ambiguous genetic variants in sudden unexplained deaths of a young cohort. Int J Legal Med 2023; 137:345-351. [PMID: 36693943 PMCID: PMC9902310 DOI: 10.1007/s00414-023-02951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
Sudden death cases in the young population remain without a conclusive cause of decease in almost 40% of cases. In these situations, cardiac arrhythmia of genetic origin is suspected as the most plausible cause of death. Molecular autopsy may reveal a genetic defect in up to 20% of families. Most than 80% of rare variants remain classified with an ambiguous role, impeding a useful clinical translation. Our aim was to update rare variants originally classified as of unknown significance to clarify their role. Our cohort included fifty-one post-mortem samples of young cases who died suddenly and without a definite cause of death. Five years ago, molecular autopsy identified at least one rare genetic alteration classified then as ambiguous following the American College of Medical Genetics and Genomics' recommendations. We have reclassified the same rare variants including novel data. About 10% of ambiguous variants change to benign/likely benign mainly because of improved population frequencies. Excluding cases who died before one year of age, almost 21% of rare ambiguous variants change to benign/likely benign. This fact makes it important to discard these rare variants as a cause of sudden unexplained death, avoiding anxiety in relatives' carriers. Twenty-five percent of the remaining variants show a tendency to suspicious deleterious role, highlighting clinical follow-up of carriers. Periodical reclassification of rare variants originally classified as ambiguous is crucial, at least updating frequencies every 5 years. This action aids to increase accuracy to enable and conclude a cause of death as well as translation into the clinic.
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Affiliation(s)
- Estefanía Martinez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain ,Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Alexandra Perez-Serra
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Anna Fernandez-Falgueras
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Mireia Alcalde
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Mónica Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Marta Puigmulé
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Carles Ferrer-Costa
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Bernat del Olmo
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ferran Picó
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Laura Lopez
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Victoria Fiol
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Clara Hernandez
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Elena Arbelo
- Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain ,Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Nuria Díez-Escuté
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Patricia Cerralbo
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy ,Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rocío Toro
- Medicine Department, School of Medicine, 11003 Cadiz, Spain
| | - Josep Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain ,Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Ramon Brugada
- Medical Science Department, School of Medicine, University of Girona, 17003, Girona, Spain. .,Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190, Girona, Spain. .,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain. .,Cardiology Service, Hospital Josep Trueta, University of Girona, 17007, Girona, Spain.
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, University of Girona, 17003, Girona, Spain. .,Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190, Girona, Spain. .,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain.
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7
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Di Resta C, Berg J, Villatore A, Maia M, Pili G, Fioravanti F, Tomaiuolo R, Sala S, Benedetti S, Peretto G. Concealed Substrates in Brugada Syndrome: Isolated Channelopathy or Associated Cardiomyopathy? Genes (Basel) 2022; 13:1755. [PMID: 36292641 PMCID: PMC9602309 DOI: 10.3390/genes13101755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 09/07/2024] Open
Abstract
Brugada syndrome (BrS) is an inherited autosomal dominant genetic disorder responsible for sudden cardiac death from malignant ventricular arrhythmia. The term "channelopathy" is nowadays used to classify BrS as a purely electrical disease, mainly occurring secondarily to loss-of-function mutations in the α subunit of the cardiac sodium channel protein Nav1.5. In this setting, arrhythmic manifestations of the disease have been reported in the absence of any apparent structural heart disease or cardiomyopathy. Over the last few years, however, a consistent amount of evidence has grown in support of myocardial structural and functional abnormalities in patients with BrS. In detail, abnormal ventricular dimensions, either systolic or diastolic dysfunctions, regional wall motion abnormalities, myocardial fibrosis, and active inflammatory foci have been frequently described, pointing to alternative mechanisms of arrhythmogenesis which challenge the definition of channelopathy. The present review aims to depict the status of the art of concealed arrhythmogenic substrates in BrS, often resulting from an advanced and multimodal diagnostic workup, to foster future preclinical and clinical research in support of the cardiomyopathic nature of the disease.
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Affiliation(s)
- Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Jan Berg
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Villatore
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Marianna Maia
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gianluca Pili
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesco Fioravanti
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rossella Tomaiuolo
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sara Benedetti
- UOC Screening Neonatale e Malattie Metaboliche, ASST Fatebenefratelli Sacco Ospedale dei Bambini “Vittore Buzzi”, 20157 Milan, Italy
| | - Giovanni Peretto
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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8
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Tirandi A, Carbone F, Montecucco F, Liberale L. The role of metabolic syndrome in sudden cardiac death risk: Recent evidence and future directions. Eur J Clin Invest 2022; 52:e13693. [PMID: 34714544 PMCID: PMC9286662 DOI: 10.1111/eci.13693] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
Metabolic syndrome (MetS) is a frequent condition whose deleterious effects on the cardiovascular system are often underestimated. MetS is nowadays considered a real pandemic with an estimated prevalence of 25% in general population. Individuals with MetS are at high risk of sudden cardiac death (SCD) as this condition accounts for 50% of all cardiac deaths in such a population. Of interest, recent studies demonstrated that individuals with MetS show 70% increased risk of SCD even without previous history of coronary heart disease (CHD). However, little is known about the interplay between the two conditions. MetS is a complex disease determined by genetic predisposition, unhealthy lifestyle and ageing with deleterious effects on different organs. MetS components trigger a systemic chronic low-grade pro-inflammatory state, associated with excess of sympathetic activity, cardiac hypertrophy, arrhythmias and atherosclerosis. Thus, MetS has an important burden on the cardiovascular system as demonstrated by both preclinical and clinical evidence. The aim of this review is to summarize recent evidence concerning the association between MetS and SCD, showing possible common aetiological processes, and to indicate prospective for future studies and therapeutic targets.
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Affiliation(s)
- Amedeo Tirandi
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
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9
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Brunetti G, Cipriani A, Perazzolo Marra M, De Lazzari M, Bauce B, Calore C, Rigato I, Graziano F, Vio R, Corrado D, Zorzi A. Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats. J Clin Med 2022; 11:426. [PMID: 35054118 PMCID: PMC8781801 DOI: 10.3390/jcm11020426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/18/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (G.B.); (A.C.); (M.P.M.); (M.D.L.); (B.B.); (C.C.); (I.R.); (F.G.); (R.V.); (A.Z.)
