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Zhang M, Zhang L, Hu Y, Wang Y, Xu S, Xie X, Xu T, Li Z, Jin H, Liu H. Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis. PeerJ 2022; 10:e14429. [PMID: 36444383 PMCID: PMC9700452 DOI: 10.7717/peerj.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sarcopenia is prevalent and is associated with the occurrence of cardiovascular complications in patients undergoing maintenance hemodialysis (MHD). It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function. This study aimed to evaluate the association between sarcopenia and cardiac structure and function in patients undergoing MHD. We also examined the prognostic role of sarcopenia for mortality and cardiovascular events (CVE) in this population. Methods Participants from a single center underwent bioimpedance body composition analysis to measure skeletal muscle and echocardiography to assess myocardial structure and function. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia criteria. The end points were all-cause mortality and CVE. Results Of the 158 participants, 46 (29.1%) had sarcopenia, 102 (64.6%) had left ventricular diastolic dysfunction (LVDD), and 106 (67.0%) had left ventricular hypertrophy (LVH). Participants with sarcopenia had smaller right ventricular sizes (2.54 ± 0.77 vs 2.76 ± 0.28; P < 0.01), inter-ventricular thickness (1.07 ± 0.19 vs 1.14 ± 0.20; P = 0.039), and left ventricular posterior wall thickness (0.96, 0.89-1.10 vs 1.06, 0.95-1.20; P = 0.018). Skeletal muscle mass was strongly correlated with left ventricular mass (LVM) (r = 0.577; P < 0.0001). Furthermore, the risk of LVDD (OR: 4.92, 95% confidence interval (CI) [1.73-13.95]) and LVH (OR: 4.88, 95% CI [1.08-21.96]) was much higher in the sarcopenic group than in the non-sarcopenic group. During a follow-up period of 18 months, 11 (6.9%) patients died, of which seven died (4.4%) of CVE, and 36 (22.8%) experienced CVE. The presence of sarcopenia (adjusted hazard ratio (HR), 6.59; 95% CI [1.08-39.91]; P = 0.041) and low skeletal muscle index (HR, 3.41; 95% CI [1.01-11.57]; P = 0.049) and handgrip strength (HR, 0.88; 95% CI [0.78-0.99]; P = 0.037) independently predicted death. Sarcopenia was a significant predictor of CVE (HR, 10.96; 95% CI [1.14-105.10]; P = 0.038). Conclusion Our findings demonstrated that sarcopenia is associated with LVDD and LVH, and is associated with a higher probability of death and CVE.
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Affiliation(s)
- Mengyan Zhang
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Liuping Zhang
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Yezi Hu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nutrition, Nanjing, Jiangsu Province, China
| | - Ying Wang
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Shengchun Xu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Xiaotong Xie
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Tian Xu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Zuolin Li
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Hui Jin
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nutrition, Nanjing, Jiangsu Province, China
| | - Hong Liu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
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Garg P, Gosling R, Swoboda P, Jones R, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ. Cardiac magnetic resonance identifies raised left ventricular filling pressure: prognostic implications. Eur Heart J 2022; 43:2511-2522. [PMID: 35512290 PMCID: PMC9259376 DOI: 10.1093/eurheartj/ehac207] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 03/13/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS Non-invasive imaging is routinely used to estimate left ventricular (LV) filling pressure (LVFP) in heart failure (HF). Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping HF. However, currently, LVFP cannot be estimated from CMR. This study sought to investigate (i) if CMR can estimate LVFP in patients with suspected HF and (ii) if CMR-modelled LVFP has prognostic power. METHODS AND RESULTS Suspected HF patients underwent right heart catheterization (RHC), CMR and transthoracic echocardiography (TTE) (validation cohort only) within 24 h of each other. Right heart catheterization measured pulmonary capillary wedge pressure (PCWP) was used as a reference for LVFP. At follow-up, death was considered as the primary endpoint. We enrolled 835 patients (mean age: 65 ± 13 years, 40% male). In the derivation cohort (n = 708, 85%), two CMR metrics were associated with RHC PCWP:LV mass and left atrial volume. When applied to the validation cohort (n = 127, 15%), the correlation coefficient between RHC PCWP and CMR-modelled PCWP was 0.55 (95% confidence interval: 0.41-0.66, P < 0.0001). Cardiovascular magnetic resonance-modelled PCWP was superior to TTE in classifying patients as normal or raised filling pressures (76 vs. 25%). Cardiovascular magnetic resonance-modelled PCWP was associated with an increased risk of death (hazard ratio: 1.77, P < 0.001). At Kaplan-Meier analysis, CMR-modelled PCWP was comparable to RHC PCWP (≥15 mmHg) to predict survival at 7-year follow-up (35 vs. 37%, χ2 = 0.41, P = 0.52). CONCLUSION A physiological CMR model can estimate LVFP in patients with suspected HF. In addition, CMR-modelled LVFP has a prognostic role.
