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Liu S, Li R, Zheng J, Lu F, Sun H, Hua L, Lip GYH, Zhong P, Bai Y. Epidemiology of arrhythmogenic ventricular cardiomyopathy in China. Clin Cardiol 2024; 47:e24160. [PMID: 37915277 PMCID: PMC10766133 DOI: 10.1002/clc.24160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Arrhythmogenic ventricular cardiomyopathy (AVC) is a common cause of ventricular arrhythmias and mortality, but limited data are available from large Asian cohorts. Our aim was to explore the current status of AVC and second, we examined the prevalence of ventricular tachycardia (VT), heart failure (HF) and mortality in patients with AVC in the Chinese population. HYPOTHESIS At present, some studies have reported that the incidence of AVC is on the rise, which may be due to the increasing number of diagnostic methods for AVC. However, there is no epidemiological data on AVC in the Chinese population, so we speculate that the incidence of AVC in the Chinese population is increasing. METHODS AND RESULTS We studied 15 888 adults from the Beijing Municipal Health Commission Information Center (BMHCIC) registry database in China from January 2010 to December 2020, and calculated the average annual percentage change (AAPC). Second, we determined the incidence of VT, HF and mortality in patients with AVC. Of the 10 318 men and 5570 women who were screened by cardiac magnetic resonance or examined by myocardial biopsy, there were a total of 256 newly diagnosed AVC patients (mean [SD]: 37.54[17.10]; 39.45% female). The incidence of AVC increased from 7.60 (3.12-12.06) in 2010 to 19.62 (11.51-27.75) per 1000 person-years in 2020. Males had higher incidence of AVC than females. The AAPC for the rising incidence of AVC was 8.9 %. Males had similar VT prevalence (70.32% vs. 62.38%, p = 0.19) and mortality (1.94% vs. 1.98%, p = 0.98) but lower HF prevalence (42.58% vs. 60.40%, p = 0.006), when compared to females. Radiofrequency ablation (RFA) was more likely to be performed in males (p = 0.006). CONCLUSIONS The rising trend in AVC incidence was evident, with two-fold increase by 2020. Males with AVC had similar VT prevalence and mortality rate, but HF prevalence were lower than females, perhaps impacted by RFA use.
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Affiliation(s)
- Si‐Tong Liu
- Cardiovascular Center, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Rui Li
- Department of PathologyBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Jian‐Peng Zheng
- Beijing Municipal Health Commission Information CenterBeijingChina
| | - Feng Lu
- Beijing Municipal Health Commission Information CenterBeijingChina
| | - Hui‐Ni Sun
- School of Electronic and Information EngineeringBeijing Jiaotong UniversityBeijingChina
| | - Lin Hua
- School of Biomedical EngineeringCapital Medical UniversityBeijingChina
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular ScienceUniversity of LiverpoolLiverpoolUK
- Liverpool Heart & Chest HospitalLiverpool John Moores UniversityLiverpoolUK
- Department of Clinical MedicineDanish Center for Health Services Research, Aalborg UniversityAalborgDenmark
| | - Peng Zhong
- Clinical Medical LaboratoryBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Ying Bai
- Cardiovascular Center, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
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Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
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Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
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3
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Khan Z, Abumedian M, Yousif Y, Gupta A, Myo SL, Mlawa G. Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient Experiencing Out-of-Hospital Ventricular Fibrillation Arrest Twice: Case Report and Review of the Literature. Cureus 2022; 14:e21457. [PMID: 35223241 PMCID: PMC8857986 DOI: 10.7759/cureus.21457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
We present a case of a 62-year-old male who was admitted to the hospital with out-of-hospital ventricular fibrillation (VF) arrest. He had a VF arrest in 2011 and was admitted to another hospital. He had several investigations excluding cardiac magnetic resonance imaging, all of which were normal. He was playing tennis on both occasions when he experienced the VF arrest. His electrocardiogram on admission showed AF with partial right bundle branch block, inverted T waves in V1-V2, low voltage QRS complexes, ventricular ectopic in lead V1-V2, and prolonged QTc. His echocardiogram showed normal left ventricular function and a dilated right ventricle. Cardiac magnetic resonance imaging showed a dilated RV cavity size with impaired systolic function and dyskinetic region in the mid-ventricular free wall proximal to the insertion of the moderator band and late gadolinium enhancement in both right and left ventricles insertion points and mid-wall late gadolinium enhancement in the basal inferolateral wall suggestive of arrhythmogenic right ventricular cardiomyopathy. He had a single chamber VVI implantable cardioverter-defibrillator fitted for primary prevention and was discharged home. He had outpatient follow-up and showed good improvement and his implantable cardioverter-defibrillator checks were satisfactory and did not experience any shocks.
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Investigating the Accuracy of Quantitative Echocardiographic-Modified Task Force Criteria for Arrhythmogenic Ventricular Cardiomyopathy in Adolescent Male Elite Athletes. Pediatr Cardiol 2022; 43:457-464. [PMID: 34689217 PMCID: PMC8850234 DOI: 10.1007/s00246-021-02744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
Athlete preparticipation screening focuses on preventing sudden cardiac death (SCD) by detecting diseases such as arrhythmogenic ventricular cardiomyopathy (AVC), which affects primarily the right ventricular myocardium. Diagnosis may be obscured by physiological remodeling of the athlete heart. Healthy athletes may meet the 2010 Task Force Criteria right ventricular outflow tract (RVOT) dimension cut-offs, questioning the suitability of the modified Task Force Criteria (mTFC) in adolescent athletes. In this study, 67 male adolescent footballers undergoing preparticipation screening were reviewed. All athletes underwent a screening for resting ECG and echocardiogram according to the English FA protocol, as well as cardiopulmonary exercise testing, stress ECG, and exercise echocardiography. Athletes' right ventricular outflow tract (RVOT) that met the major AVC diagnostic criteria for dilatation were identified. Of 67 evaluated athletes, 7 had RVOT dilatation that met the major criteria, all in the long axis parasternal view measurement. All had normal right ventricular systolic function, including normal free-wall longitudinal strain (ranging from - 21.5 to - 32.7%). Left ventricular ejection fraction ranged from 52 to 67%, without evidence of structural changes. Resting ECGs and cardiopulmonary exercise tests were normal in all individuals. In a series of healthy athletes meeting the major AVC diagnostic criteria for RVOT dilatation, none had any other pathological changes on a detailed screening including ECG, exercise testing, and echocardiography. This report highlights that current AVC echocardiographic diagnosis criteria have limitations in this population.