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10
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Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Yan F, Chen Y, Ye X, Zhang F, Wang S, Zhang L, Luo X. miR-3113-5p, miR-223-3p, miR-133a-3p, and miR-499a-5p are sensitive biomarkers to diagnose sudden cardiac death. Diagn Pathol 2021; 16:67. [PMID: 34332589 PMCID: PMC8325858 DOI: 10.1186/s13000-021-01127-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/12/2021] [Indexed: 01/30/2023] Open
Abstract
Background Sudden cardiac death (SCD) remains a great health threat and diagnostic challenge, especially those cases without positive autopsy findings. Molecular biomarkers have been urgently needed for the diagnosis of SCD displaying negative autopsy results. Due to their nature of stability, microRNAs (miRNAs) have emerged as promising diagnostic biomarkers for cardiovascular diseases. Methods This study investigated whether specific cardio-miRNAs (miR-3113-5p, miR-223-3p, miR-499a-5p, and miR-133a-3p) could serve as potential biomarkers for the diagnosis of SCD. Thirty-four SCD cases were selected, 18 categorized as SCD with negative autopsy (SCD-negative autopsy) findings and 16 as SCD with positive autopsy (SCD-positive autopsy) findings such as coronary atherosclerosis and gross myocardial scar. Carbon monoxide (CO) intoxication (n = 14) and fatal injury death (n = 14) that displayed no pathological changes of myocardium were selected as control group, respectively. Histological analyses were performed to reveal the pathological changes and real-time quantitative polymerase chain reaction (RT-qPCR) was used to determine the expression of those miRNAs. Results It showed that heart samples from the SCD-negative autopsy group displayed no remarkable difference with regard to the expression of cleaved-caspase3, CD31, and CD68 and the extent of fibrotic tissue accumulation when compared with control samples. The four cardio-miRNAs were significantly up-regulated in the SCD samples as compared with control. When discriminating SCD from controls, receiver operating characteristic (ROC) curve analysis revealed that the areas under the curve (AUC) of these 4 miRNAs were from 0.7839 to 0.9043 with sensitivity of 64.71–97.06% and specificity of 70–100%. Moreover, when discriminating the specific causes of SCD, the four miRNA expressions increased in the heart from the SCD-negative autopsy group as relative to that from the SCD-positive autopsy group, and a combination of two miRNAs presented higher diagnostic value (AUC = 0.7407–0.8667). Conclusion miR-3113-5p, miR-223-3p, miR-499a-5p, and miR-133a-3p may serve as independent diagnostic biomarkers for SCD, and a combination of two of these miRNAs could further discriminate detailed causes of SCD.
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Affiliation(s)
- Fengping Yan
- Department of Forensic Medicine, School of Basic Medical Sciences, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, PR China. .,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, People's Republic of China.
| | - Yuanyuan Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, PR China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, People's Republic of China
| | - Xing Ye
- Department of Forensic Medicine, School of Basic Medical Sciences, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, PR China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, People's Republic of China
| | - Fu Zhang
- Criminal Technology Center of Guangdong Province Public Security Bureau, Guangzhou, Guangdong, 510050, PR China
| | - Shiquan Wang
- Department of Forensic Medicine, School of Basic Medical Sciences, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, PR China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, People's Republic of China
| | - Le Zhang
- Forensic Science Center of Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, People's Republic of China
| | - Xiaoting Luo
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Gannan Medical University, 1 Yixueyuan Road, Zhanggong District, Ganzhou, Jiangxi, 341000, PR China.
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12
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Yu H, Guo Y, Yang Z, Zhang Q, Xu J, Yang Q, Qu Y, Tan R, Li L, He Y, Li C, Zhang S, Luo B, Gao Y. Regulatory variation within 3’UTR of STAT5A correlates with sudden cardiac death in Chinese populations. Forensic Sci Res 2021; 7:726-735. [PMID: 37101540 PMCID: PMC9976584 DOI: 10.1080/20961790.2021.1895410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Definitive diagnosis to sudden cardiac death (SCD) is often challenging since the postmortem examination on SCD victims could hardly demonstrate an adequate cause of death. It is therefore important to uncover the inherited risk component to SCD. Signal transducer and activators of transcription 5 A (STAT5A) is a member of the STAT family and a transcription factor that is activated by many cell ligands and associated with various cardiovascular processes. In this study, we performed a systematic variant screening on the STAT5A to filter potential functional genetic variations. Based on the screening results, an insertion/deletion polymorphism (rs3833144) in 3'UTR of STAT5A was selected as the candidate variant. A total of 159 SCD cases and 668 SCD matched healthy controls was enrolled to perform a case-control study and evaluate the association between rs3833144 and SCD susceptibility in Chinese populations. Logistic regression analysis showed that the deletion allele of rs3833144 had significantly increased the SCD risk (odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.18-2.01; P = 0.000955). Further genotype-expression eQTL analysis showed that samples with deletion allele appeared to lower expression of STAT5A, and in silico prediction suggested the local 3 D structure changes of STAT5A mRNA caused by the variant. On the other hand, the bioinformatic analysis presented that promoters of RARA and PTGES3L-AARSD1 could interact with rs3833144, and eQTL analysis showed the higher expression of both genes in samples with deletion allele. Dual-luciferase activity assays also suggested the significant regulatory role of rs3833144 in gene transcription. Our current data thus suggested a possible involvement of rs3833144 to SCD predisposition in Chinese populations and rs3833144 with potential function roles may become a candidate marker for SCD diagnosis and prevention.
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Affiliation(s)
- Huan Yu
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Yadong Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Zhenzhen Yang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Qing Zhang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Jiabin Xu
- Public Security Bureau of Taixing, Taizhou, China
| | - Qi Yang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Yiling Qu
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Rui Tan
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Lijuan Li
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Yan He
- Department of Epidemiology, Medical College of Soochow University, Suzhou, China
| | - Chengtao Li
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | - Suhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | - Bin Luo
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
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13
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Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel) 2021; 9:870. [PMID: 34356248 PMCID: PMC8307931 DOI: 10.3390/healthcare9070870] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Campus “S. Venuta”, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
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14
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. [Adult advanced life support]. Notf Rett Med 2021; 24:406-446. [PMID: 34121923 PMCID: PMC8185697 DOI: 10.1007/s10049-021-00893-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Advanced Life Support guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Köln, Köln, Deutschland
| | - Pierre Carli
- SAMU de Paris, Center Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, Frankreich
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
- Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Charles D. Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, Großbritannien
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Großbritannien
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Schweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Schweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italien
| | - Gavin D. Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, Großbritannien
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rom, Italien
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rom, Italien
| | - Jerry P. Nolan
- Warwick Medical School, Coventry, Großbritannien, Consultant in Anaesthesia and Intensive Care Medicine Royal United Hospital, University of Warwick, Bath, Großbritannien
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15
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161:115-151. [PMID: 33773825 DOI: 10.1016/j.resuscitation.2021.02.010] [Citation(s) in RCA: 487] [Impact Index Per Article: 162.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry,UK
| | - Charles D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne,UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet,Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
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16
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Differential Methylation in the GSTT1 Regulatory Region in Sudden Unexplained Death and Sudden Unexpected Death in Epilepsy. Int J Mol Sci 2021; 22:ijms22062790. [PMID: 33801838 PMCID: PMC7999472 DOI: 10.3390/ijms22062790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Sudden cardiac death (SCD) is a diagnostic challenge in forensic medicine. In a relatively large proportion of the SCDs, the deaths remain unexplained after autopsy. This challenge is likely caused by unknown disease mechanisms. Changes in DNA methylation have been associated with several heart diseases, but the role of DNA methylation in SCD is unknown. In this study, we investigated DNA methylation in two SCD subtypes, sudden unexplained death (SUD) and sudden unexpected death in epilepsy (SUDEP). We assessed DNA methylation of more than 850,000 positions in cardiac tissue from nine SUD and 14 SUDEP cases using the Illumina Infinium MethylationEPIC BeadChip. In total, six differently methylated regions (DMRs) between the SUD and SUDEP cases were identified. The DMRs were located in proximity to or overlapping genes encoding proteins that are a part of the glutathione S-transferase (GST) superfamily. Whole genome sequencing (WGS) showed that the DNA methylation alterations were not caused by genetic changes, while whole transcriptome sequencing (WTS) showed that DNA methylation was associated with expression levels of the GSTT1 gene. In conclusion, our results indicate that cardiac DNA methylation is similar in SUD and SUDEP, but with regional differential methylation in proximity to GST genes.
