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Fialho GL, Wolf P, Walz R, Lin K. Left ventricle end-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling in Epilepsy. Acta Neurol Scand 2021; 143:34-38. [PMID: 32772359 DOI: 10.1111/ane.13334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is a tragic event. Cardiac models of sudden death state that, paradoxically, healthy individuals compose most of the victims of this event. Exploration of cardiac physiological variables related to outcome could help unveil risk markers for sudden death in epilepsy. We investigated left ventricle end-systolic elastance, arterial-effective elastance and ventricle-arterial coupling (VAC) in PWE compared with controls. MATERIAL & METHODS Adult patients with temporal lobe epilepsy without known cardiovascular diseases were submitted to treadmill test and transthoracic echocardiogram. Individuals without epilepsy matched by sex, age, and body mass index composed the control group. Cardiac risk factors, exercise performance, autonomic data from treadmill test, systolic and diastolic function, morphological cardiac data, and left ventricle pressure-volume loop were recorded. RESULTS Sixty subjects were consecutively enrolled (30 PWE and 30 controls). Epilepsy duration was 22.5 ± 10.7 years (age of onset 15.2 ± 10.1 years). Treadmill variables were significantly worse in TLE patients compared with controls. End-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling were similar between groups. Female sex, percentage of maximal predicted heart rate achieved in exercise, exercise time, and epilepsy duration explained 28,4% of VAC in PWE in multiple stepwise linear regression (P = .018). CONCLUSIONS Some aspects of the cardiac pressure-volume curves, mainly linked to left ventricle systolic performance, contractile function and their interaction with afterload appears normal in young PWE and cannot explain their increase risk to adverse outcomes or lower physical fitness.
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Affiliation(s)
- Guilherme L. Fialho
- Cardiology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
| | - Peter Wolf
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Neurology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Danish Epilepsy Centre Dianalund Denmark
| | - Roger Walz
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Neurology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Center for Applied Neurosciences (CeNAp) Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
| | - Katia Lin
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Neurology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Center for Applied Neurosciences (CeNAp) Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
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2
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Short stature is associated with incident sudden cardiac death in a large Asian cohort. Heart Rhythm 2020; 17:931-936. [DOI: 10.1016/j.hrthm.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/24/2020] [Indexed: 12/28/2022]
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Andersson J, Fall T, Delicano R, Wennberg P, Jansson JH. GDF-15 is associated with sudden cardiac death due to incident myocardial infarction. Resuscitation 2020; 152:165-169. [PMID: 32422242 DOI: 10.1016/j.resuscitation.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/09/2020] [Accepted: 05/01/2020] [Indexed: 11/27/2022]
Abstract
AIMS Preventing sudden cardiac death (SCD) due to acute myocardial infarction (MI) in previously healthy patients is challenging. Proteomic analysis may lead to an understanding of biological mechanisms and provide predictive biomarkers. METHODS In this prospective, nested case-control study from northern Sweden, 87 candidate cardiovascular protein biomarkers were studied in 244 individuals who later died within 24 h from an incident MI and 244 referents without MI and individually matched for age, sex and date of health examination and alive at the date of event in the index person. Association analysis was conducted using conditional logistic regression. Bonferroni correction was applied to avoid false positive findings. RESULTS Ten proteins were associated with future SCD due to acute MI in the non-adjusted analysis. The strongest association were found for growth differentiation factor 15 (GDF-15) with an odds ratio (OR) of 1.79 (95% confidence interval [CI] 1.41, 2.25) per standard deviation increase in protein, and urokinase-type plasminogen activator receptor with an OR of 1.66 (95% CI 1.34, 2.06). In models adjusted for lipid levels, body mass index, education, smoking, hypertension and C-reactive protein, only association with GDF-15 remained (OR 1.47 (95% 1.11, 1.95)). CONCLUSION Elevated levels of GDF-15 are associated with increased risk of SCD within 24 h of incident MI. Further research may enable the use of GDF-15 together with other clinical and biological markers to guide primary preventive interventions for individuals at high risk for SCD.
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Affiliation(s)
- Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden.
| | - Tove Fall
- Uppsala University and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Rachel Delicano
- Uppsala University and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden
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4
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Sondergaard KB, Weeke P, Wissenberg M, Schjerning Olsen AM, Fosbol EL, Lippert FK, Torp-Pedersen C, Gislason GH, Folke F. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case-time-control study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 3:100-107. [PMID: 28025218 DOI: 10.1093/ehjcvp/pvw041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022]
Abstract
Aims Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been associated with increased cardiovascular risk. Nonetheless, it remains unknown whether use of NSAIDs is associated with out-of-hospital cardiac arrest (OHCA). Methods and results From the nationwide Danish Cardiac Arrest Registry, all persons with OHCA during 2001-10 were identified. NSAID use 30 days before OHCA was categorized as follows: diclofenac, naproxen, ibuprofen, rofecoxib, celecoxib, and other. Risk of OHCA associated with use of NSAIDs was analysed by conditional logistic regression in case-time-control models matching four controls on sex and age per case to account for variation in drug utilization over time. We identified 28 947 persons with OHCA of whom 3376 were treated with an NSAID up to 30 days before OHCA. Ibuprofen and diclofenac were the most commonly used NSAIDs and represented 51.0% and 21.8% of total NSAID use, respectively. Use of diclofenac (odds ratio [OR], 1.50 [95% confidence interval (CI) 1.23-1.82]) and ibuprofen [OR, 1.31 (95% CI 1.14-1.51)] was associated with a significantly increased risk of OHCA. Use of naproxen [OR, 1.29 (95% CI 0.77-2.16)], celecoxib [OR, 1.13 (95% CI 0.74-1.70)], and rofecoxib (OR, 1.28 [95% CI 0.74-1.70)] was not significantly associated with increased risk of OHCA; however, these groups were characterized by few events. Conclusion Use of non-selective NSAIDs was associated with an increased early risk of OHCA. The result was driven by an increased risk of OHCA in ibuprofen and diclofenac users.
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Affiliation(s)
- Kathrine B Sondergaard
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Peter Weeke
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,Emergency Medical Services, Copenhagen, the Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup
| | - Anne-Marie Schjerning Olsen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Emil L Fosbol
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Freddy K Lippert
- Emergency Medical Services, Copenhagen, the Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup
| | - Christian Torp-Pedersen
- Institute of Health, Science and Technology, Aalborg University, Fredrik Bajers Vej 7D, 9220 Aalborg Ø , Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2, 1353 Copenhagen K, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,Emergency Medical Services, Copenhagen, the Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup
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5
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Janusek D, Svehlikova J, Zelinka J, Weigl W, Zaczek R, Opolski G, Tysler M, Maniewski R. The roles of mid-myocardial and epicardial cells in T-wave alternans development: a simulation study. Biomed Eng Online 2018; 17:57. [PMID: 29739399 PMCID: PMC5941457 DOI: 10.1186/s12938-018-0492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/28/2018] [Indexed: 01/31/2023] Open
Abstract
Background The occurrence of T-wave alternans in electrocardiographic signals was recently linked to susceptibility to ventricular arrhythmias and sudden cardiac death. Thus, by detecting and comprehending the origins of T-wave alternans, it might be possible to prevent such events. Results Here, we simulated T-wave alternans in a computer-generated human heart model by modulating the action potential duration and amplitude during the first part of the repolarization phase. We hypothesized that changes in the intracardiac alternans patterns of action potential properties would differentially influence T-wave alternans measurements at the body surface. Specifically, changes were simulated globally in the whole left and right ventricles to simulate concordant T-wave alternans, and locally in selected regions to simulate discordant and regional discordant, hereinafter referred to as “regional”, T-wave alternans. Body surface potential maps and 12-lead electrocardiographic signals were then computed. In depth discrimination, the influence of epicardial layers on T-wave alternans development was significantly higher than that of mid-myocardial cells. Meanwhile, spatial discrimination revealed that discordant and regional action potential property changes had a higher influence on T-wave alternans amplitude than concordant changes. Notably, varying T-wave alternans sources yielded distinct body surface potential map patterns for T-wave alternans amplitude, which can be used for location of regions within hearts exhibiting impaired repolarization. The highest ability for T-wave alternans detection was achieved in lead V1. Ultimately, we proposed new parameters Vector Magnitude Alternans and Vector Angle Alternans, with higher ability for T-wave alternans detection when using multi-lead electrocardiographic signals processing than for single leads. Finally, QT alternans was found to be associated with the process of T-wave alternans generation. Conclusions The distributions of the body surface T-wave alternans amplitude have been shown to have unique patterns depending on the type of alternans (concordant, discordant or regional) and the location of the disturbance in the heart. The influence of epicardial cells on T-wave alternans development is significantly higher than that of mid-myocardial cells, among which the sub-endocardial layer exerted the highest influence. QT interval alternans is identified as a phenomenon that correlate with T-wave alternans.