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Seki A, Fishbein MC. Age-related cardiovascular changes and diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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6
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AlTurki A, Alotaibi B, Joza J, Proietti R. Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: Mechanisms and Management . RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2020. [DOI: 10.2147/rrcc.s198185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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7
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Chu YQ, Wang C, Li XM, Wang H. Propafenone-Induced QRS Widening in a Child With Arrhythmogenic Right Ventricular Cardiomyopathy: A Case Report and Literatures Review. Front Pediatr 2020; 8:481330. [PMID: 33194879 PMCID: PMC7661465 DOI: 10.3389/fped.2020.481330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/05/2020] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiac disease in children, and can lead to sudden cardiac death (SCD). Propafenone is classIC antiarrhythmic medication, and its side effects include cardiovascular compromise in the form of hypotension, bradycardia, ventricular dysrhythmias, QRS widening, and heart block. Propafenone has been reported causing QRS widening, but rarely in children. In this article, we presented a boy diagnosed with ARVC who meets diagnosis criteria based on typical symptoms, electrocardiograph (ECG), echocardiography (Echo), cardiac magnetic resonance imaging (CMRI), sudden death of first family member, and genetic mutation in desmosomal DSG2 gene. Antiarrhythmic drugs have been used for treating patients with ARVC, by eliminating or decreasing the occurring frequency of arrhythmias. As his ECG showed frequent premature ventricular contractions (PVC), he was prescribed with oral propafenone. One day after the drug treatment, he presented dizziness accompanied with significant QRS widening in ECG. His dizziness was improved when Propafenone dose was reduced, and resolved after sotalol replacement, with ECG recovered to nearly normal state of QRS. Propafenone may lead to QRS widening and increase the risk of ventricular tachycardia, and it may not reduce ARVC associated mortality. This report may serve as a precaution for clinicians when providing cares for ARVC patients.
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Affiliation(s)
- Yan-Qiu Chu
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Ce Wang
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xue-Mei Li
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Hong Wang
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
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8
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Thompson N, Frontera A, Takigawa M, Cheniti G, Massoullie G, Cochet H, Denis A, Chaumeil A, Derval N, Hocini M, Haissaguerre M, Jais P, Sacher F. Catheter Ablation for Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy. Card Electrophysiol Clin 2017; 9:47-54. [PMID: 28167085 DOI: 10.1016/j.ccep.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although catheter ablation has been successful in reducing the recurrence of ventricular tachycardia in patients with ischemic disease, outcomes in patients with nonischemic cardiomyopathy (NICM) have not met with the same results. Success is predicated on a methodical approach to diagnosis of disease type and identification of critical substrate, and the ablation strategies used. Cardiac MRI with delayed enhancement is able to identify areas of substrate involvement, particularly in situations when conventional catheter mapping is not able to do so. Radiofrequency needle, irrigated bipolar radiofrequency, and transcoronary alcohol ablation are effective and alternative techniques to endocardial and epicardial ablation.
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Affiliation(s)
- Nathaniel Thompson
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France.
| | - Antonio Frontera
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Masateru Takigawa
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Ghassen Cheniti
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Gregoire Massoullie
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Hubert Cochet
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Arnaud Denis
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Arnaud Chaumeil
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Nicolas Derval
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Meleze Hocini
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Michel Haissaguerre
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Pierre Jais
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
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Blaskovics I, Valchanov K. Anaesthesia for patients with arrhythmogenic right ventricular dysplasia. World J Anesthesiol 2016; 5:44-53. [DOI: 10.5313/wja.v5.i3.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/14/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited heart muscle disease. Myocyte apoptosis and fibro-fatty scar tissue predisposes patients to malignant ventricular arrhythmias. Patients may present to variety of surgical procedures with diagnosed ARVD. Surgical insult, catecholamine surge and physiological disturbance can be hazardous on the vulnerable myocardium and may result in life-threatening ventricular tachycardia or sudden cardiac death in the perioperative period. Anaesthetists have particular role in perioperative management of this patient population, meticulous perioperative planning, close haemodynamic monitoring and maintenance of physiological stability throughout helps to avoid devastating perioperative loss.
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10
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Restrepo CA. Capítulo 15. Utilidad del mapeo tridimensional en pacientes con miocardiopatía arritmogénica (displasia arritmogénica del ventrículo derecho). REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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11
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Do VBD, Tsai WC, Lin YJ, Higa S, Yagi N, Chang SL, Lo LW, Chung FP, Liao JN, Huang YC, Chan CS, Huang HK, Hu YF, Tsao HM, Chen SA. The Different Substrate Characteristics of Arrhythmogenic Triggers in Idiopathic Right Ventricular Outflow Tract Tachycardia and Arrhythmogenic Right Ventricular Dysplasia: New Insight from Noncontact Mapping. PLoS One 2015; 10:e0140167. [PMID: 26488594 PMCID: PMC4619190 DOI: 10.1371/journal.pone.0140167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM). Methods Thirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination. Results Overall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients. Conclusions/Interpretation The substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.
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Affiliation(s)
- Van Buu Dan Do
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chin Tsai
- Division of Cardiology, Department of Medicine, Hualien Tzu-Chi General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan
| | - Nobumori Yagi
- Division of Cardiovascular Medicine, Nakagami Hospital, Okinawa, Japan
| | - Shih-Lin Chang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Chang Huang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Shun Chan
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hung-Kai Huang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Ming Tsao
- Cardiology, National Yang Ming University Hospital, I-Lan, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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Comparison of radionuclide angiographic synchrony analysis to echocardiography and magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2015; 12:1268-75. [DOI: 10.1016/j.hrthm.2015.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 11/22/2022]
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13
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Albrecht LV, Zhang L, Shabanowitz J, Purevjav E, Towbin JA, Hunt DF, Green KJ. GSK3- and PRMT-1-dependent modifications of desmoplakin control desmoplakin-cytoskeleton dynamics. ACTA ACUST UNITED AC 2015; 208:597-612. [PMID: 25733715 PMCID: PMC4347645 DOI: 10.1083/jcb.201406020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Phosphorylation and methylation of desmoplakin are required for proper junction assembly and adhesion strengthening, and inhibition of these modifications might contribute to skin and heart diseases. Intermediate filament (IF) attachment to intercellular junctions is required for skin and heart integrity, but how the strength and dynamics of this attachment are modulated during normal and pathological remodeling is poorly understood. We show that glycogen synthase kinase 3 (GSK3) and protein arginine methyltransferase 1 (PRMT-1) cooperate to orchestrate a series of posttranslational modifications on the IF-anchoring protein desmoplakin (DP) that play an essential role in coordinating cytoskeletal dynamics and cellular adhesion. Front-end electron transfer dissociation mass spectrometry analyses of DP revealed six novel serine phosphorylation sites dependent on GSK3 signaling and four novel arginine methylation sites including R2834, the mutation of which has been associated with arrhythmogenic cardiomyopathy (AC). Inhibition of GSK3 or PRMT-1 or overexpression of the AC-associated mutant R2834H enhanced DP–IF associations and delayed junction assembly. R2834H blocked the GSK3 phosphorylation cascade and reduced DP–GSK3 interactions in cultured keratinocytes and in the hearts of transgenic R2834H DP mice. Interference with this regulatory machinery may contribute to skin and heart diseases.