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17
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Schulze-Bahr E, Dettmeyer RB, Klingel K, Kauferstein S, Wolf C, Baba HA, Bohle RM, Gebauer R, Milting H, Schmidt U, Meder B, Rieß O, Paul T, Bajanowski T, Schunkert H. Postmortale molekulargenetische Untersuchungen (molekulare Autopsie) bei kardiovaskulären und bei ungeklärten Todesfällen. KARDIOLOGE 2021. [DOI: 10.1007/s12181-020-00438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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18
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Fornès P, Callon D. [Autopsies are essential for a better knowledge and prevention of sudden cardiac death]. Ann Pathol 2021; 41:85-96. [PMID: 33413973 DOI: 10.1016/j.annpat.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
In France, the incidence of sudden cardiac deaths (SCD) is approximately 30,000-50,000 per year. In the whole population, their cause is an atherosclerotic coronary disease in more than 80 % of cases, but in the young (<35 years old), causes are various, including genetic, infectious, toxic, congenital anomalies, immune…Therefore a multidisciplinary approach is required for a better knowledge and prevention of SCD. In this article, we examine different aspects of autopsies and complementary investigations: histopathology, toxicology, biochemistry, genetics and virology. Six cases illustrate the importance of a multidisciplinary approach. There are two categories of autopsies: medicolegal or medical. Medicolegal autopsies are requested by a judicial authority when a death is considered suspicious. These autopsies are performed by forensic doctors. Most of them are not pathologists. During the autopsies, blood and tissue samples are taken, but analyses are done only at the request of the judicial authority if the analyses are useful for the truth. Consequently, the cause of death can remain uncertain. Medical autopsies are performed by a pathologist at the request of a clinician. The family consent is required. Useful analyses are performed, which is essential for the determination of a precise cause of death. In the young, "molecular autopsy", in addition to histology and other analyses, is essential in preventing genetic causes of SCD.
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Affiliation(s)
- Paul Fornès
- Laboratoire de biopathologie, hôpital Robert-Debré, institut-médico-légal, CHU, avenue du Général-Koenig, 51100 Reims, France.
| | - Domitille Callon
- Laboratoire de biopathologie, hôpital Robert-Debré, institut-médico-légal, CHU, avenue du Général-Koenig, 51100 Reims, France
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19
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Autopsy examination in sudden cardiac death: a current perspective on behalf of the Association for European Cardiovascular Pathology. Virchows Arch 2020; 478:687-693. [PMID: 33111163 PMCID: PMC7990811 DOI: 10.1007/s00428-020-02949-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 01/19/2023]
Abstract
In sudden cardiac death, an autopsy is an essential step in establishing a diagnosis of inherited cardiac disease and identifying families that require cardiac screening. To evaluate aspects of post-mortem practice in Europe, a questionnaire was designed and circulated to both clinical and forensic pathologists. There was a 48% response rate and information was obtained from 17 countries. The results showed a wide variety in the management of sudden cardiac death, with a general tendency towards a lack of thorough investigation. In up to 40% of cases, autopsies were not performed in subjects less than 50 years who may have died from cardiac disease. Reasons for this were lack of finance and lack of interest from police, legal authorities, and doctors. Only 50% of pathologists seem to follow a standard protocol for autopsy examination, apparently due to lack of expertise and/or training. When autopsies were performed, histology and toxicology were almost always taken, genetic studies were generally available and retention of the heart for specialist study was usually permitted. Our results suggest that although the standard of practice is appropriate in many centres, many more cases should have autopsies, especially in sudden deaths in subjects less than 50 years.
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20
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Jaouadi H, Bouyacoub Y, Chabrak S, Kraoua L, Zaroui A, Elouej S, Nagara M, Dallali H, Delague V, Levy N, Benkhalifa R, Mechmeche R, Zaffran S, Abdelhak S. Multiallelic rare variants support an oligogenic origin of sudden cardiac death in the young. Herz 2020; 46:94-102. [PMID: 31970460 DOI: 10.1007/s00059-019-04883-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/20/2019] [Accepted: 12/06/2019] [Indexed: 12/16/2022]
Abstract
Unexplained sudden death in the young is cardiovascular in most cases. Structural and conduction defects in cardiac-related genes can conspire to underlie sudden cardiac death. Here we report a clinical investigation and an extensive genetic assessment of a Tunisian family with sudden cardiac death in young members. In order to identify the family-genetic basis of sudden cardiac death, we performed Whole Exome Sequencing (WES), read depth copy-number-variation (CNV) screening and segregation analysis. We identify 6 ultra-rare pathogenic heterozygous variants in OBSCN, RYR2, DSC2, AKAP9, CACNA1C and RBM20 genes, and one homozygous splicing variant in TECRL gene consistent with an oligogenic model of inheritance. CNV analysis did not reveal any causative CNV consistent with the family phenotype. Overall, our results are highly suggestive for a cumulative effect of heterozygous missense variants as disease causation and to account for a greater disease severity among offspring. Our study further confirms the complexity of the inheritance of sudden cardiac death and highlights the utility of family-based WES and segregation analysis in the identification of family specific mutations within different cardiac genes pathways.