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Affiliation(s)
- D Janusek
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks Trojdena Str., 02-109, Warsaw, Poland.
| | - J Svehlikova
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - J Zelinka
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - W Weigl
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - R Zaczek
- Department of Cardiology, Central Clinical Hospital of Medical University of Warsaw, Warsaw, Poland
| | - G Opolski
- Department of Cardiology, Central Clinical Hospital of Medical University of Warsaw, Warsaw, Poland
| | - M Tysler
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - R Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks Trojdena Str., 02-109, Warsaw, Poland
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6
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Morin DP, Lavie CJ. The Many Faces of Sudden Death. Mayo Clin Proc 2016; 91:S0025-6196(16)30512-2. [PMID: 27810087 DOI: 10.1016/j.mayocp.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel P Morin
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
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7
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Blewer AL, Putt ME, Becker LB, Riegel BJ, Li J, Leary M, Shea JA, Kirkpatrick JN, Berg RA, Nadkarni VM, Groeneveld PW, Abella BS. Video-Only Cardiopulmonary Resuscitation Education for High-Risk Families Before Hospital Discharge: A Multicenter Pragmatic Trial. Circ Cardiovasc Qual Outcomes 2016; 9:740-748. [PMID: 27703033 DOI: 10.1161/circoutcomes.116.002493] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/23/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) training rates in the United States are low, highlighting the need to develop CPR educational approaches that are simpler, with broader dissemination potential. The minimum training required to ensure long-term skill retention remains poorly characterized. We compared CPR skill retention among laypersons randomized to training with video-only (VO; no manikin) with those trained with a video self-instruction kit (VSI; with manikin). We hypothesized that VO training would be noninferior to the VSI approach with respect to chest compression (CC) rate. METHODS AND RESULTS We performed a prospective, cluster randomized trial of CPR education for family members of patients with high-risk cardiac conditions on hospital cardiac units, using a multicenter pragmatic design. Eight hospitals were randomized to offer either VO or VSI training before discharge using volunteer trainers. CPR skills were assessed 6 months post training. Mean CC rate among those trained with VO compared with those trained with VSI was assessed with a noninferiority margin set at 8 CC per min; as a secondary outcome, mean differences in CC depth were assessed. From February 2012 to May 2015, 1464 subjects were enrolled and 522 subjects completed a skills assessment. The mean CC rates were 87.7 (VO) CC per min and 89.3 (VSI) CC per min; we concluded noninferiority for VO based on a mean difference of -1.6 (90% confidence interval, -5.2 to 2.1). The mean CC depth was 40.2 mm (VO) and 45.8 mm (VSI) with a mean difference of -5.6 (95% confidence interval, -7.6 to -3.7). Results were similar after multivariate regression adjustment. CONCLUSIONS In this large, prospective trial of CPR skill retention, VO training yielded a noninferior difference in CC rate compared with VSI training. CC depth was greater in the VSI group. These findings suggest a potential trade-off in efforts for broad dissemination of basic CPR skills; VO training might allow for greater scalability and dissemination, but with a potential reduction in CC depth. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01514656.
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Affiliation(s)
- Audrey L Blewer
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Mary E Putt
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Lance B Becker
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Barbara J Riegel
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Jiaqi Li
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Marion Leary
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Judy A Shea
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - James N Kirkpatrick
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Robert A Berg
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Vinay M Nadkarni
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Peter W Groeneveld
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.)
| | - Benjamin S Abella
- From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
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Silva RT, Martinelli Filho M, Peixoto GDL, de Lima JJG, de Siqueira SF, Costa R, Gowdak LHW, de Paula FJ, Kalil Filho R, Ramires JAF. Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates. Arq Bras Cardiol 2015; 105:493-502. [PMID: 26351983 PMCID: PMC4651408 DOI: 10.5935/abc.20150106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/21/2015] [Accepted: 06/01/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used. OBJECTIVE We aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR). METHODS A prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE. RESULTS During a mean follow-up of 424 ± 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01-26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02-1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01-7.96; p = 0.041). CONCLUSIONS In medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.
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Affiliation(s)
- Rodrigo Tavares Silva
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Giselle de Lima Peixoto
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - José Jayme Galvão de Lima
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Sérgio Freitas de Siqueira
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Luís Henrique Wolff Gowdak
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Flávio Jota de Paula
- Unidade de Transplante Renal - Divisão de Urologia do
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo,
SP - Brazil
| | - Roberto Kalil Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - José Antônio Franchini Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade
de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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Badarau S, Siriopol D, Drugus D, Dumea R, Hogas S, Blaj M, Voroneanu L, Gramaticu A, Petris A, Burlacu A, Covic A. Electrocardiogram abnormalities and heart rate variability in predicting mortality and cardiovascular events among hemodialyzed patients. Int Urol Nephrol 2015; 47:1703-8. [PMID: 26329736 DOI: 10.1007/s11255-015-1063-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study was to evaluate the correlation between electrocardiographic parameters and heart rate variability with cardiovascular events and mortality among chronic hemodialysis patients. METHODS In this prospective study, we enrolled 116 asymptomatic patients in whom we performed ambulatory 24-h electrocardiographic Holter monitoring and before and after hemodialysis electrocardiographs. We measured the interval (PR, QRS, QTc, QTc dispersion) differences on the surface electrocardiographs and obtained frequency-domain measures from Holter monitoring (VLF, LF, HF and the LF/HF ratio). RESULTS During the follow-up period, 13 participants died (11.2 %) and 16 (13.8 %) patients experienced a cardiovascular event. The pre-post-dialysis difference in QTc interval was the best predictor for cardiovascular events (95 % CI 0.453-0.786), while pre-dialysis QRS interval was the predictor for all-cause mortality (95 % CI 1.134-3.136). Also, both outcomes were predicted by pre-post-dialysis difference in PR interval and VLF. CONCLUSIONS Interval changes during hemodialysis are predictive for cardiovascular events and mortality. Autonomic dysfunction and changes in PR should be monitored routinely, particularly in patients with suspected coronary artery disease.