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Affiliation(s)
- Lauren V Albrecht
- Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - Lichao Zhang
- Department of Chemistry and Department of Pathology, University of Virginia, Charlottesville, VA 22904
| | - Jeffrey Shabanowitz
- Department of Chemistry and Department of Pathology, University of Virginia, Charlottesville, VA 22904
| | - Enkhsaikhan Purevjav
- Department of Pediatrics (Cardiology), Baylor College of Medicine, Texas Children's Hospital, Houston, TX 45229
| | - Jeffrey A Towbin
- Department of Pediatrics (Cardiology), Baylor College of Medicine, Texas Children's Hospital, Houston, TX 45229
| | - Donald F Hunt
- Department of Chemistry and Department of Pathology, University of Virginia, Charlottesville, VA 22904 Department of Chemistry and Department of Pathology, University of Virginia, Charlottesville, VA 22904
| | - Kathleen J Green
- Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
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Tschabrunn CM, Marchlinski FE. Ventricular tachycardia mapping and ablation in arrhythmogenic right ventricular cardiomyopathy/dysplasia: Lessons Learned. World J Cardiol 2014; 6:959-967. [PMID: 25276297 PMCID: PMC4176805 DOI: 10.4330/wjc.v6.i9.959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/25/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is primarily believed to be an inherited cardiomyopathy that subsequently results in significant myocardial fibrosis. The arrhythmogenic consequences that result from the development of fibrosis are similar to other nonischemic cardiomyopathies, but the unique endocardial-epicardial disease process of ARVC/D requires a specialized approach for arrhythmia treatment in the electrophysiology laboratory. Although the association between ARVC/D and development of ventricular arrhythmias has become increasingly clear over the last 2 decades, our understanding of the arrhythmia mechanisms, underlying electrophysiologic substrate, and treatment strategies were significantly limited. Prospective studies performed in the electrophysiology laboratory allowed detailed characterization of the electrophysiologic and electroanatomic substrate underlying ventricular tachycardia in patients with ARVC/D. This has allowed clinician scientists to better characterize the arrhythmia mechanism and develop the necessary strategies to perform successful catheter ablation. Early in this experience, catheter ablation was considered a limited and largely unsuccessful treatment for patients experiencing painful and recurrent defibrillator therapy. Through our increased understanding of the disease process, catheter ablation has evolved to become an effective and preferred therapy for a majority of these patients. Our understanding of the disease and necessary approaches to provide successful treatment continues to evolve as the clinical experience grows. This article will review these important insights from the electrophysiology laboratory and how application of this knowledge has facilitated the development of a methodical approach to successfully perform ventricular tachycardia ablation in patients with ARVC/D.
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Borgquist R, Haugaa KH, Gilljam T, Bundgaard H, Hansen J, Eschen O, Jensen HK, Holst AG, Edvardsen T, Svendsen JH, Platonov PG. The diagnostic performance of imaging methods in ARVC using the 2010 Task Force criteria. Eur Heart J Cardiovasc Imaging 2014; 15:1219-25. [DOI: 10.1093/ehjci/jeu109] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Tomaszewska M, Czekajska-Chehab E, Olchowik G, Tomaszewski M, Drop A. Fatty foci within the heart diagnosed with ECG-gated multi-slice computed tomography: frequency and morphology. Med Sci Monit 2014; 20:833-42. [PMID: 24846568 PMCID: PMC4043540 DOI: 10.12659/msm.890271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of our study was to analyze the frequency of focal fatty replacement (FR) of the heart, as well as the distribution and detailed morphology of FR in a large group of patients referred to multi-slice computed tomography with ECG-gating examinations (ECG-MSCT) for various clinical reasons. MATERIAL AND METHODS The ECG-MSCT examinations of 1830 consecutive patients were analyzed. The examinations were performed using 8-row (1015 patients) and 64-row (815 patients) MSCT, in pre- and post-contrast scanning. We analyzed the morphology of FR, the dimensions and densities of changes, as well as the morphology and localization of FR with regard to clinical diagnosis. RESULTS 204 subjects (11.1%) had FR within the heart (113 men; 91 women; mean age 57.8 years); 66% of fatty foci were seen only in the native scanning. The distribution of the fat was: right ventricle (RV) 31.9%, left ventricle (LV) 21.5%, biventricular 39.7%, interventricular or atrial septum 5.9%, and atria 1%. In the RV, fat was localized mainly in the papillary muscles, while in the LV fat was mainly subendocardial (p<0.001). The morphology of the fat was: linear 61.6%, oval 14.8%, punctuate 10.6%, irregular 10.2%, and bilobular 2.8%. Fat was primarily located subendocardially in the LV in patients after myocardial infarction. In patients with suspected coronary artery disease, it was mainly observed subpericardially in the RV and in papillary muscles (p<0.001). CONCLUSIONS The incidental frequency of FR within the heart in patients diagnosed with the ECG-MSCT examinations is about 11%. Pre-contrast scanning is the most valuable for FR assessment.
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Affiliation(s)
- Monika Tomaszewska
- 1st Department of Radiology, Medical University of Lublin, Lublin, Poland
| | | | - Grażyna Olchowik
- Department of Biophysics, Medical University of Lublin, Lublin, Poland
| | - Marek Tomaszewski
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Andrzej Drop
- 1st Department of Radiology, Medical University of Lublin, Lublin, Poland
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Sadjadieh G, Jabbari R, Risgaard B, Olesen MS, Haunsø S, Tfelt-Hansen J, Winkel BG. Nationwide (Denmark) study of symptoms preceding sudden death due to arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol 2014; 113:1250-4. [PMID: 24513468 DOI: 10.1016/j.amjcard.2013.12.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/08/2013] [Accepted: 12/08/2013] [Indexed: 01/02/2023]
Abstract
In this study, we investigated medical history and symptoms before death in all subjects aged 1 to 35 years who died a sudden cardiac death (SCD) from arrhythmogenic right ventricular cardiomyopathy (ARVC) in Denmark in the years 2000 to 2006. All deaths (n=6,629) in subjects aged 1 to 35 years in Denmark in the period 2000 to 2006 were included. A total of 16 cases of SCD due to ARVC were identified based on histopathologic examination. Information on medical history was retrieved from The National Patient Registry, general practitioners, and hospitals. Symptoms before death were compared with 2 control groups in the same age group and time interval: one consisting of subjects who died in traffic accidents (n=74) and the other consisting of patients who died a SCD due to coronary artery disease (CAD; n=34). In the case group, 8 of the 16 patients with ARVC experienced antecedent cardiac symptoms and 7 of them sought medical attention. None were diagnosed with ARVC before death. Only 1 patient in the healthy control group and 31 of the 39 patients with CAD experienced cardiac symptoms before death. A total of 6 patients of the 16 with ARVC died during strenuous physical activity and 4 of the deaths were sports-related SCDs. In conclusion, antecedent cardiac symptoms before SCD in the young were seen in 1/2 of the patients who died because of ARVC, and this is significantly higher than in the healthy control group. When considering the ARVC and CAD groups collectively, antecedent cardiac symptoms are seen in the majority.