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Affiliation(s)
- Hager Jaouadi
- Biomedical Genomics and Oncogenetics Laboratory LR16IPT05, Institut Pasteur de Tunis, Université Tunis El Manar, 13 Place Pasteur, BP74-1002, Tunis, belvédère, Tunisia.
| | - Yosra Bouyacoub
- Biomedical Genomics and Oncogenetics Laboratory LR16IPT05, Institut Pasteur de Tunis, Université Tunis El Manar, 13 Place Pasteur, BP74-1002, Tunis, belvédère, Tunisia
| | - Sonia Chabrak
- Department of Cardiology, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Lilia Kraoua
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
| | - Amira Zaroui
- Faculty of Medicine of Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Sahar Elouej
- Aix Marseille University, INSERM, U1251, Marseille Medical Genetics, Marseille, France
| | - Majdi Nagara
- Biomedical Genomics and Oncogenetics Laboratory LR16IPT05, Institut Pasteur de Tunis, Université Tunis El Manar, 13 Place Pasteur, BP74-1002, Tunis, belvédère, Tunisia
| | - Hamza Dallali
- Biomedical Genomics and Oncogenetics Laboratory LR16IPT05, Institut Pasteur de Tunis, Université Tunis El Manar, 13 Place Pasteur, BP74-1002, Tunis, belvédère, Tunisia
| | - Valérie Delague
- Aix Marseille University, INSERM, U1251, Marseille Medical Genetics, Marseille, France
| | - Nicolas Levy
- Aix Marseille University, INSERM, U1251, Marseille Medical Genetics, Marseille, France
| | - Rym Benkhalifa
- Venoms and Therapeutic Biomolecules Laboratory LR16IPT08, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Rachid Mechmeche
- Department of Cardiology, La Rabta Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Stéphane Zaffran
- Aix Marseille University, INSERM, U1251, Marseille Medical Genetics, Marseille, France
| | - Sonia Abdelhak
- Biomedical Genomics and Oncogenetics Laboratory LR16IPT05, Institut Pasteur de Tunis, Université Tunis El Manar, 13 Place Pasteur, BP74-1002, Tunis, belvédère, Tunisia
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21
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Graziosi M, Leone O, Foà A, Agostini V, Ditaranto R, Foroni M, Rossi C, Lovato L, Seri M, Rapezzi C. Postmortem diagnosis of left dominant arrhythmogenic cardiomyopathy: the importance of a multidisciplinary network for sudden death victims. “HIC mors gaudet succurere vitae”. Cardiovasc Pathol 2020; 44:107157. [DOI: 10.1016/j.carpath.2019.107157] [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: 07/22/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
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22
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Herath J, Liu O. Sudden Natural Deaths in Ontario, Canada: A Retrospective Autopsy Analysis (2012–2016). JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2020. [DOI: 10.4103/jfsm.jfsm_50_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Pinchi E, Frati P, Aromatario M, Cipolloni L, Fabbri M, La Russa R, Maiese A, Neri M, Santurro A, Scopetti M, Viola RV, Turillazzi E, Fineschi V. miR-1, miR-499 and miR-208 are sensitive markers to diagnose sudden death due to early acute myocardial infarction. J Cell Mol Med 2019; 23:6005-6016. [PMID: 31240830 PMCID: PMC6714215 DOI: 10.1111/jcmm.14463] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022] Open
Abstract
MicroRNAs (miRNAs) are strongly up-regulated under pathological stress and in a wide range of diseases. In recent years, miRNAs are under investigation for their potential use as biomarkers in cardiovascular diseases. We investigate whether specific cardio-miRNAs are overexpressed in heart samples from subjects deceased for acute myocardial infarction (AMI) or sudden cardiac death (SCD), and whether miRNA could help differentiate between them. Forty four cases of death due to cardiovascular disease were selected, respectively, 19 cases categorized as AMI and 25 as SCD. Eighteen cases of traumatic death without pathological cardiac involvement were selected as control. Immunohistochemical investigation was performed for CD15, IL-15, Cx43, MCP-1, tryptase, troponin C and troponin I. Reverse transcription and quantitative real-time PCR were performed for miR-1, miR-133, miR-208 and miR-499. In AMI group, stronger immunoreaction for the CD15, IL-15 and MCP-1 antibodies was detectable compared with SCD and control. Cx43 showed a negative reaction with respect to the other groups. Real-time PCR results showed a down-regulation of all miRNAs in the AMI group compared with SCD and control. The selected miRNAs presented high accuracy in discriminating SCD from AMI (miR-1 and miR-499) and AMI from control (miR-208) representing a potential aid for both clinicians and pathologists for differential diagnosis.
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Affiliation(s)
- Enrica Pinchi
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
- IRCSS Neuromed Mediterranean Neurological InstitutePozzilliItaly
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Matteo Fabbri
- Department of Morphology, Experimental Medicine and SurgeryUniversity of FerraraFerraraItaly
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
- IRCSS Neuromed Mediterranean Neurological InstitutePozzilliItaly
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Margherita Neri
- Department of Morphology, Experimental Medicine and SurgeryUniversity of FerraraFerraraItaly
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of PisaPisaItaly
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic SciencesSapienza University of RomeRomeItaly
- IRCSS Neuromed Mediterranean Neurological InstitutePozzilliItaly
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Hata Y, Hirono K, Yamaguchi Y, Ichida F, Oku Y, Nishida N. Minimal inflammatory foci of unknown etiology may be a tentative sign of early stage inherited cardiomyopathy. Mod Pathol 2019; 32:1281-1290. [PMID: 31024045 DOI: 10.1038/s41379-019-0274-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 01/18/2023]
Abstract
Although relatively uncommon, pathologists may encounter minimal inflammatory foci in the absence of typical structural heart disease; however, the clinicopathological significance of minimal inflammatory foci, including correlation with sudden unexpected death, is unexplored. From 1072 serial autopsy subjects, cases with unexplained minimal inflammatory foci, the extent of which was under 1% of the whole examined ventricle, were extracted to exclude cases with borderline/focal myocarditis resulting from local, systemic infection, or autoimmune mechanisms. Immunohistochemistry and genetic analysis targeting viral genomes and heart disease-related genes using next generation sequencing were performed. We detected 10 cases with unexplained minimal inflammatory foci (five males, five females, aged 15-68 years). The cause and/or manner of death were sudden unexpected death (6 cases, 60%), sudden unexpected death with epilepsy (1 case, 10%), drowning in a hot bath (1 case, 10%), and suicide (2 cases, 20%). In none of these cases was pathogen-derived DNA or RNA detected. In 8 of the 10 cases (80%), 17 possible pathogenic genetic variants causative for arrhythmogenic right ventricular cardiomyopathy or dilated cardiomyopathy; DSP was the most frequently involved gene (three cases with two different variants), followed by LAMA4 and MYBPC3 (two cases, two variants for each gene), LDB3 (two cases, one variant), and the remaining 10 variants occurred in seven cases (DSC2, RYR2, SOS1, SCN5A, SGCD, LPL, PKP2, MYH11, GATA6, and DSG2). All mutations were missense mutations. DSP_Lys1581Glu and DSC2_p.Thr275Met were classified according to American College of Medical Genetics and Genomics consensus statement guidelines as pathogenic or likely pathogenic for arrhythmogenic cardiomyopathy in three patients (30%). The remaining 15 variants were classified as potentially pathogenic variants. Unexplained minimal inflammatory foci may be an early sign of inherited cardiomyopathy, and such cases might already have arrhythmogenic potential that can lead to sudden unexpected death. Detection of minimal inflammatory foci by careful pathological examination may indicate the value of conducting comprehensive genetic analysis, even if significant structural abnormalities are not evident.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yoshiaki Yamaguchi
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yuko Oku
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
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25
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Rizzo S, Carturan E, De Gaspari M, Pilichou K, Thiene G, Basso C. Update on cardiomyopathies and sudden cardiac death. Forensic Sci Res 2019; 4:202-210. [PMID: 31489386 PMCID: PMC6713087 DOI: 10.1080/20961790.2019.1631957] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) remains a leading mode of death in western countries. Since SCD can be the first and last clinical presentation of the underlying disease, autopsy could be the only medical examination available for early diagnosis and it should be performed according to the guidelines of the Association for European Cardiovascular Pathology. Although the vast majority of SCD are due to coronary artery disease, non-ischemic causes of SCD do exist and are prevalent in young people with structural (i.e. arrhythmogenic, hypertrophic and inflammatory cardiomyopathy) and non-structural (ion channel diseases) cardiomyopathies, accounting for up to one half of cases. A standardized autopsy protocol, in combination with blood sampling to ensure feasibility of postmortem molecular testing if needed, is mandatory. The pathologist is called to provide the correct diagnosis and to advice the relatives on the need of a cascade clinical and genetic screening in the presence of a heredo-familial disease.