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Affiliation(s)
- Silvia Badarau
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
| | - Dimitrie Siriopol
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Daniela Drugus
- Gr. T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115, Iasi, Romania.
| | - Raluca Dumea
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Simona Hogas
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mihaela Blaj
- Department of Cardiology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Luminita Voroneanu
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Angelica Gramaticu
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Antoniu Petris
- Department of Cardiology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Alexandru Burlacu
- Department of Cardiology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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Myerburg RJ, Ullmann SG. Alternative research funding to improve clinical outcomes: model of prediction and prevention of sudden cardiac death. Circ Arrhythm Electrophysiol 2015; 8:492-8. [PMID: 25669654 DOI: 10.1161/circep.114.002580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 12/03/2014] [Indexed: 11/16/2022]
Abstract
Although identification and management of cardiovascular risk markers have provided important population risk insights and public health benefits, individual risk prediction remains challenging. Using sudden cardiac death risk as a base case, the complex epidemiology of sudden cardiac death risk and the substantial new funding required to study individual risk are explored. Complex epidemiology derives from the multiple subgroups having different denominators and risk profiles, while funding limitations emerge from saturation of conventional sources of research funding without foreseeable opportunities for increases. A resolution to this problem would have to emerge from new sources of funding targeted to individual risk prediction. In this analysis, we explore the possibility of a research funding strategy that would offer business incentives to the insurance industries, while providing support for unresolved research goals. The model is developed for the case of sudden cardiac death risk, but the concept is applicable to other areas of the medical enterprise.
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Affiliation(s)
- Robert J Myerburg
- From the Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (R.J.M.); and Center for Health Sector Management and Policy, University of Miami, Coral Gables, FL (S.G.U.).
| | - Steven G Ullmann
- From the Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (R.J.M.); and Center for Health Sector Management and Policy, University of Miami, Coral Gables, FL (S.G.U.)
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Hepatocyte growth factor modification enhances the anti-arrhythmic properties of human bone marrow-derived mesenchymal stem cells. PLoS One 2014; 9:e111246. [PMID: 25360679 PMCID: PMC4216066 DOI: 10.1371/journal.pone.0111246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/17/2014] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Chronic myocardial infarction (MI) results in the formation of arrhythmogenic substrates, causing lethal ventricular arrhythmia (VA). We aimed to determine whether mesenchymal stem cells (MSCs) carrying a hepatocyte growth factor (HGF) gene modification (HGF-MSCs) decrease the levels of arrhythmogenic substrates and reduce the susceptibility to developing VA compared with unmodified MSCs and PBS in a swine infarction model. Methods The left descending anterior artery was balloon-occluded to establish an MI model. Four weeks later, the randomly grouped pigs were administered MSCs, PBS or HGF-MSCs via thoracotomy. After an additional four weeks, dynamic electrocardiography was performed to assess heart rate variability, and programmed electrical stimulation was conducted to evaluate the risk for VA. Then, the pigs were euthanized for morphometric, immunofluorescence and western blot analyses. Results: The HGF-MSC group displayed the highest vessel density and Cx43 expression levels, and the lowest levels of apoptosis, and tyrosine hydroxylase (TH) and growth associated protein 43 (GAP43) expression. Moreover, the HGF-MSC group exhibited a decrease in the number of sympathetic nerve fibers, substantial decreases in the low frequency and the low-/high- frequency ratio and increases in the root mean square of successive differences (rMSSD) and the percentage of successive normal sinus R-R intervals longer than 50 ms (pNN50), compared with the other two groups. Finally, the HGF-MSC group displayed the lowest susceptibility to developing VA. Conclusion HGF-MSCs displayed potent antiarrhythmic effects, reducing the risk for VA.
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12
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Blom MT, Cohen D, Seldenrijk A, Penninx BWJH, Nijpels G, Stehouwer CDA, Dekker JM, Tan HL. Brugada syndrome ECG is highly prevalent in schizophrenia. Circ Arrhythm Electrophysiol 2014; 7:384-91. [PMID: 24591540 DOI: 10.1161/circep.113.000927] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The causes of increased risk of sudden cardiac death in schizophrenia are not resolved. We aimed to establish (1) whether ECG markers of sudden cardiac death risk, in particular Brugada-ECG pattern, are more prevalent among patients with schizophrenia, and (2) whether increased prevalence of these ECG markers in schizophrenia is explained by confounding factors, notably sodium channel-blocking medication. METHODS AND RESULTS In a cross-sectional study, we analyzed ECGs of a cohort of 275 patients with schizophrenia, along with medication use. We determined whether Brugada-ECG was present and assessed standard ECG measures (heart rate, PQ-, QRS-, and QT-intervals). We compared the findings with nonschizophrenic individuals of comparable age (the Netherlands Study of Depression and Anxiety [NESDA] cohort; N=179) and, to account for assumed increased aging rate in schizophrenia, with individuals 20 years older (Hoorn cohort; n=1168), using multivariate regression models. Brugada-ECG was significantly more prevalent in the schizophrenia cohort (11.6%) compared with NESDA controls (1.1%) or Hoorn controls (2.4%). Moreover, patients with schizophrenia had longer QT-intervals (410.9 versus 393.1 and 401.9 ms; both P<0.05), increased proportion of mild or severe QTc prolongation (13.1% and 5.8% versus 3.4% and 0.0% [NESDA], versus 5.1 and 2.8% [Hoorn]), and higher heart rates (80.8 versus 61.7 and 68.0 beats per minute; both P<0.05). The prevalence of Brugada-ECG was still increased (9.6%) when patients with schizophrenia without sodium channel-blocking medication were compared with either of the control cohorts. CONCLUSIONS Brugada-ECG has increased prevalence among patients with schizophrenia. This association is not explained by the use of sodium channel-blocking medication.
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Affiliation(s)
- Marieke T Blom
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Dan Cohen
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Adrie Seldenrijk
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Brenda W J H Penninx
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Giel Nijpels
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Coen D A Stehouwer
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Jacqueline M Dekker
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.)
| | - Hanno L Tan
- From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.).
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Rosenberg MA, Lopez FL, Bůžková P, Adabag S, Chen LY, Sotoodehnia N, Kronmal RA, Siscovick DS, Alonso A, Buxton A, Folsom AR, Mukamal KJ. Height and risk of sudden cardiac death: the Atherosclerosis Risk in Communities and Cardiovascular Health studies. Ann Epidemiol 2014; 24:174-179.e2. [PMID: 24360853 PMCID: PMC3945001 DOI: 10.1016/j.annepidem.2013.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Sudden cardiac death (SCD) is an important cause of mortality in the adult population. Height has been associated with cardiac hypertrophy and an increased risk of arrhythmias but also with decreased risk of coronary heart disease, suggesting a complex association with SCD. METHODS We examined the association of adult height with the risk of physician-adjudicated SCD in two large population-based cohorts: the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study. RESULTS Over an average follow-up time of 11.7 years in Cardiovascular Health Study, there were 199 (3.6%) cases of SCD among 5556 participants. In Atherosclerosis Risk in Communities study, over 12.6 years, there were 227 (1.5%) cases of SCD among 15,633 participants. In both cohorts, there was a trend toward decreased SCD with taller height. In fixed effects meta-analysis, the pooled hazard ratio per 10 cm of height was 0.84; 95% confidence interval, 0.73-0.98; P = .03. The association of increased height with lower risk of SCD was slightly attenuated after inclusion of risk factors associated with height, such as hypertension and left ventricular hypertrophy. The association appeared stronger among men than women in both cohorts. CONCLUSIONS In two population-based prospective cohorts of different ages, greater height was associated with lower risk of SCD.