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Affiliation(s)
- Golnaz Sadjadieh
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Reza Jabbari
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bjarke Risgaard
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten S Olesen
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stig Haunsø
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo G Winkel
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Israel CW. Mechanisms of sudden cardiac death. Indian Heart J 2014; 66 Suppl 1:S10-7. [PMID: 24568819 DOI: 10.1016/j.ihj.2014.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/21/2014] [Indexed: 02/06/2023] Open
Abstract
Worldwide, sudden cardiac death (SCD) is a major problem. It is most frequently caused by ventricular tachyarrhythmias: Monomorphic and polymorphic ventricular tachycardia (VT), torsade de pointes (TdP), and ventricular fibrillation (VF). Beta blockade, ACE inhibition, coronary reperfusion and other treatments have reduced the incidence of VT but pulseless electrical activity (PEA) is increasingly seen, particularly in patients with advanced chronic heart disease. From existing data, bradyarrhythmia in the form of asystole (usually complete heart block without escape rhythm) causes only a minor proportion (10-15%) of SCD. In patients aged 50 years and more, coronary artery disease plays a dominant role causing more than 75% of SCD cases, either by acute ischemia and ventricular fibrillation or by chronic scar formation and reentrant VT. In younger patients, SCD may occur in patients with structurally normal hearts. A number of arrhythmogenic disorders with an increased risk of SCD have been detected and better understood recently, such as long and short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and the early repolarization syndrome. Most importantly, ECG signs and clinical features indicating high risk for SCD have been identified. Knowledge of the exact electrophysiologic mechanisms of ventricular tachyarrhythmias at the cellular level has been improved and mechanisms such as phase 2 reentry and reflection proposed to better understand why and how SCD occurs.
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Affiliation(s)
- Carsten W Israel
- Assistant Professor, Dept. of Medicine, Div. of Cardiology, Evangelical Hospital Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
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Rao U, Agarwal S, Gilbert TJ. Arrhythmogenic right ventricular cardiomyopathy (ARVC): case report and review of literature. HEART ASIA 2014; 6:145-9. [PMID: 27326192 DOI: 10.1136/heartasia-2014-010569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/14/2014] [Indexed: 11/03/2022]
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited condition characterised by fibrofatty replacement of the right ventricle. It causes sudden death in 30% of young adults and in 5% of those less than 65 years of age. As the presentation is non-specific, ARVD can be a diagnostic challenge leading to delayed treatment. We report a case along with the review of literature, of a 63-year-old man who presented (atypical) with a history of palpitations, dizziness and raised cardiac enzymes associated with ECG changes in the inferior and anterior leads. Further investigation helped in confirming this rare and potentially fatal cardiac condition.
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Affiliation(s)
- Usha Rao
- Department of Cardiology , University Hospital of Norfolk & Norwich , Norwich , UK
| | - S Agarwal
- Department of Cardiology , Papworth Hospital , Cambridge , UK
| | - T J Gilbert
- Department of Cardiology , University Hospital of Norfolk & Norwich , Norwich , UK
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21
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Cabanelas N, Vidigal Ferreira MJ, Donato P, Gaspar A, Pinto J, Caseiro-Alves F, Providência LA. Added value of cardiac magnetic resonance in etiological diagnosis of ventricular arrhythmias. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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22
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Cabanelas N, Vidigal Ferreira MJ, Donato P, Gaspar A, Pinto J, Caseiro-Alves F, Providência LA. A ressonância magnética cardíaca como uma mais-valia no diagnóstico etiológico de arritmias ventriculares. Rev Port Cardiol 2013; 32:785-91. [DOI: 10.1016/j.repc.2012.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/11/2012] [Indexed: 11/30/2022] Open
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Valchanov K, Goddard M, Ghosh S. Anesthesia for heart transplantation in patients with arrhythmogenic right ventricular dysplasia. J Cardiothorac Vasc Anesth 2013; 28:355-7. [PMID: 23994174 DOI: 10.1053/j.jvca.2013.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Kamen Valchanov
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom.