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Affiliation(s)
- Stefania Rizzo
- Cardiovascular Pathology, Department of Cardio-Thoracic-Vascular Sciences & Public Health and Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
| | - Elisa Carturan
- Cardiovascular Pathology, Department of Cardio-Thoracic-Vascular Sciences & Public Health and Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology, Department of Cardio-Thoracic-Vascular Sciences & Public Health and Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
| | - Kalliopi Pilichou
- Cardiovascular Pathology, Department of Cardio-Thoracic-Vascular Sciences & Public Health and Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardio-Thoracic-Vascular Sciences & Public Health and Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardio-Thoracic-Vascular Sciences & Public Health and Azienda Ospedaliera, University of Padua Medical School, Padua, Italy
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26
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Affiliation(s)
- Joaquín S Lucena
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Seville, Spain
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27
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery. Cardiol J 2019; 26:777-781. [PMID: 30701514 DOI: 10.5603/cj.a2019.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/12/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of sudden cardiac arrest (SCA) in patients undergoing valve surgery is currently unknown. METHODS A prospective study was conducted on a group of 815 consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary end-point was postoperative SCA. RESULTS The postoperative SCA occurred in 26 patients. At multivariate analysis of hs-TnT measured immediately after surgery (hs-TnT I) and age remained independent predictors of the primary end-point. CONCLUSIONS Elevated postoperative hs-TnT was associated with a higher risk of postoperative SCA.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland.
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
| | - Piotr Szymański
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
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28
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Abstract
Genetic testing has an increasingly important role in the diagnosis and management of cardiac disorders, where it confirms the diagnosis, aids prognostication and risk stratification and guides treatment. A genetic diagnosis in the proband also enables clarification of the risk for family members by cascade testing. Genetics in cardiac disorders is complex where epigenetic and environmental factors might come into interplay. Incomplete penetrance and variable expressivity is also common. Genetic results in cardiac conditions are mostly probabilistic and should be interpreted with all available clinical information. With this complexity in cardiac genetics, testing is only indicated in patients with a strong suspicion of an inheritable cardiac disorder after a full clinical evaluation. In this review we discuss the genetics underlying the major cardiomyopathies and channelopathies, and the practical aspects of diagnosing these conditions in the laboratory.
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29
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Functional significance of channelopathy gene variants in unexplained death. Forensic Sci Med Pathol 2018; 15:437-444. [DOI: 10.1007/s12024-018-0063-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
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30
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Kotta MC, Sala L, Ghidoni A, Badone B, Ronchi C, Parati G, Zaza A, Crotti L. Calmodulinopathy: A Novel, Life-Threatening Clinical Entity Affecting the Young. Front Cardiovasc Med 2018; 5:175. [PMID: 30574507 PMCID: PMC6291462 DOI: 10.3389/fcvm.2018.00175] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/22/2018] [Indexed: 01/31/2023] Open
Abstract
Sudden cardiac death (SCD) in the young may often be the first manifestation of a genetic arrythmogenic disease that had remained undiagnosed. Despite the significant discoveries of the genetic bases of inherited arrhythmia syndromes, there remains a measurable fraction of cases where in-depth clinical and genetic investigations fail to identify the underlying SCD etiology. A few years ago, 2 cases of infants with recurrent cardiac arrest episodes, due to what appeared to be as a severe form of long QT syndrome (LQTS), came to our attention. These prompted a number of clinical and genetic research investigations that allowed us to identify a novel, closely associated to LQTS but nevertheless distinct, clinical entity that is now known as calmodulinopathy. Calmodulinopathy is a life-threatening arrhythmia syndrome, affecting mostly young individuals, caused by mutations in any of the 3 genes encoding calmodulin (CaM). Calmodulin is a ubiquitously expressed Ca2+ signaling protein that, in the heart, modulates several ion channels and participates in a plethora of cellular processes. We will hereby provide an overview of CaM's structure and function under normal and disease states, highlighting the genetic etiology of calmodulinopathy and the related disease mechanisms. We will also discuss the phenotypic spectrum of patients with calmodulinopathy and present state-of-the art approaches with patient-derived induced pluripotent stem cells that have been thus far adopted in order to accurately model calmodulinopathy in vitro, decipher disease mechanisms and identify novel therapies.