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Affiliation(s)
- Michael A Rosenberg
- Division of Cardiac Electrophysiology, Veteran's Administration Hospitals of Boston, Harvard Medical School, West Roxbury, MA; Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Faye L Lopez
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle
| | - Selcuk Adabag
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN
| | - Lin Y Chen
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | | | - David S Siscovick
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Alfred Buxton
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Kenneth J Mukamal
- Division of General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center, Boston, MA
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Adabag S, Smith LG, Anand IS, Berger AK, Luepker RV. Sudden cardiac death in heart failure patients with preserved ejection fraction. J Card Fail 2013; 18:749-54. [PMID: 23040109 DOI: 10.1016/j.cardfail.2012.08.357] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/17/2012] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whereas sudden cardiac death (SCD) risk has been recognized in heart failure (HF) patients with reduced ejection fraction (HFrEF), less is known about SCD risk in HF patients with preserved EF (HFpEF). We examined the incidence and predictors of SCD in HFpEF in a large population sample. METHODS AND RESULTS Medical records of patients discharged with a primary diagnosis of HF from hospitals in Minneapolis-St Paul in 1995 and 2000 were abstracted. HFpEF was defined as EF ≥ 45%. SCD was defined as cardiac arrest or out-of-hospital death due to coronary heart disease (CHD) on death certificates. A total of 2,203 patients (age 70 ± 11 years, 53% male) were included. The 787 patients (36%) with HFpEF were older, more often female and more likely to have hypertension than the 1,416 (64%) with HFrEF. All-cause mortality (52% vs 58%; P = .01) and SCD (6% vs 14%; P < .0001) rates were lower in HFpEF than in HFrEF 5 years after hospital discharge. Age, sex, CHD, and length of index hospitalization were the only independent predictors of SCD in HFpEF. CONCLUSIONS Incidence of SCD in HFpEF is lower than in HFrEF. Present markers of SCD in HFpEF are sparse and insufficient to identify the patient at risk.
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Affiliation(s)
- Selcuk Adabag
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
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Mirza M, Strunets A, Shen WK, Jahangir A. Mechanisms of arrhythmias and conduction disorders in older adults. Clin Geriatr Med 2013; 28:555-73. [PMID: 23101571 DOI: 10.1016/j.cger.2012.08.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aging is associated with an increased prevalence of cardiac arrhythmias, which contribute to higher morbidity and mortality in the elderly. The frequency of cardiac arrhythmias, particularly atrial fibrillation and ventricular tachyarrhythmia, is projected to increase as the population ages, greatly impacting health care resource utilization. Several clinical factors associated with the risk of arrhythmias have been identified in the population, yet the molecular bases for the increased predisposition to arrhythmogenesis in the elderly are not fully understood. This review highlights the epidemiology of cardiac dysrhythmias, changes in cardiac structure and function associated with aging, and the basis for arrhythmogenesis in the elderly.
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Affiliation(s)
- Mahek Mirza
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Health Care, 3033 South 27th Street, Milwaukee, WI 53215, USA
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Affiliation(s)
- Robert J Myerburg
- Division of Cardiology (D-39), University of Miami Miller School of Medicine, P.O. Box 016960, Miami, FL 33101, USA.
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Soliman EZ, Prineas RJ, Case LD, Russell G, Rosamond W, Rea T, Sotoodehnia N, Post WS, Siscovick D, Psaty BM, Burke GL. Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease. Heart 2011; 97:1597-601. [PMID: 21775508 PMCID: PMC3638973 DOI: 10.1136/hrt.2010.215871] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify specific ECG and clinical predictors that separate atherosclerotic sudden cardiac death (SCD) from incident coronary heart disease (CHD) (non-fatal events and non-sudden death) in the combined cohorts of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study. METHODS This analysis included 18,497 participants (58% females, 24% black individuals, mean age 58 years) who were initially free of clinical CHD. A competing risk analysis was conducted to examine the prognostic significance of baseline clinical characteristics and an extensive electronic database of ECG measurements for prediction of 229 cases of SCD as a first event versus 2297 incident CHD cases (2122 non-fatal events and 175 non-sudden death) that occurred during a median follow-up time of 13 years in the Cardiovascular Health Study and 14 years in the Atherosclerosis Risk in Communities study. RESULTS After adjusting for common CHD risk factors, a number of clinical characteristics and ECG measurements were independently predictive of SCD and CHD. However, the risk of SCD versus incident CHD was significantly different for race/ethnicity, hypertension, body mass index (BMI), heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2. Black race/ethnicity (compared to non-black) was predictive of high SCD risk but less risk of incident CHD (p value for differences in the risk (HR) for SCD versus CHD <0.0001). Hypertension, increased heart rate, prolongation of QTc and abnormally inverted T wave were stronger predictors of high SCD risk compared to CHD (p value=0.0460, 0.0398, 0.0158 and 0.0265, respectively). BMI was not predictive of incident CHD but was predictive of high SCD risk in a quadratic fashion (p value=0.0220). On the other hand, elevated ST height as measured at the J point and that measured at 60 ms after the J point in V2 were not predictive of SCD but were predictive of high incident CHD risk (p value=0.0251 and 0.0155, respectively). CONCLUSIONS SCD and CHD have many risk factors in common. Hypertension, race/ethnicity, BMI, heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2 have the potential to separate between the risks of SCD and CHD. These results need to be validated in another cohort.
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Affiliation(s)
- Elsayed Z Soliman
- Epidemiological Cardiology Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Gow R. Preventing sudden cardiac death in the young: Is electrocardiogram screening the most effective means? Paediatr Child Health 2011; 14:185-8. [PMID: 20190902 DOI: 10.1093/pch/14.3.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2009] [Indexed: 01/10/2023] Open
Affiliation(s)
- Robert Gow
- Department of Paediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario
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Lopera G, Curtis AB. Risk stratification for sudden cardiac death: current approaches and predictive value. Curr Cardiol Rev 2011; 5:56-64. [PMID: 20066150 PMCID: PMC2803290 DOI: 10.2174/157340309787048130] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 07/05/2008] [Accepted: 07/05/2008] [Indexed: 11/22/2022] Open
Abstract
Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF <35% could benefit from prophylactic ICD implantation, particularly in the setting of symptomatic heart failure. Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims. However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear. The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers.
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Affiliation(s)
- Gustavo Lopera
- Division of Cardiology, University of Miami/Miller School of Medicine, Miami, FL, USA
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Burgess SN, Harding SA, Melton IC, Lever NA, Swain AH, Shi B, Larsen PD. An unmet need for implantable cardioverter-defibrillators in New Zealand. Europace 2011; 13:1299-303. [DOI: 10.1093/europace/eur113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Houmsse M, Franco V, Abraham WT. Epidemiology of Sudden Cardiac Death in Patients with Heart Failure. Heart Fail Clin 2011; 7:147-55, vii. [DOI: 10.1016/j.hfc.2010.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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van Noord C, Eijgelsheim M, Stricker BHC. Drug- and non-drug-associated QT interval prolongation. Br J Clin Pharmacol 2011; 70:16-23. [PMID: 20642543 DOI: 10.1111/j.1365-2125.2010.03660.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sudden cardiac death is among the most common causes of cardiovascular death in developed countries. The majority of sudden cardiac deaths are caused by acute ventricular arrhythmia following repolarization disturbances. An important risk factor for repolarization disturbances is use of QT prolonging drugs, probably partly explained by gene-drug interactions. In this review, we will summarize QT interval physiology, known risk factors for QT prolongation, including drugs and the contribution of pharmacogenetics. The long QT syndrome can be congenital or acquired. The congenital long QT syndrome is caused by mutations in ion channel subunits or regulatory protein coding genes and is a rare monogenic disorder with a mendelian pattern of inheritance. Apart from that, several common genetic variants that are associated with QT interval duration have been identified. Acquired QT prolongation is more prevalent than the congenital form. Several risk factors have been identified with use of QT prolonging drugs as the most frequent cause. Most drugs that prolong the QT interval act by blocking hERG-encoded potassium channels, although some drugs mainly modify sodium channels. Both pharmacodynamic as well as pharmacokinetic mechanisms may be responsible for QT prolongation. Pharmacokinetic interactions often involve drugs that are metabolized by cytochrome P450 enzymes. Pharmacodynamic gene-drug interactions are due to genetic variants that potentiate the QT prolonging effect of drugs. QT prolongation, often due to use of QT prolonging drugs, is a major public health issue. Recently, common genetic variants associated with QT prolongation have been identified. Few pharmacogenetic studies have been performed to establish the genetic background of acquired QT prolongation but additional studies in this newly developing field are warranted.