| | - Martin Goddard
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
| | - Sunit Ghosh
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
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Freel KM, Morrison LR, Thompson H, Else RW. Arrhythmogenic right ventricular cardiomyopathy as a cause of unexpected cardiac death in two horses. VETERINARY RECORD CASE REPORTS 2013. [DOI: 10.1136/vetreccr.c3000rep] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K. M. Freel
- Department of PathologyRoyal (Dick) School of Veterinary StudiesUniversity of EdinburghEaster BushRoslinMidlothianEH25 9RG
| | - L. R. Morrison
- Department of PathologyRoyal (Dick) School of Veterinary StudiesUniversity of EdinburghEaster BushRoslinMidlothianEH25 9RG
| | - H. Thompson
- Department of PathologyFaculty of Veterinary MedicineUniversity of Glasgow464 Bearsden RoadGlasgowG61 1QH
| | - R. W. Else
- Department of PathologyRoyal (Dick) School of Veterinary StudiesUniversity of EdinburghEaster BushRoslinMidlothianEH25 9RG
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Reyhan M, Natsuaki Y, Ennis DB. Off-resonance insensitive complementary SPAtial Modulation of Magnetization (ORI-CSPAMM) for quantification of left ventricular twist. J Magn Reson Imaging 2013; 39:339-45. [PMID: 23625854 DOI: 10.1002/jmri.24154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/05/2013] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate Off Resonance Insensitive Complementary SPAtial Modulation of Magnetization (ORI-CSPAMM) and Fourier Analysis of STimulated echoes (FAST) for the quantification of left ventricular (LV) systolic and diastolic function and compare it with the previously validated FAST+SPAMM technique. MATERIALS AND METHODS LV short-axis tagged images were acquired with ORI-CSPAMM and SPAMM in healthy volunteers (n = 13). The FAST method was used to automatically estimate LV systolic and diastolic twist parameters from rotation of the stimulated echo and stimulated anti-echo about the middle of k-space subsequent to ∼3 min of user interaction. RESULTS There was no significant difference between measures obtained for FAST+ORI-CSPAMM and FAST+SPAMM for mean peak twist (12.9 ± 3.4° versus 11.9 ± 4.0°; P = 0.4), torsion (3.3 ± 0.9°/cm versus 2.9 ± 1.0°/cm, P = 0.3), circumferential-longitudinal shear angle (9.1 ± 3.0° versus 8.2 ± 3.4°, P = 0.3), twisting rate (79.6 ± 20.2°/s versus 68.2 ± 23.4°/s, P = 0.1), untwisting rate (-117.5 ± 31.4°/s versus -106.6 ± 32.4°/s, P = 0.3), normalized untwisting rate (-9.3 ± 2.0/s versus -9.9 ± 4.4/s, P = 0.7), and time of peak twist (281 ± 18 ms versus 293 ± 25 ms, P = 0.04). FAST+ORI-CSPAMM also provided measures of duration of untwisting (148 ± 21 ms) and the ratio of rapid untwisting to peak twist (0.9 ± 0.3). Bland-Altman analysis of FAST+ORI-CSPAMM and FAST+SPAMM twist data demonstrates excellent agreement with a bias of -0.1° and 95% confidence intervals of (-1.0°, 3.2°). CONCLUSION FAST+ORI-CSPAMM is a semi-automated method that provides a quick and quantitative assessment of LV systolic and diastolic twist and torsion. ORI-CSPAMM corrects off-resonance accrued during tagging preparation and readout and visibly removes chemical shift from the tagging pattern, which confers greater robustness to the derived quantitative measures.
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Affiliation(s)
- Meral Reyhan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA; Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA
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Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare adrenergically mediated arrhythmogenic disorder classically induced by exercise or emotional stress and found in structurally normal hearts. It is an important cause of cardiac syncope and sudden death in childhood. Catecholaminergic polymorphic ventricular tachycardia is a genetic cardiac channelopathy with known mutations involving genes affecting intracellular calcium regulation. We present a case of a 14-year-old boy who had cardiopulmonary arrest after an emotionally induced episode of CPVT while attempting to invite a girl to the school dance. Review of his presenting cardiac rhythm, induction of concerning ventricular arrhythmias during an exercise stress test, and genetic testing confirmed the diagnosis of CPVT. He recovered fully and was treated with β-blocker therapy and placement of an implantable cardioverter-defibrillator. In this report, we discuss this rare but important entity, including its molecular foundation, clinical presentation, basics of diagnosis, therapeutic options, and implications of genetic testing for family members. We also compare CPVT to other notable cardiomyopathic and channelopathic causes of sudden death in youth including hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, long QT syndrome, short QT syndrome, and Brugada syndrome.
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28
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Marek J, Bufalino V, Davis J, Marek K, Gami A, Stephan W, Zimmerman F. Feasibility and findings of large-scale electrocardiographic screening in young adults: Data from 32,561 subjects. Heart Rhythm 2011; 8:1555-9. [DOI: 10.1016/j.hrthm.2011.04.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
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Abstract
The transcriptional regulation orchestrating the development of the heart is increasingly recognized to play an essential role in the regulation of ion channel and gap junction gene expression and consequently the proper generation and conduction of the cardiac electrical impulse. This has led to the realization that in some instances, abnormal cardiac electrical function and arrhythmias in the postnatal heart may stem from a developmental abnormality causing maintained (epigenetic) changes in gene regulation. The role of developmental genes in the regulation of cardiac electrical function is further underscored by recent genome-wide association studies that provide strong evidence that common genetic variation, at loci harbouring these genes, modulates electrocardiographic indices of conduction and repolarization and susceptibility to arrhythmia. Here we discuss recent findings and provide background insight into these complex mechanisms.
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Affiliation(s)
- Alex V Postma
- Heart Failure Research Center, Academic Medical Center, Amsterdam, The Netherlands
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30
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Abstract
Sudden cardiac death (SCD) is a leading cause of mortality in industrialized countries, and ventricular fibrillation and sustained ventricular tachycardia are the major causes of SCD. Although there are now effective devices and medications that can prevent such serious arrhythmias, it is crucial to have methods of identifying patients at risk. Numerous studies suggest that most patients dying of SCD have coronary artery disease or cardiomyopathy. Functional or electrophysiological measurements are effective in risk stratification. Left ventricular ejection fraction measured by echocardiography or cardiac imaging techniques is the gold standard to detect high-risk patients. Electrophysiological studies have also been used for risk stratification. Noninvasive techniques and measurements, such as T-wave alternans, signal-averaged electrocardiography, nonsustained ventricular tachycardia, heart rate variability, and heart rate turbulence, have been proposed as useful tools in identifying patients at risk for SCD. This article reviews the epidemiology, mechanisms, substrates, and current status of risk stratification of SCD.
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Affiliation(s)
- Takanori Ikeda
- Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan.
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31
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Nair M, Yaduvanshi A, Kataria V, Kumar M. Radiofrequency catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy using non-contact electroanatomical mapping: single-center experience with follow-up up to median of 30 months. J Interv Card Electrophysiol 2011; 31:141-7. [PMID: 21437652 PMCID: PMC3141829 DOI: 10.1007/s10840-011-9556-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 02/10/2011] [Indexed: 02/07/2023]
Abstract
Objective of study To evaluate the efficacy of radiofrequency ablation (RFA) of ventricular tachycardia (VT) using non-contact electro-anatomic mapping in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Methods Fifteen consecutive patients (44 ± 15 years) with ARVD/C and symptomatic VTs were studied. Eight patients had syncopal VTs. Two patients had recurrent VT while on AICD; in three patients, RFA was done prior to AICD implantation, and ten patients refused AICD. After obtaining activation maps, first, the clinical VT was targeted, and then, other VTs were sought. Results Twenty-five inducible VTs were mapped, and 22 of them were successfully ablated. In 13 out of 15 patients, all the clinical and inducible VTs were ablated. In two patients, non-clinical inducible VTs could not be ablated. At 25 ± 16 months (2–52 months), all patients remained asymptomatic. Antiarrhythmic medications were discontinued after 6 months. Two patients had recurrence of non-clinical VT on follow-up. There were no episodes of asymptomatic VT recorded in five patients with AICD. Conclusion A majority of induced VT in patients with ARVD/C can be successfully mapped and ablated using the non-contact Ensite Array Mapping system with good long-term VT-free outcome. Ablation can be a useful adjunct to AICD implantation in such patients.