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Affiliation(s)
- Maria-Christina Kotta
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Luca Sala
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Alice Ghidoni
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Beatrice Badone
- Department of Biotechnology and Bioscience, University of Milano-Bicocca, Milan, Italy
| | - Carlotta Ronchi
- Department of Biotechnology and Bioscience, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Antonio Zaza
- Department of Biotechnology and Bioscience, University of Milano-Bicocca, Milan, Italy
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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31
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Willson C. The clinical toxicology of caffeine: A review and case study. Toxicol Rep 2018; 5:1140-1152. [PMID: 30505695 PMCID: PMC6247400 DOI: 10.1016/j.toxrep.2018.11.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 10/09/2018] [Accepted: 11/01/2018] [Indexed: 02/08/2023] Open
Abstract
Caffeine is a widely recognized psychostimulant compound with a long history of consumption by humans. While it has received a significant amount of attention there is still much to be learned with respect to its toxicology in humans, especially in cases of overdose. A review of the history of consumption and the clinical toxicology of caffeine including clinical features, pharmacokinetics, toxicokinetics, a thorough examination of mechanism of action and management/treatment strategies are undertaken. While higher (i.e., several grams) quantities of caffeine are known to cause toxicity and potentially lethality, cases of mainly younger individuals who have experienced severe side effects and death despite consuming doses not otherwise known to cause such harm is troubling and deserves further study. An attempted case reconstruction is performed in an effort to shed light on this issue with a focus on the pharmacokinetics and pharmacodynamics of caffeine.
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32
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Wu J, Wu Q, Dai W, Kong J, Lv J, Yu X, Wang X, Wang D. Serum lipid feature and potential biomarkers of lethal ventricular tachyarrhythmia (LVTA) induced by myocardial ion channel diseases: a rat model study. Int J Legal Med 2018; 132:439-448. [PMID: 29063180 DOI: 10.1007/s00414-017-1710-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/11/2017] [Indexed: 02/05/2023]
Abstract
To determine the cause of death in myocardial ion channel diseases (MICD)-induced sudden cardiac death (SCD) cases is a difficulty in forensic identification practices. The majority of MICD-induced SCD cases would experience lethal ventricular tachyarrhythmia (LVTA) before deaths; thus, confirming the occurrence of LVTA in bodies can offer a key evidence to identify these cases. Several lipids in the myocardia were found disturbed after LVTA; yet, whether serum lipidome would be disrupted by LVTA is not clear. Therefore, we aimed to screen lipid feature and related diagnostic markers of LVTA in serum here. An aconitine-induced LVTA-SCD rat model was produced. Blood samples before LVTA and immediately after LVTA were retrieved and related serum specimens were used for ultra-performance liquid chromatography-mass spectrometry (UPLC-MS)-based lipidomics analyses. On the basis of the defined differential lipids, a lipid-related metabolic pathway network was constructed and potential biomarkers were screened. Twelve aconitine-induced LVTA rats were produced. Totally, 188 lipids in serum were disrupted during the LVTA-SCD process, which belong to 11 lipid classes. Most of the differential lipids were correlated, suggesting that they were interacted and that the changes were holistic during LVTA process. Ten lipid pathways were activated during LVTA process; the main lipid classes involved in these pathways were ceramide, sphingomyelin, phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine. Phosphatidylcholine O-40:4, sphingomyelin d46:5, and phosphatidylethanolamine 40:4 were tested as potential diagnostic markers of LVTA-SCD event in serum. The current results indicate a substantial change in serum lipidome after LVTA-SCD; lipidomics holds promise to identify MICD-induced SCDs in forensic practices.
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Affiliation(s)
- Jiayan Wu
- Department of Forensic Medicine, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Qian Wu
- Shanghai Center for Bioinformation Technology, Shanghai, 201203, China
| | - WenTao Dai
- Shanghai Center for Bioinformation Technology, Shanghai, 201203, China
| | - Jing Kong
- Department of Forensic Medicine, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Junyao Lv
- Department of Forensic Medicine, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Xiaojun Yu
- Department of Forensic Medicine, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Xingxing Wang
- 2nd Affiliated Hospital, Shantou University Medical College, Shantou, 515041, China
| | - Dian Wang
- Department of Forensic Medicine, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China.
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34
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Basso C, Aguilera B, Banner J, Cohle S, d'Amati G, de Gouveia RH, di Gioia C, Fabre A, Gallagher PJ, Leone O, Lucena J, Mitrofanova L, Molina P, Parsons S, Rizzo S, Sheppard MN, Mier MPS, Kim Suvarna S, Thiene G, van der Wal A, Vink A, Michaud K. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Arch 2017; 471:691-705. [PMID: 28889247 PMCID: PMC5711979 DOI: 10.1007/s00428-017-2221-0] [Citation(s) in RCA: 310] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 02/07/2023]
Abstract
Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented.
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Affiliation(s)
- Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Beatriz Aguilera
- Histopathology Service, National Institute of Toxicology and Forensic Sciences, Madrid, Spain
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Cohle
- Department of Pathology and Laboratory Medicine, Grand Rapids, MI, USA
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Rosa Henriques de Gouveia
- Department of Pathology, Hospital de Santa Cruz (CHLO), Lisbon & Forensic Pathology, INMLCF & FMUC, Coimbra, Portugal
| | - Cira di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Aurelie Fabre
- Department of Histopathology, St Vincent's University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | | | - Ornella Leone
- Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Joaquin Lucena
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Seville, Spain
| | - Lubov Mitrofanova
- Department of Pathology, Federal Almazov North-West Medical Research Centre, St. Petersburg, Russian Federation
| | - Pilar Molina
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Valencia, Spain
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine and Monash University, Victoria, Australia
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Mary N Sheppard
- Department of Cardiovascular Pathology, St Georges Medical School, London, UK
| | - Maria Paz Suárez Mier
- Histopathology Service, National Institute of Toxicology and Forensic Sciences, Madrid, Spain
| | | | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Allard van der Wal
- Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Katarzyna Michaud
- University Hospital of Lausanne, University Center of Legal Medicine, Lausanne and Geneva, Chemin de la Vulliette 4, 25, 1000, Lausanne, Switzerland.
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Magi S, Lariccia V, Maiolino M, Amoroso S, Gratteri S. Sudden cardiac death: focus on the genetics of channelopathies and cardiomyopathies. J Biomed Sci 2017; 24:56. [PMID: 28810874 PMCID: PMC5556354 DOI: 10.1186/s12929-017-0364-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/09/2017] [Indexed: 01/22/2023] Open
Abstract
Sudden cardiac death (SCD) describes a natural and unexpected death from cardiac causes occurring within a short period of time (generally within 1 h of symptom onset) in the absence of any other potentially lethal condition. Most SCD-related diseases have a genetic basis; in particular congenital cardiac channelopathies and cardiomyopathies have been described as leading causes of SCD. Congenital cardiac channelopathies are primary electric disorders caused by mutations affecting genes encoding cardiac ion channels or associated proteins, whereas cardiomyopathies are related to mutations in genes encoding several categories of proteins, including those of sarcomeres, desmosomes, the cytoskeleton, and the nuclear envelope. The purpose of this review is to provide a general overview of the main genetic variants that have been linked to the major congenital cardiac channelopathies and cardiomyopathies. Functional alterations of the related proteins are also described.