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Affiliation(s)
- Charlotte van Noord
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Padeletti L, Innocenti L, Paoletti Perini A, Gronda E. Arrhythmic complication in cardiorenal syndrome. Heart Fail Rev 2010; 16:569-73. [DOI: 10.1007/s10741-010-9210-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Sudden cardiac death (SCD) is a leading cause of total and cardiovascular mortality, and ventricular fibrillation is the underlying arrhythmia in the majority of cases. In the young, where the incidence of SCD is low, a great proportion of SCDs occur in the context of inherited disorders such as cardiomyopathy or primary electrical disease, where a monogenic hereditary component is a strong determinant of risk. Marked advancement has been made over the past 15 years in the understanding of the genetic basis of the primary electrical disorders, and this has had an enormous impact on the management of these patients. At older ages, the great majority of SCDs occur in the context of acute myocardial ischemia and infarction. Although epidemiologic studies have shown that heritable factors also determine risk in these cases, inheritance is likely complex and multifactorial, and progress in understanding the genetic and molecular mechanisms that determine susceptibility to these arrhythmias, affecting a greater proportion of the population, has been very limited. We review the most recent insights gained into the genetic basis of both the monogenic and the more complex ventricular arrhythmias.
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Affiliation(s)
- Raha Pazoki
- Department of Clinical and Experimental Cardiology, Heart Failure Research Center, Amsterdam, The Netherlands
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Arthur A. M. Wilde
- Department of Clinical and Experimental Cardiology, Heart Failure Research Center, Amsterdam, The Netherlands
| | - Connie R. Bezzina
- Department of Clinical and Experimental Cardiology, Heart Failure Research Center, Amsterdam, The Netherlands
- Department of Experimental Cardiology, Academic Medical Center, Room L2-108-1 Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Hage FG, de Mattos AM, Khamash H, Mehta S, Warnock D, Iskandrian AE. QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol 2010; 33:361-6. [PMID: 20556806 DOI: 10.1002/clc.20768] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the predominant cause of sudden cardiac death in the general population, and sudden cardiac death is the leading cause of mortality in end-stage renal disease (ESRD). HYPOTHESIS QT-interval prolongation is an independent prognosticator in ESRD. METHODS We reviewed clinical, electrocardiographic, stress test, and coronary angiography data on ESRD patients evaluated for transplantation at our institution between 2000 and 2004 who underwent coronary angiography. The QT interval was corrected for heart rate and QRS duration (QTc). All-cause mortality data were prospectively collected and verified against the Social Security Death Index database. RESULTS During 40 +/- 28 months of follow-up, 132 of the 280 (47%) patients died prior to renal transplantation. Patients with a prolonged QTc (39%) had 1-, 3-, and 5-year death-rates of 12%, 36%, and 47%, respectively, vs 8%, 24%, and 36% for those with normal QTc (log-rank P = 0.03). In a multivariate Cox regression model that adjusted for age, gender, diabetes mellitus, myocardial infarction, presence and severity of CAD on angiography, left ventricular (LV) hypertrophy, LV ejection fraction (EF), and multiple other variables, QTc remained to be an independent predictor of survival (hazard ratio [HR]: 1.008, 95% confidence interval [CI]: 1.001-1.014, P = 0.016). Female gender, decreasing LVEF, and decreasing severity of CAD on angiography were independent predictors of prolonged QTc. CONCLUSIONS QTc prolongation is an independent predictor of mortality in ESRD patients being evaluated for renal transplantation. The prognostic information gained from the QTc is additive to that provided by the LVEF and the severity of CAD.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, USA.
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De Lima JJG, Gowdak LHW, de Paula FJ, Arantes RL, Cesar LAM, Ramires JAF, Krieger EM. Unexplained sudden death in patients on the waiting list for renal transplantation. Nephrol Dial Transplant 2010; 26:1392-6. [DOI: 10.1093/ndt/gfq570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Single-photon emission computed tomography myocardial perfusion imaging and the risk of sudden cardiac death in patients with coronary disease and left ventricular ejection fraction>35%. J Am Coll Cardiol 2010; 56:206-14. [PMID: 20620740 DOI: 10.1016/j.jacc.2010.01.061] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 12/09/2009] [Accepted: 01/25/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is an effective method of risk stratification for sudden cardiac death (SCD) in patients with coronary artery disease (CAD) and left ventricular ejection fraction (LVEF)>35%. BACKGROUND Most victims of SCD have an LVEF>35%. METHODS The study population included 4,865 patients with CAD and LVEF>35% who underwent gated SPECT MPI. We used Cox proportional hazard modeling to examine the relationship between patient characteristics and SCD. RESULTS The median age of the population was 63 years (25th, 75th percentile: 54, 71 years), and the median LVEF was 56% (25th, 75th percentile: 50%, 64%). The median follow-up for all patients was 6.5 years (25th, 75th percentile: 3.6, 9.3 years). During follow-up, there were 161 SCDs (3.3%). After multivariable adjustment, LVEF, the Charlson index, hypertension, smoking, antiarrhythmic drug therapy, and the summed stress score (SSS) were associated with SCD (all p<0.05). For each 3-U increase in the SSS, the hazard ratio for SCD was 1.13 (95% confidence interval: 1.04 to 1.23). The addition of perfusion data to the clinical history and LVEF was associated with increased discrimination for SCD events (c-index 0.728). Risk stratification with a derived SPECT nomogram did not result in statistically significant net reclassification improvement (p=0.26) or integrated discrimination improvement (p=0.38). CONCLUSIONS Among patients with CAD and LVEF>35%, the extent of stress MPI perfusion defects is associated with an increased risk of SCD. Future large prospective studies should address the role of perfusion imaging in the identification of high-risk patients with LVEF>35% who might benefit from ICD implantation.
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Bezzina CR, Pazoki R, Bardai A, Marsman RF, de Jong JSSG, Blom MT, Scicluna BP, Jukema JW, Bindraban NR, Lichtner P, Pfeufer A, Bishopric NH, Roden DM, Meitinger T, Chugh SS, Myerburg RJ, Jouven X, Kääb S, Dekker LRC, Tan HL, Tanck MWT, Wilde AAM. Genome-wide association study identifies a susceptibility locus at 21q21 for ventricular fibrillation in acute myocardial infarction. Nat Genet 2010; 42:688-691. [PMID: 20622880 DOI: 10.1038/ng.623] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 06/15/2010] [Indexed: 11/09/2022]
Abstract
Sudden cardiac death from ventricular fibrillation during acute myocardial infarction is a leading cause of total and cardiovascular mortality. To our knowledge, we here report the first genome-wide association study for this trait, conducted in a set of 972 individuals with a first acute myocardial infarction, 515 of whom had ventricular fibrillation and 457 of whom did not, from the Arrhythmia Genetics in The Netherlands (AGNES) study. The most significant association to ventricular fibrillation was found at 21q21 (rs2824292, odds ratio = 1.78, 95% CI 1.47-2.13, P = 3.3 x 10(-10)). The association of rs2824292 with ventricular fibrillation was replicated in an independent case-control set consisting of 146 out-of-hospital cardiac arrest individuals with myocardial infarction complicated by ventricular fibrillation and 391 individuals who survived a myocardial infarction (controls) (odds ratio = 1.49, 95% CI 1.14-1.95, P = 0.004). The closest gene to this SNP is CXADR, which encodes a viral receptor previously implicated in myocarditis and dilated cardiomyopathy and which has recently been identified as a modulator of cardiac conduction. This locus has not previously been implicated in arrhythmia susceptibility.