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Affiliation(s)
- Mohan Nair
- Department of Cardiology, Max Healthcare, New Delhi, India.
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Cardiac magnetic resonance imaging in daily practice in a peripheral medical centre: description of the first 383 patients. Neth Heart J 2010; 18:524-30. [PMID: 21113376 DOI: 10.1007/s12471-010-0828-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging has evolved over the last decade into an indispensable diagnostic instrument. CMR imaging noninvasively provides structural, functional and morphological information with high spatial resolution and an unlimited field of view. Since October 2006 the VieCuri Medical Centre in Venlo has a CMR scanner at its disposal. OBJECTIVES The goal of this study was to analyse the impact of CMR imaging on diagnosis and treatment in daily practice in the setting of a medium-volume peripheral hospital. METHODS All patients who underwent CMR imaging between October 2006 and November 2008 were included in this analysis. The medical history before and after the CMR scan, the application form for CMR imaging and the outcome of the scans were reviewed. CMR images, obtained using a 1.5-T magnetic resonance imaging system, were reviewed by a multidisciplinary team. RESULTS In 235 patients CMR imaging demonstrated one or more abnormalities, whereas CMR imaging did not identify any abnormalities in 148 patients. CMR imaging confirmed an expected finding in 166 cases, identified an unexpected condition in 69 cases, ruled out an expected finding in 59 cases and ruled out a suspected condition in 89 cases. Due to better insight into diagnosis, CMR imaging resulted in a change of treatment in 166 of the total of 383 CMR scans (43%). CONCLUSION In a relevant number of cases CMR imaging leads to a change in the treatment of a patient, proving the value of CMR imaging as a diagnostic modality. Therefore, CMR imaging is an excellent opportunity for peripheral medical centres to improve efficiency and the standard of patient care. (Neth Heart J 2010;18:524-30.).
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Polin GM, Haqqani H, Tzou W, Hutchinson MD, Garcia FC, Callans DJ, Zado ES, Marchlinski FE. Endocardial unipolar voltage mapping to identify epicardial substrate in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart Rhythm 2010; 8:76-83. [PMID: 20933099 DOI: 10.1016/j.hrthm.2010.09.088] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/29/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND The risk and success of epicardial substrate ablation for ventricular tachycardia (VT) support the value of techniques identifying the epicardial substrate with endocardial mapping. OBJECTIVE The purpose of this study was to test the hypothesis that endocardial unipolar voltage mapping in patients with right ventricular (RV) VT and preserved endocardial bipolar voltage abnormalities might identify the extent of epicardial bipolar voltage abnormality. METHODS Using a cutoff of < 5.5 mV for normal endocardial unipolar voltage derived from 8 control patients without structural heart disease, 10 patients with known ARVC/D (group 1, retrospective) and 13 patients with RV VT (group 2, prospective) with modest or no endocardial bipolar voltage abnormalities underwent detailed endocardial and epicardial mapping. RESULTS The area of epicardial unipolar voltage abnormality in all 10 group 1 patients with ARVC/D (62 ± 21 cm²) and in 9 of the 13 group 2 patients (8 with criteria for ARVC/D) (53 ± 21 cm²) was on average three times more extensive than the endocardial bipolar abnormality and correlated (r = 0.63, P <.05 and r = 0.81, P <.008, respectively) with the larger area epicardial bipolar abnormality with respect to size (group 1: 82 ± 22 cm²; group 2: 68 ± 41 cm²) and location. In the remaining 4 group 2 patients and 3 additional reference patients without structural heart disease, endocardial bipolar, endocardial unipolar, and, as predicted, epicardial bipolar voltage all were normal. CONCLUSION Endocardial unipolar mapping with cutoff of 5.5 mV identifies more extensive areas of epicardial bipolar signal abnormalities in patients with ARVC/D and limited endocardial VT substrate.
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Affiliation(s)
- Glenn M Polin
- Section of Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Morales A, Pinto JR, Siegfried JD, Li D, Norton N, Hofmeyer M, Vallin M, Morales AR, Potter JD, Hershberger RE. Late onset sporadic dilated cardiomyopathy caused by a cardiac troponin T mutation. Clin Transl Sci 2010; 3:219-26. [PMID: 20973921 PMCID: PMC2965560 DOI: 10.1111/j.1752-8062.2010.00228.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Mutations in TNNT2, encoding cardiac troponin T, commonly shows early onset, aggressive dilated cardiomyopathy (DCM). This observation may influence the decision of whether to undertake clinical genetic testing for TNNT2 in later onset DCM. Further, the trigger for late onset DCM remains enigmatic. A 70-year-old woman, previously healthy with a left ventricular ejection fraction of 50%-55% at age 69, presented with DCM of unknown cause and a 4-month history progressive heart failure requiring cardiac transplantation. Clinical genetic testing revealed a novel TNNT2 R139H mutation but no relevant variants in 18 other DCM genes. Her explanted heart showed partial fatty replacement in the right ventricle. Sequencing for five arrhythmogenic right ventricular dysplasia genes was negative. Functional studies in porcine cardiac skinned fibers reconstituted with the mutant R139H troponin T protein showed decreased Ca(2+) sensitivity at pH 7, characteristic of DCM. Because fatty infiltration may acidify the myocellular environment, maximal force development examined at pH 6.5 was diminished, suggesting a possible environmental trigger. We conclude that the TNNT2 R139H mutation was likely to be disease causing. Further, later age of onset may not be relevant to exclude genetic testing for TNNT2 mutations.