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Affiliation(s)
- Simona Magi
- Department of Biomedical Sciences and Public Health, School of Medicine, University "Politecnica delle Marche", Via Tronto 10/A, 60126, Ancona, Italy.
| | - Vincenzo Lariccia
- Department of Biomedical Sciences and Public Health, School of Medicine, University "Politecnica delle Marche", Via Tronto 10/A, 60126, Ancona, Italy
| | - Marta Maiolino
- Department of Biomedical Sciences and Public Health, School of Medicine, University "Politecnica delle Marche", Via Tronto 10/A, 60126, Ancona, Italy
| | - Salvatore Amoroso
- Department of Biomedical Sciences and Public Health, School of Medicine, University "Politecnica delle Marche", Via Tronto 10/A, 60126, Ancona, Italy
| | - Santo Gratteri
- Department of Health Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
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36
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Radnic B, Radojevic N, Vucinic J, Duborija-Kovacevic N. The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths? Cardiol Young 2017; 27:929-935. [PMID: 27821197 PMCID: PMC5422132 DOI: 10.1017/s1047951116001864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.
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Affiliation(s)
- Bojana Radnic
- 1Institute of Forensic Medicine "Milovan Milovanovic",School of Medicine,University of Belgrade,Belgrade,Serbia
| | - Nemanja Radojevic
- 2Department of Forensic Medicine,Clinical Centre of Montenegro,Podgorica,Montenegro
| | - Jelena Vucinic
- 3Department of Pathology,Centre for Pathology and Forensic Medicine,Clinical Centre of Montenegro,Podgorica,Montenegro
| | - Natasa Duborija-Kovacevic
- 4Department of Pharmacology and Clinical Pharmacology,School of Medicine, University of Montenegro,Podgorica,Montenegro
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Zorzi A, Perazzolo Marra M, Rigato I, De Lazzari M, Susana A, Niero A, Pilichou K, Migliore F, Rizzo S, Giorgi B, De Conti G, Sarto P, Serratosa L, Patrizi G, De Maria E, Pelliccia A, Basso C, Schiavon M, Bauce B, Iliceto S, Thiene G, Corrado D. Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004229. [PMID: 27390211 PMCID: PMC4956679 DOI: 10.1161/circep.116.004229] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/23/2016] [Indexed: 12/12/2022]
Abstract
Background— The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. Methods and Results— We compared 35 athletes (80% men, age: 14–48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. Conclusions— Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography.
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Affiliation(s)
- Alessandro Zorzi
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Martina Perazzolo Marra
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Ilaria Rigato
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Manuel De Lazzari
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Angela Susana
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Alice Niero
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Kalliopi Pilichou
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Federico Migliore
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Stefania Rizzo
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Benedetta Giorgi
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Giorgio De Conti
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Patrizio Sarto
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Luis Serratosa
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Giampiero Patrizi
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Elia De Maria
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Antonio Pelliccia
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Cristina Basso
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Maurizio Schiavon
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Barbara Bauce
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Sabino Iliceto
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Gaetano Thiene
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.)
| | - Domenico Corrado
- From the Department of Cardiac, Thoracic, and Vascular Sciences (A.Z., M.P.M., I.R., M.D.L., A.S., A.N., K.P., F.M., S.R., C.B., B.B., S.I., G.T., D.C.) and Division of Radiology, Department of Medicine (B.G.), University of Padova, Padova, Italy; Department of Radiology, Azienda Ospedaliera di Padova, Padova, Italy (G.D.C.); Center for Sports Medicine, Treviso, Italy (P.S.); Unidad de Cardiologica del Deporte, Hospital Universitario Quiron, Madrid, Spain (L.S.); U.O. Cardiologia, Ospedale B.Ramazzini, Carpi (MO), Italy (G.P., E.D.M.); Center for Sports Medicine, CONI, Rome, Italy (A.P.); and Center for Sports Medicine, Padova, Italy (M.S.).
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Basso C, Rizzo S, Thiene G. Key role of the post-mortem in sudden cardiac death. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gando I, Morganstein J, Jana K, McDonald TV, Tang Y, Coetzee WA. Infant sudden death: Mutations responsible for impaired Nav1.5 channel trafficking and function. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:703-712. [PMID: 28370132 DOI: 10.1111/pace.13087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Two genetic variants in SCN5A, encoding the Nav1.5 Na+ channel α-subunit, were found in a 5-month-old girl who died suddenly in her sleep. The first variant is a missense mutation, resulting in an amino acid change (Q1832E), which has been described (but not characterized) in a patient with Brugada syndrome. The second is a nonsense mutation that produces a premature stop codon and a C-terminal truncation (R1944Δ). METHODS AND RESULTS To investigate their functional relevance with patch clamp experiments in transfected HEK-293 cells. The Q1832E mutation drastically reduced Nav1.5 current density. The R1944Δ C-terminal truncation had negligible effects on Nav1.5 current density. Neither of the mutations affected the voltage dependence of steady activation and inactivation or influenced the late Na+ current or the recovery from inactivation. Biochemical and immunofluorescent approaches demonstrated that the Q1832E mutation caused severe trafficking defects. Polymerase chain reaction cloning and sequencing the victim's genomic DNA allowed us to determine that the two variants were in trans. We investigated the functional consequences by coexpressing Nav1.5(Q1832E) and Nav1.5(R1944Δ), which led to a significantly reduced current amplitude relative to wild-type. CONCLUSIONS These sudden infant death syndrome (SIDS)-related variants caused a severely dysfunctional Nav1.5 channel, which was mainly due to trafficking defects caused by the Q1832E mutation. The decreased current density is likely to be a major contributing factor to arrhythmogenesis in Brugada syndrome and the sudden death of this SIDS victim.
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Affiliation(s)
- Ivan Gando
- Pediatrics, NYU School of Medicine, New York, NY
| | | | - Kundan Jana
- Pediatrics, NYU School of Medicine, New York, NY
| | - Thomas V McDonald
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Yingying Tang
- Molecular Genetics Laboratory, Office of Chief Medical Examiner, New York, NY
| | - William A Coetzee
- Pediatrics, NYU School of Medicine, New York, NY.,Physiology & Neuroscience, NYU School of Medicine, New York, NY.,Biochemistry and Molecular Pharmacology, NYU School of Medicine, New York, NY
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Abstract
Competitive sports activity is associated with an increased risk of sudden cardiovascular death (SCD) in adolescents and young adults with clinically silent cardiovascular disorders. While in middle-aged/senior athletes atherosclerotic coronary artery disease accounts for the vast majority of SCDs, in young athletes the spectrum of substrates is wider and includes inherited (cardiomyopathies) and congenital (anomalous origin of coronary arteries) structural heart diseases. Inherited ion channel diseases have been implicated in SCDs occurring with an apparently normal heart at autopsy. Screening including the ECG allows identification of athletes affected by heart muscle diseases at a pre-symptomatic stage and may lead to reduction of the risk of SCD during sports. The use of modern criteria for interpretation of the ECG in the athlete offers the potential to improve the screening accuracy by reducing the number of false positives. Screening with exercise testing middle aged/senior athletes engaged in leisure sports activity is likely to be effective in patients with significant coronary risk factors, while it is not useful in low-risk subgroups. The availability of automated external defibrillator on the athletic field provides a "back-up" preventive strategy for unpredictable arrhythmic cardiac arrest, mostly occurring in patients with coronary artery diseases.