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Affiliation(s)
- Connie R Bezzina
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Raha Pazoki
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdennasser Bardai
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Roos F Marsman
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonas S S G de Jong
- Heart Failure Research Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brendon P Scicluna
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Durrer Center for Cardiogenetic Research, Amsterdam, The Netherlands
| | - Navin R Bindraban
- Heart Failure Research Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Lichtner
- Institute of Human Genetics, Klinikum Rechts der Isar Technische Universität München, Munich, Germany
| | - Arne Pfeufer
- Institute of Human Genetics, Klinikum Rechts der Isar Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | - Nanette H Bishopric
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dan M Roden
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Thomas Meitinger
- Institute of Human Genetics, Klinikum Rechts der Isar Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Myerburg
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xavier Jouven
- Université Paris Descartes, Assistance Publique-Hopitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Stefan Kääb
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lukas R C Dekker
- Heart Failure Research Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Hanno L Tan
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure Research Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Failure Research Center, Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure Research Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Bayer JD, Narayan SM, Lalani GG, Trayanova NA. Rate-dependent action potential alternans in human heart failure implicates abnormal intracellular calcium handling. Heart Rhythm 2010; 7:1093-101. [PMID: 20382266 DOI: 10.1016/j.hrthm.2010.04.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 04/02/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alternans in action potential voltage (APV-ALT) at heart rates <110 bpm is a novel index to predict ventricular arrhythmias. However, the rate dependency of APV-ALT and its mechanisms in failing versus nonfailing human myocardium are poorly understood. It is hypothesized that APV-ALT in human heart failure (HF) reflects abnormal calcium handling. OBJECTIVE Using a modeling and clinical approach, our objectives were to (1) determine how APV-ALT varies with pacing rate and (2) ascertain whether abnormalities in calcium handling explain the rate dependence of APV-ALT in HF. METHODS APV-ALT was analyzed at several cycle lengths (CLs) using a dynamic pacing protocol applied to a human left ventricle wedge model with various alterations in calcium handling. Modeled APV-ALT was used to predict APV-ALT in left ventricle monophasic action potentials recorded from HF (n = 3) and control (n = 2) patients with the same pacing protocol. RESULTS Reducing the sarcoplasmic reticulum calcium uptake current < or =25%, the release current < or =11%, or the sarcolemmal L-type calcium channel current < or =43% of control predicted APV-ALT to arise at CL > or =600 ms and then increase in magnitude by >400% for CL <400 ms. In HF patients, APV-ALT arose at CL = 600 ms and then increased in magnitude by >500% at CL <350 ms. For all other model alterations and for control patients, APV-ALT occurred only at CL <500 ms. CONCLUSIONS APV-ALT shows differing rate dependence in HF versus control patients, arising at slower rates in HF and predicted by models with abnormal calcium handling. Future studies should investigate whether APV-ALT at slow rates identifies patients with deranged calcium handing, including HF patients before decompensation or at risk for arrhythmias.
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Affiliation(s)
- Jason D Bayer
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Ritz E, Bommer J. Cardiovascular Problems on Hemodialysis: Current Deficits and Potential Improvement. Clin J Am Soc Nephrol 2009; 4 Suppl 1:S71-8. [DOI: 10.2215/cjn.01960309] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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31
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Soliman EZ, Elsalam MA, Li Y. The relationship between high resting heart rate and ventricular arrhythmogenesis in patients referred to ambulatory 24 h electrocardiographic recording. Europace 2009; 12:261-5. [PMID: 19887457 DOI: 10.1093/europace/eup344] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS High resting heart rate (HR) has been associated with sudden cardiac death (SCD). This association is not fully explained by the reported association between HR with coronary heart disease (CHD) or left ventricular systolic dysfunction, the major pathological substrates for SCD. Ventricular arrhythmia is the most common antecedent event before SCD. Examining associations between resting HR and ventricular arrhythmogenesis may enhance our understanding of the association between high resting HR and SCD. METHODS AND RESULTS This study included 867 patients (age 54 +/- 5, 57% females) who underwent 24 h ambulatory electrocardiographic (ECG) recording (Holter) in the period from 1998 to 2000. We examined the unadjusted and multivariable-adjusted associations between resting HR with factors involved in ventricular arrhythmogenesis [ventricular late potentials (LPs) detected by signal-averaged ECG, heart rate variability (HRV), and premature ventricular complexes (PVCs)]. Linear regression models were used for continuous outcomes and logistic regression analysis was used for categorical outcomes. The multivariable models included first age and sex, then history of hypertension, diabetes, hypercholesterolaemia, CHD, heart failure, left ventricular ejection fraction (LVEF), smoking, body mass index, the use of anti-arrhythmic drugs, and ST-depression in the 24 h ambulatory ECG recording (Holter) were included in the final models. In the unadjusted and multivariable-adjusted analysis, high resting HR was significantly associated with positive ventricular LPs, depressed HRV indices, and increased prevalence of PVCs/24 h independently from demographic and clinical variables including LVEF, history of CHD, and the presence of ST-depression in Holter (P-value <0.05 in all comparisons and models). CONCLUSION High resting HR is independently associated with ventricular arrhythmogenesis, the major cause of SCD. These findings could partially explain the reported association between increased HR and SCD.
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Affiliation(s)
- Elsayed Z Soliman
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27104, USA.
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Myerburg RJ, Reddy V, Castellanos A. Indications for Implantable Cardioverter-Defibrillators Based on Evidence and Judgment. J Am Coll Cardiol 2009; 54:747-63. [DOI: 10.1016/j.jacc.2009.03.078] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/20/2009] [Accepted: 03/24/2009] [Indexed: 12/26/2022]
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Eijgelsheim M, Newton-Cheh C, Aarnoudse ALHJ, van Noord C, Witteman JCM, Hofman A, Uitterlinden AG, Stricker BHC. Genetic variation in NOS1AP is associated with sudden cardiac death: evidence from the Rotterdam Study. Hum Mol Genet 2009; 18:4213-8. [PMID: 19643915 DOI: 10.1093/hmg/ddp356] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Common variation within the nitric oxide-1 synthase activator protein (NOS1AP) locus is strongly related to QT interval, a sudden cardiac death (SCD) risk factor. A recent report describes common variation in NOS1AP associated with SCD in a US population of European ancestry. The objective of the current study was to obtain additional evidence by investigating the association between NOS1AP variants and SCD in the prospective population-based Rotterdam Study. The study population consisted of 5974 European ancestry subjects, aged 55 years and older, genotyped on Illumina arrays. SCD was defined according to European Society of Cardiology guidelines. Smoking, body mass index, diabetes mellitus, hypertension, heart failure and myocardial infarction were used as covariates in Cox proportional hazard models. Results were combined with reported evidence using inverse-variance weighted meta-analysis. Two hundred and eight (109 witnessed) cases of SCD occurred during a mean follow-up of 10.4 years. Within the Rotterdam Study alone, no significant associations were observed. Upon pooling of results with existing data, we observed strengthening of existing evidence for rs16847549 (US data HR = 1.31, P = 0.0024; Rotterdam Study HR = 1.18, P = 0.16; joint HR = 1.26, P = 0.0011). When the case definition in the Rotterdam Study was restricted to witnessed SCD, association of rs16847549 with SCD became stronger (joint P = 0.00019) and additionally the association between rs12567209 and SCD gained significance (US data HR = 0.57, P = 0.0035; Rotterdam Study HR = 0.69, P = 0.23; joint HR = 0.60, P = 0.0018). In conclusion, this study provided additional evidence for association between genetic variation within NOS1AP and SCD. The mechanism by which this effect is exerted remains to be elucidated.