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Affiliation(s)
- Ana Morales
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, USA
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Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, Pagani FD, Piña IL, Semigran MJ, Walsh MN, Wiener DH, Yancy CW. ACCF/AHA/ACP/HFSA/ISHLT 2010 clinical competence statement on management of patients with advanced heart failure and cardiac transplant: a report of the ACCF/AHA/ACP Task Force on Clinical Competence and Training. Circulation 2010; 122:644-72. [PMID: 20644017 DOI: 10.1161/cir.0b013e3181ecbd97] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
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- American College of Cardiology Foundation, USA
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Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, Pagani FD, Piña IL, Semigran MJ, Walsh MN, Wiener DH, Yancy CW. ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant. J Am Coll Cardiol 2010; 56:424-53. [DOI: 10.1016/j.jacc.2010.04.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Arrhythmogenic right ventricular cardiomyopathy. COR ET VASA 2010. [DOI: 10.33678/cor.2010.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Palpitaciones recurrentes y síncope en la miocardiopatía arritmogénica del ventrículo derecho: las cosas no son siempre como parecen. Rev Clin Esp 2010; 210:e31-2. [DOI: 10.1016/j.rce.2010.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 03/17/2010] [Accepted: 04/11/2010] [Indexed: 11/23/2022]
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Freel KM, Morrison LR, Thompson H, Else RW. Arrhythmogenic right ventricular cardiomyopathy as a cause of unexpected cardiac death in two horses. Vet Rec 2010; 166:718-21. [PMID: 20525948 DOI: 10.1136/vr.c3000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Postmortem and histological examination of the hearts from two horses, a five-year-old Clydesdale gelding and a 15-year-old cob gelding, revealed changes characteristic of arrhythmogenic right ventricular cardiomyopathy. In both cases, on gross examination, the right ventricular endocardium and interventricular septum were almost entirely replaced with a gelatinous yellow fibroareolar tissue. This tissue was histologically a combination of fibrous and adipose tissue that had replaced the normal myofibres and disrupted the Purkinje fibres.
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Affiliation(s)
- K M Freel
- Department of Pathology, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Roslin, Midlothian EH25 9RG.
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Stein M, Boulaksil M, Jansen JA, Herold E, Noorman M, Joles JA, van Veen TAB, Houtman MJC, Engelen MA, Hauer RNW, de Bakker JMT, van Rijen HVM. Reduction of fibrosis-related arrhythmias by chronic renin-angiotensin-aldosterone system inhibitors in an aged mouse model. Am J Physiol Heart Circ Physiol 2010; 299:H310-21. [PMID: 20435847 DOI: 10.1152/ajpheart.01137.2009] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Myocardial fibrosis increases arrhythmia vulnerability of the diseased heart. The renin-angiotensin-aldosterone system (RAAS) governs myocardial collagen synthesis. We hypothesized that reducing cardiac fibrosis by chronic RAAS inhibition would result in reduced arrhythmia vulnerability of the senescent mouse heart. Wild-type mice (52 wk old) were treated for 36 wk: 1) untreated control (C); 2) eplerenone (E); 3) losartan (L); and 4) cotreatment with eplerenone and losartan (EL). Ventricular epicardial activation mapping was performed on Langendorff-perfused hearts. Arrhythmia inducibility was tested by one to three premature stimuli and burst pacing. Longitudinal and transverse conduction velocity and dispersion of conduction were determined during pacing at a basic cycle length of 150 ms. Sirius red staining (collagen) was performed. As a result, in the RV of mice in the E, L, and EL groups, transverse conduction velocity was significantly increased and anisotropic ratio was significantly decreased compared with those values of mice in the C group. Anisotropic reentrant arrhythmias were induced in 52% of untreated mice and significantly reduced to 22%, 26%, and 16% in the E, L, and EL groups, respectively. Interstitial fibrosis was significantly decreased in both the RV and LV of all treated groups. Scattered patches of replacement fibrosis were found in 90% of untreated hearts, which were significantly reduced in the E, L, and EL groups. A strong correlation between the abundance of patchy fibrosis and arrhythmia inducibility was found. In conclusion, chronic RAAS inhibition limited aging-related interstitial fibrosis. The lower arrhythmogeneity of treated mice was directly correlated to the reduced amount of patchy fibrosis.
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Affiliation(s)
- Mera Stein
- Div. of Heart & Lungs, Dept. of Medical, Physiology, Univ. Medical Ctr. Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands
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Tratamiento basado en la evidencia de la insuficiencia cardiaca derecha: una revisión sistemática de un campo empírico. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70066-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Arbelo E, Josephson ME. Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia. J Cardiovasc Electrophysiol 2010; 21:473-86. [PMID: 20132399 DOI: 10.1111/j.1540-8167.2009.01694.x] [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] [Indexed: 12/29/2022]
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is a genetically determined myocardial disease characterized by fibrofatty replacement of the right ventricular wall. Ventricular tachyarrhythmias can be seen in the early stages of the disease, which is one of the most important causes of sudden death in young healthy individuals. Radiofrequency (RF) catheter ablation is an option for the treatment of medically refractory ventricular arrhythmias and it has shown to successfully abolish recurrent ventricular tachycardias (VT) as well as reduce the frequency in defibrillator therapies. However, variable acute and long-term success rates have been reported. The current mapping and ablation techniques include activation and entrainment mapping during tolerated VT and substrate ablation using 3-dimensional electroanatomic mapping systems. This article aims at providing a comprehensive review of RF catheter ablation of ventricular arrhythmias in the context of ARVD.
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Affiliation(s)
- Elena Arbelo
- Cardiology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
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Hershberger RE, Cowan J, Morales A, Siegfried JD. Progress with genetic cardiomyopathies: screening, counseling, and testing in dilated, hypertrophic, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Heart Fail 2009; 2:253-61. [PMID: 19808347 DOI: 10.1161/circheartfailure.108.817346] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This review focuses on the genetic cardiomyopathies: principally dilated cardiomyopathy, with salient features of hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia/cardiomyopathy, regarding genetic etiology, genetic testing, and genetic counseling. Enormous progress has recently been made in identifying genetic causes for each cardiomyopathy, and key phenotype and genotype information is reviewed. Clinical genetic testing is rapidly emerging with a principal rationale of identifying at-risk asymptomatic or disease-free relatives. Knowledge of a disease-causing mutation can guide clinical surveillance for disease onset, thereby enhancing preventive and treatment interventions. Genetic counseling is also indicated for patients and their family members regarding the symptoms of their cardiomyopathy, its inheritance pattern, family screening recommendations, and genetic testing options and possible results.
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Affiliation(s)
- Ray E Hershberger
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Fla 33136, USA.