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Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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Fernández-Falgueras A, Sarquella-Brugada G, Brugada J, Brugada R, Campuzano O. Cardiac Channelopathies and Sudden Death: Recent Clinical and Genetic Advances. BIOLOGY 2017; 6:biology6010007. [PMID: 28146053 PMCID: PMC5372000 DOI: 10.3390/biology6010007] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 12/19/2022]
Abstract
Sudden cardiac death poses a unique challenge to clinicians because it may be the only symptom of an inherited heart condition. Indeed, inherited heart diseases can cause sudden cardiac death in older and younger individuals. Two groups of familial diseases are responsible for sudden cardiac death: cardiomyopathies (mainly hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy) and channelopathies (mainly long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). This review focuses on cardiac channelopathies, which are characterized by lethal arrhythmias in the structurally normal heart, incomplete penetrance, and variable expressivity. Arrhythmias in these diseases result from pathogenic variants in genes encoding cardiac ion channels or associated proteins. Due to a lack of gross structural changes in the heart, channelopathies are often considered as potential causes of death in otherwise unexplained forensic autopsies. The asymptomatic nature of channelopathies is cause for concern in family members who may be carrying genetic risk factors, making the identification of these genetic factors of significant clinical importance.
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Affiliation(s)
| | | | - Josep Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona 08950, Spain.
| | - Ramon Brugada
- Cardiovascular Genetics Center, IDIBGI, Girona 17190, Spain.
- Medical Sciences Department, School of Medicine, University of Girona, Girona 17071, Spain.
- Familial Cardiomyopathies Unit, Hospital Josep Trueta, Girona 17007, Spain.
| | - Oscar Campuzano
- Cardiovascular Genetics Center, IDIBGI, Girona 17190, Spain.
- Medical Sciences Department, School of Medicine, University of Girona, Girona 17071, Spain.
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Diab SS, Poppenga R, Uzal FA. Sudden death in racehorses: postmortem examination protocol. J Vet Diagn Invest 2017; 29:442-449. [DOI: 10.1177/1040638716687004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In racehorses, sudden death (SD) associated with exercise poses a serious risk to jockeys and adversely affects racehorse welfare and the public perception of horse racing. In a majority of cases of exercise-associated sudden death (EASD), there are no gross lesions to explain the cause of death, and an examination of the cardiovascular system and a toxicologic screen are warranted. Cases of EASD without gross lesions are often presumed to be sudden cardiac deaths (SCD). We describe an equine SD autopsy protocol, with emphasis on histologic examination of the heart (“cardiac histology protocol”) and a description of the toxicologic screen performed in racehorses in California. By consistently utilizing this standardized autopsy and cardiac histology protocol, the results and conclusions from postmortem examinations will be easier to compare within and across institutions over time. The generation of consistent, reliable, and comparable multi-institutional data is essential to improving the understanding of the cause(s) and pathogenesis of equine SD, including EASD and SCD.
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Affiliation(s)
- Santiago S. Diab
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Diab, Poppenga) and San Bernardino, CA (Uzal)
| | - Robert Poppenga
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Diab, Poppenga) and San Bernardino, CA (Uzal)
| | - Francisco A. Uzal
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Diab, Poppenga) and San Bernardino, CA (Uzal)
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Ottaviani G, Buja LM. Anatomopathological changes of the cardiac conduction system in sudden cardiac death, particularly in infants: advances over the last 25 years. Cardiovasc Pathol 2016; 25:489-499. [PMID: 27616614 DOI: 10.1016/j.carpath.2016.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/04/2016] [Accepted: 08/23/2016] [Indexed: 02/08/2023] Open
Abstract
Sudden cardiac death (SCD) is defined as the unexpected death without an obvious noncardiac cause that occurs within 1 h of witnessed symptom onset (established SCD) or within 24 h of unwitnessed symptom onset (probable SCD). In the United States, its incidence is 69/100,000 per year. Dysfunctions of the cardiac conduction and autonomic nervous systems are known to contribute to SCD pathogenesis, even if most clinicians and cardiovascular pathologists lack experience with detailed examination of the cardiac conduction system and fail to recognize lesions that are crucial to explain the SCD itself. In this review, we sought to describe the advances over the last 25 years in the study of the anatomopathological changes of the conducting tissue, in SCD, in mature hearts and particularly in sudden infant death syndrome (SIDS) and sudden intrauterine unexpected death syndrome (SIUDS), through the articles published in our journal Cardiovascular Pathology (CVP). We carried out an extensive Medline search to retrieve and review all articles published in CVP in which the sudden unexpected death of one or more subjects believed healthy was reported, especially if associated with lesions of the conducting tissue in settings that revealed no other explained causes of death, particularly in infants and fetuses. The cardiac conduction findings of resorptive degeneration, His bundle dispersion, Mahaim fibers, cartilaginous meta-hyperplasia, persistent fetal dispersion, left-sided His bundle, septation of the bifurcation, atrioventricular node dispersion, sinus node hypoplasia, Zahn node, His bundle hypoplasia, atrioventricular node, and His bundle dualism were similarly detected in SIDS and SIUDS victims.
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Affiliation(s)
- Giulia Ottaviani
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and Sudden Infant Death Syndrome (SIDS), Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 926] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Akdis D, Brunckhorst C, Duru F, Saguner AM. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes. Arrhythm Electrophysiol Rev 2016; 5:90-101. [PMID: 27617087 PMCID: PMC5013177 DOI: 10.15420/aer.2016.4.3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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Abstract
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.
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Affiliation(s)
- Michael Ackerman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - Dianne L Atkins
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - John K Triedman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.).
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48
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The electrical heart: 25 years of discovery in cardiac electrophysiology, arrhythmias and sudden death. Cardiovasc Pathol 2016; 25:149-57. [DOI: 10.1016/j.carpath.2015.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 12/16/2022] Open
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Seidman M, Mitchell R. Fundamental Principles in Cardiovascular Genetics. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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