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Affiliation(s)
- Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Kao WHL, Arking DE, Post W, Rea TD, Sotoodehnia N, Prineas RJ, Bishe B, Doan BQ, Boerwinkle E, Psaty BM, Tomaselli GF, Coresh J, Siscovick DS, Marbán E, Spooner PM, Burke GL, Chakravarti A. Genetic variations in nitric oxide synthase 1 adaptor protein are associated with sudden cardiac death in US white community-based populations. Circulation 2009; 119:940-51. [PMID: 19204306 DOI: 10.1161/circulationaha.108.791723] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The ECG QT interval is associated with risk of sudden cardiac death (SCD). A previous genome-wide association study demonstrated that allelic variants (rs10494366 and rs4657139) in the nitric oxide synthase 1 adaptor protein (NOS1AP), which encodes a carboxy-terminal PDZ ligand of neuronal nitric oxide synthase, are associated with the QT interval in white adults. The present analysis was conducted to validate the association between NOS1AP variants and the QT interval and to examine the association with SCD in a combined population of 19 295 black and white adults from the Atherosclerosis Risk In Communities Study and the Cardiovascular Health Study. METHODS AND RESULTS We examined 19 tagging single-nucleotide polymorphisms in the genomic blocks containing rs10494366 and rs4657139 in NOS1AP. SCD was defined as a sudden pulseless condition of cardiac origin in a previously stable individual. General linear models and Cox proportional hazards regression models were used. Multiple single-nucleotide polymorphisms in NOS1AP, including rs10494366, rs4657139, and rs16847548, were significantly associated with adjusted QT interval in whites (P<0.0001). In whites, after adjustment for age, sex, and study, the relative hazard of SCD associated with each C allele at rs16847548 was 1.31 (95% confidence interval 1.10 to 1.56, P=0.002), assuming an additive model. In addition, a downstream neighboring single-nucleotide polymorphism, rs12567209, which was not correlated with rs16847548 or QT interval, was also independently associated with SCD in whites (relative hazard 0.57, 95% confidence interval 0.39 to 0.83, P=0.003). Adjustment for QT interval and coronary heart disease risk factors attenuated but did not eliminate the association between rs16847548 and SCD, and such adjustment had no effect on the association between rs12567209 and SCD. No significant associations between tagging single-nucleotide polymorphisms in NOS1AP and either QT interval or SCD were observed in blacks. CONCLUSIONS In a combined analysis of 2 population-based prospective cohort studies, sequence variations in NOS1AP were associated with baseline QT interval and the risk of SCD in white US adults.
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Affiliation(s)
- W H Linda Kao
- Department of Epidemiology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
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Narayan SM, Bayer JD, Lalani G, Trayanova NA. Action potential dynamics explain arrhythmic vulnerability in human heart failure: a clinical and modeling study implicating abnormal calcium handling. J Am Coll Cardiol 2008; 52:1782-92. [PMID: 19022157 DOI: 10.1016/j.jacc.2008.08.037] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/07/2008] [Accepted: 08/14/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether abnormalities of calcium cycling explain ventricular action potential (AP) oscillations and cause electrocardiogram T-wave alternans (TWA). BACKGROUND Mechanisms explaining why heart failure patients are at risk for malignant ventricular arrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]) are unclear. We studied whether oscillations in human ventricular AP explain TWA and predict VT/VF, and used computer modeling to suggest potential cellular mechanisms. METHODS We studied 53 patients with left ventricular ejection fraction 28 +/- 8% and 18 control subjects. Monophasic APs were recorded in the right ventricle (n = 62) and/or left ventricle (n = 9) at 109 beats/min. RESULTS Alternans of AP amplitude, computed spectrally, had higher magnitude in study patients than in controls (p = 0.03), particularly in AP phase II (p = 0.02) rather than phase III (p = 0.10). The AP duration and activation restitution (n = 11 patients) were flat at 109 beats/min and did not explain TWA. In computer simulations, only reduced sarcoplasmic reticulum calcium uptake explained our results, causing calcium oscillations, AP amplitude alternans, and TWA that were all abolished by calcium clamping. On prospective follow-up for 949 +/- 553 days, 17 patients had VT/VF. The AP amplitude alternans predicted VT/VF (p = 0.04), and was 78% concordant with simultaneous TWA (p = 0.003). CONCLUSIONS Patients with systolic dysfunction show ventricular AP amplitude alternans that prospectively predicted VT/VF. Alternans in AP amplitude, but not variations in AP duration or conduction, explained TWA at < or =109 beats/min. In computer models, these findings were best explained by reduced sarcoplasmic reticulum calcium uptake. Thus, in heart failure patients, in vivo AP alternans may reflect cellular calcium abnormalities and provide a mechanistic link with VT/VF.
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Affiliation(s)
- Sanjiv M Narayan
- Department of Medicine and Whitaker Institute for Biomedical Engineering, University of California, San Diego, California 92161, USA.
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36
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Affiliation(s)
- Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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37
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Eijgelsheim M, Aarnoudse ALHJ, Rivadeneira F, Kors JA, Witteman JCM, Hofman A, van Duijn CM, Uitterlinden AG, Stricker BHC. Identification of a common variant at the NOS1AP locus strongly associated to QT-interval duration. Hum Mol Genet 2008; 18:347-57. [PMID: 18927126 DOI: 10.1093/hmg/ddn341] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
QT-interval prolongation is an electrophysiologic phenomenon associated with sudden cardiac death. The QT-interval in the general population is approximately 35% heritable. In genome-wide association studies, a common variant (rs10494366T > G) within the nitric oxide synthase 1 adaptor protein (NOS1AP) gene was identified and consistently associated with QT-interval duration. Yet, the causal variant remains unclear. Therefore, we performed fine mapping of the association of the NOS1AP locus with QT-interval within the Rotterdam Study, a population-based, prospective cohort study of individuals of > or =55 years of age. First, we tested the association of single-nucleotide polymorphisms (SNPs) in or within +/-100 kb of the NOS1AP gene with QT-interval duration, using sex-specific unstandardized residuals after regression on age and RR-interval, in 385 individuals using the combined set of SNPs present in the Affymetrix 500k and Illumina 550k chip arrays. Subsequently, we examined correspondence of the association signals in 4606 individuals using the Illumina 550k array. A C-to-T SNP at chromosome 1 position 160300514 (rs12143842, T-allele frequency = 24%) was associated with a QT-interval duration increase of 4.4 ms per additional T-allele (P = 4.4 x 10(-28)). For comparison, the most strongly associated variant to date, rs10494366T > G, was associated with a 3.5 ms increase (P = 1.6 x 10(-23)) per additional G-allele. None of the inferred haplotypes showed a stronger effect than the individual rs12143842C > T SNP. In conclusion, we found rs12143842 6 kb upstream distance of NOS1AP to be more strongly associated to QT-interval duration than rs10494366T > G. Functional analysis of this marker is warranted.