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Tops LF, Prakasa K, Tandri H, Dalal D, Jain R, Dimaano VL, Dombroski D, James C, Tichnell C, Daly A, Marcus F, Schalij MJ, Bax JJ, Bluemke D, Calkins H, Abraham TP. Prevalence and pathophysiologic attributes of ventricular dyssynchrony in arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 2009; 54:445-51. [PMID: 19628120 DOI: 10.1016/j.jacc.2009.04.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/06/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study sought to investigate the prevalence and mechanisms underlying right ventricular (RV) dyssynchrony in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using tissue Doppler echocardiography (TDE). BACKGROUND An ARVD/C is characterized by fibrofatty replacement of RV myocardium and RV dilation. These pathologic changes may result in electromechanical dyssynchrony. METHODS Echocardiography, both conventional and TDE, was performed in 52 ARVD/C patients fulfilling Task Force criteria and 25 control subjects. The RV end-diastolic and -systolic areas, right ventricular fractional area change (RVFAC), and left ventricular (LV) volumes and function were assessed. Mechanical synchrony was assessed by measuring differences in time-to-peak systolic velocity (T(SV)) between the RV free wall, ventricular septum, and LV lateral wall. An RV dyssynchrony was defined as the difference in T(SV) between the RV free wall and the ventricular septum, >2 SD above the mean value for control subjects. RESULTS The mean difference in RV T(SV) was higher in ARVD/C compared with control subjects (55 +/- 34 ms vs. 26 +/- 15 ms, p < 0.001). Significant RV dyssynchrony was not noted in any of the control subjects. Based on a cutoff value of 56 ms, significant RV dyssynchrony was present in 26 ARVD/C patients (50%). Patients with RV dyssynchrony had a larger RV end-diastolic area (22 +/- 5 cm(2) vs. 19 +/- 4 cm(2), p = 0.02), and lower RVFAC (29 +/- 8% vs. 34 +/- 8%, p = 0.03) compared with ARVD/C patients without RV dyssynchrony. No differences in QRS duration, LV volumes, or function were present between the 2 groups. CONCLUSIONS An RV dyssynchrony may occur in up to 50% of ARVD/C patients, and is associated with RV remodeling. This finding may have therapeutic and prognostic implications in ARVD/C.
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Affiliation(s)
- Laurens F Tops
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Koulouris S, Pastromas S, Sakellariou D, Kratimenos T, Manolis AS. Arrhythmogenic right ventricular cardiomyopathy in an octogenarian presenting with ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:e43-7. [PMID: 19744268 DOI: 10.1111/j.1540-8159.2009.02540.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is one of the major causes of sudden death. Myocardial atrophy with subsequent fibro-fatty replacement predominantly affects right ventricular myocardium and results in global and regional dysfunction as well as areas of slow conduction and dispersion of refractoriness, which are prerequisites for reentrant ventricular tachyarrhythmias. ARVC is commonly presented in patients <65 years old. However, few cases of elderly people suffering from this cardiomyopathy have been reported in the literature. We present a case of an 82-year-old woman with sustained ventricular tachycardia due to first diagnosed ARVC.
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Stoughton SJ. Arrhythmogenic Right Ventricular Cardiomyopathy. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2009. [DOI: 10.1177/8756479309344098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiac muscle disorder. Damaged myocardium is replaced by scar tissue and fat. ARVC was discovered in the late 1970s on postmortem examinations of young athletes who had died suddenly. This disease has since been observed to affect the left ventricle as well.
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Marcus GM, Glidden DV, Polonsky B, Zareba W, Smith LM, Cannom DS, Estes NAM, Marcus F, Scheinman MM. Efficacy of antiarrhythmic drugs in arrhythmogenic right ventricular cardiomyopathy: a report from the North American ARVC Registry. J Am Coll Cardiol 2009; 54:609-15. [PMID: 19660690 DOI: 10.1016/j.jacc.2009.04.052] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 03/16/2009] [Accepted: 04/03/2009] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study sought to examine the efficacy of empiric antiarrhythmic drugs in a rigorously characterized cohort of arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. BACKGROUND Antiarrhythmic drugs are important in protecting against ventricular arrhythmias in ARVC, but no studies have provided data in a group rigorously screened for the disease. METHODS Antiarrhythmic medicines were examined in all subjects with implantable cardioverter-defibrillators (ICDs) enrolled in the North American ARVC Registry. A Cox proportional hazards model was used to account for time on each drug, and a hierarchical analysis was performed for repeated measures within individuals. RESULTS Ninety-five patients were studied, with a mean follow-up of 480 +/- 389 days. Fifty-eight (61%) received beta-blockers, and these medicines were not associated with an increased or decreased risk of ventricular arrhythmias. Sotalol was associated with a greater risk of any clinically relevant ventricular arrhythmia as defined by sustained ventricular tachycardia or ICD therapy (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.02 to 6.39, p = 0.045), but this was not statistically significant after adjusting for potential confounders. An increased risk of any ICD shock and first clinically relevant ventricular arrhythmia while on sotalol remained significant after multivariable adjustment. Those on amiodarone (n = 10) had a significantly lower risk of any clinically relevant ventricular arrhythmia (HR: 0.25, 95% CI: 0.07 to 0.95, p = 0.041), a finding that remained significant after multivariable adjustment. CONCLUSIONS In a cohort of well-characterized ARVC subjects, neither beta-blockers nor sotalol seemed to be protective. Evidence from a small number of patients suggests that amiodarone has superior efficacy in preventing ventricular arrhythmias.
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Affiliation(s)
- Gregory M Marcus
- Division of Cardiology, Electrophysiology Section, University of California, San Francisco, CA 94143-1354, USA.
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Wei YJ, Cui CJ, Huang YX, Zhang XL, Zhang H, Hu SS. Upregulated expression of cardiac ankyrin repeat protein in human failing hearts due to arrhythmogenic right ventricular cardiomyopathy. Eur J Heart Fail 2009; 11:559-66. [PMID: 19359327 DOI: 10.1093/eurjhf/hfp049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Expression of cardiac ankyrin repeat protein (CARP) is augmented in heart failure due to dilated or ischaemic cardiomyopathy. It is unclear whether CARP is upregulated in heart failure due to arrhythmogenic right ventricular cardiomyopathy (ARVC). In the present study, we investigated the expression pattern of CARP and the correlation between CARP and the well-known heart failure marker pro-atrial natriuretic peptide (proANP) in ARVC failing hearts. METHODS AND RESULTS Gene microarray analysis demonstrated increased CARP expression in ARVC failing hearts compared with non-failing control hearts, which was further validated by real-time RT-PCR, western blot, and ELISA at the mRNA and protein levels. Fractionation experiments revealed that the upregulation of CARP expression is restricted to the nuclei of residual cardiac cells in ARVC failing hearts. Regression analysis showed a positive correlation between CARP and proANP in ARVC failing hearts. CONCLUSION Augmented CARP expression may be a common molecular event in failing hearts regardless of cardiomyopathic aetiology. The upregulation of nuclear CARP expression and positive correlation between cardiac CARP and proANP suggests that CARP may be used as a genetic marker existing in the nuclei in contrast to proANP existing in the cytosol of cardiac cells in heart failure patients.
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Affiliation(s)
- Ying-Jie Wei
- Key Laboratory of Cardiovascular Regenerative Medicine, Chinese Academy of Medical Science, Peking Union Medical College, Fuwai Hospital & Cardiovascular Institute, Ministry of Health, Beijing 100037, People's Republic of China.
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