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Affiliation(s)
- Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center 3000, CA, Rotterdam, The Netherlands
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Hallstrom AP, Wyse DG, McAnulty J. Clinical criteria for predicting benefit of ICD/PM in post myocardial infarction patients: an AVID and CAST analysis. J Interv Card Electrophysiol 2008; 23:159-66. [PMID: 18810620 DOI: 10.1007/s10840-008-9304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 07/11/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Three clinical factors from the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial-heart failure, left ventricular dysfunction and certain historical features defined a subgroup in which an implantable cardioverter defibrillator (ICD/PM) has a mortality advantage over amiodarone. METHODS These three factors were jointly evaluated in the AVID cohort with ischemic heart disease (IHD) and the results applied in placebo-treated post-infarction patients in the cardiac arrhythmia suppression trial (CAST). RESULTS Similar predictive power was noted in AVID patients with IHD. In CAST the factors defined three groups; one group (5.8%), corresponding to AVID patients that had high risk and benefited from an ICD/PM and another group (17.2%) corresponding to patients in AVID where the risk was moderate and ICD/PM and amiodarone had equal efficacy, demonstrated a two-fold higher risk of sudden arrhythmic than non-arrhythmic death and hence would be expected to benefit from antiarrhythmia therapy. The third group, corresponding to AVID patients with low risk of arrhythmia, demonstrated similar and low risks of sudden arrhythmic and non-arrhythmic death. Thus this group (77%) is unlikely to benefit from indiscriminate antiarrhythmia therapy. Onset of risk of death in CAST patients was offset from randomization by 3 to 6 months. CONCLUSIONS Readily available clinical criteria identify a small group likely to benefit from an ICD/PM after recent myocardial infarction (MI) and the remainder unlikely to benefit from nonselective ICD/PM therapy. Additional risk stratification should focus on the latter patients and be timed to allow ICD/PM implantation between 2 and 6 months after MI.
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Affiliation(s)
- Alfred P Hallstrom
- Department of Biostatistics, University of Washington, Seattle, WA 98105, USA.
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Herzog CA, Mangrum JM, Passman R. NON-CORONARY HEART DISEASE IN DIALYSIS PATIENTS: Sudden Cardiac Death and Dialysis Patients. Semin Dial 2008; 21:300-7. [DOI: 10.1111/j.1525-139x.2008.00455.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
This article reviews current thinking on the problem of sudden cardiac death (SCD) within community settings, highlighting progress in understanding risks and mechanisms. Information available on the influence of diabetes as a risk factor for SCD and the question of whether this disease enhances susceptibility to ventricular arrhythmias is summarized as are central strategies in risk stratification and mortality prevention.
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MESH Headings
- Aged
- Aged, 80 and over
- Arrhythmias, Cardiac/epidemiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/prevention & control
- Diabetes Complications/epidemiology
- Diabetes Complications/prevention & control
- Diet, Mediterranean
- Disease Susceptibility/epidemiology
- Female
- Humans
- Male
- Risk Factors
- Survival Analysis
- Ventricular Function, Left/physiology
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Affiliation(s)
- P M Spooner
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
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Myerburg RJ, Vetter VL. Electrocardiograms should be included in preparticipation screening of athletes. Circulation 2008; 116:2616-26; discussion 2626. [PMID: 18040041 DOI: 10.1161/circulationaha.107.733519] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Robert J Myerburg
- Division of Cardiology (D-39), University of Miami Miller School of Medicine, PO Box 016960, Miami, FL 33101, USA.
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Aarnoudse AJLHJ, Newton-Cheh C, de Bakker PIW, Straus SMJM, Kors JA, Hofman A, Uitterlinden AG, Witteman JCM, Stricker BHC. Common NOS1AP variants are associated with a prolonged QTc interval in the Rotterdam Study. Circulation 2007; 116:10-6. [PMID: 17576865 DOI: 10.1161/circulationaha.106.676783] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND QT prolongation is an important risk factor for sudden cardiac death. About 35% of QT-interval variation is heritable. In a recent genome-wide association study, a common variant (rs10494366) in the nitric oxide synthase 1 adaptor protein (NOS1AP) gene was found to be associated with QT-interval variation. We tested for association of 2 NOS1AP variants with QT duration and sudden cardiac death. METHODS AND RESULTS The Rotterdam Study is a population-based, prospective cohort study of individuals > or = 55 years of age. The NOS1AP variants rs10494366 T>G and rs10918594 C>G were genotyped in 6571 individuals. Heart rate-corrected QT interval (QTc) was determined with ECG analysis software on up to 3 digital ECGs per individual (total, 11,108 ECGs from 5374 individuals). The association with QTc duration was estimated with repeated-measures analyses, and the association with sudden cardiac death was estimated by Cox proportional-hazards analyses. The rs10494366 G allele (36% frequency) was associated with a 3.8-ms (95% confidence interval, 3.0 to 4.6; P=7.8x10(-20)) increase in QTc interval duration for each additional allele copy, and the rs10918594 G allele (31% frequency) was associated with a 3.6-ms (95% confidence interval, 2.7 to 4.4; P=6.9x10(-17)) increase per additional allele copy. None of the inferred NOS1AP haplotypes showed a stronger effect than the individual single-nucleotide polymorphisms. There were 233 sudden cardiac deaths over 11.9 median years of follow-up. No significant association was observed with sudden cardiac death risk. CONCLUSIONS Common variants in NOS1AP are strongly associated with QT-interval duration in an elderly population. Larger sample sizes are needed to confirm or exclude an effect on sudden cardiac death risk.
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Affiliation(s)
- Albert-Jan L H J Aarnoudse
- Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Post W, Shen H, Damcott C, Arking DE, Kao WHL, Sack PA, Ryan KA, Chakravarti A, Mitchell BD, Shuldiner AR. Associations between genetic variants in the NOS1AP (CAPON) gene and cardiac repolarization in the old order Amish. Hum Hered 2007; 64:214-9. [PMID: 17565224 PMCID: PMC2880727 DOI: 10.1159/000103630] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 04/04/2007] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Through a genome-wide association study, we discovered an association of the electrocardiographic QT interval with polymorphisms in the NOS1AP (CAPON) gene. The purpose of the current study was to replicate this association in the Old Order Amish. METHODS Four NOS1AP SNPs were selected that captured all major haplotypes in the region of interest ( approximately 120 kb segment). Genotyping was completed in 763 subjects from the Heredity and Phenotype Intervention (HAPI) Heart Study. Association analyses were performed using a variance components methodology, accounting for relatedness of individuals. RESULTS Heritability of the QT interval was 0.50 +/- 0.09 (p = 1.9 x 10(-9)). All four SNPs were common with a high degree of correlation between SNPs. Two of the four SNPs (pairwise r(2) = 0.86) were significantly associated with variation in adjusted QT interval (rs1415262, p = 0.02 and rs10494366, p = 0.006, additive models for both). SNP rs10494366 explained 0.9% of QT interval variability, with an average genetic effect of 6.1 ms. Haplotypes that contained the minor allele for rs10494366 were associated with longer QT interval. CONCLUSIONS This study provides further evidence that NOS1AP variants influence QT interval and further validates the utility of genome-wide association studies, a relatively new approach to gene discovery.
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Affiliation(s)
- Wendy Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
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Affiliation(s)
- Sanjiv M. Narayan
- University of California and Veterans Affairs Medical Centers, San Diego, Cardiology 111A, 3350 La Jolla Village Drive, San Diego, California 92161, Voice: 858/642-1108, Fax: 858/552-7490,
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