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Affiliation(s)
- Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Peter Swoboda
- The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Rachel Jones
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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Prediction of Sudden Cardiac Death Manifesting With Documented Ventricular Fibrillation or Pulseless Ventricular Tachycardia. JACC Clin Electrophysiol 2022; 8:411-423. [PMID: 35450595 PMCID: PMC9034059 DOI: 10.1016/j.jacep.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to develop a novel clinical prediction algorithm for avertable sudden cardiac death. BACKGROUND Sudden cardiac death manifests as ventricular fibrillation (VF)/ ventricular tachycardia (VT) potentially treatable with defibrillation, or nonshockable rhythms (pulseless electrical activity/asystole) with low likelihood of survival. There are no available clinical risk scores for targeted prediction of VF/VT. METHODS Subjects with out-of-hospital sudden cardiac arrest presenting with documented VF or pulseless VT (33% of total cases) were ascertained prospectively from the Portland, Oregon, metro area with population ≈1 million residents (n = 1,374, 2002-2019). Comparisons of lifetime clinical records were conducted with a control group (n = 1,600) with ≈70% coronary disease prevalence. Prediction models were constructed from a training dataset using backwards stepwise logistic regression and applied to an internal validation dataset. Receiver operating characteristic curves (C statistic) were used to evaluate model discrimination. External validation was performed in a separate, geographically distinct population (Ventura County, California, population ≈850,000, 2015-2020). RESULTS A clinical algorithm (VFRisk) constructed with 13 clinical, electrocardiogram, and echocardiographic variables had very good discrimination in the training dataset (C statistic = 0.808; [95% CI: 0.774-0.842]) and was successfully validated in internal (C statistic = 0.776 [95% CI: 0.725-0.827]) and external (C statistic = 0.782 [95% CI: 0.718-0.846]) datasets. The algorithm substantially outperformed the left ventricular ejection fraction (LVEF) ≤35% (C statistic = 0.638) and performed well across the LVEF spectrum. CONCLUSIONS An algorithm for prediction of sudden cardiac arrest manifesting with VF/VT was successfully constructed using widely available clinical and noninvasive markers. These findings have potential to enhance primary prevention, especially in patients with mid-range or preserved LVEF.
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Corbo MD, Vitale E, Pesolo M, Casavecchia G, Gravina M, Pellegrino P, Brunetti ND, Iacoviello M. Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11061519. [PMID: 35329848 PMCID: PMC8955301 DOI: 10.3390/jcm11061519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.
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Affiliation(s)
- Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Maurizio Pesolo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Matteo Gravina
- University Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy;
| | - Pierluigi Pellegrino
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
- Correspondence: or
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van der Burgh AC, Stricker BH, Rizopoulos D, Ikram MA, Hoorn EJ, Chaker L. Kidney function and the risk of sudden cardiac death in the general population. Clin Kidney J 2022; 15:1524-1533. [PMID: 35892020 PMCID: PMC9308098 DOI: 10.1093/ckj/sfac049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease increases sudden cardiac death (SCD) risk, but the association between kidney function and SCD in a general population is largely unknown. Therefore, we investigated the association between kidney function and SCD in a general middle-aged and elderly population. Methods We included individuals aged ≥45 years from a prospective population-based cohort study. The association between kidney function assessments [estimated glomerular filtration rate based on serum creatinine (eGFRcreat), cystatin C (eGFRcys) or both (eGFRcreat-cys)] and SCD was investigated using Cox proportional-hazards and joint models. Absolute 10-year risks were computed using competing risk analyses. Mediation analyses were performed using a four-way decomposition method. Results We included 9687 participants (median follow-up 8.9 years; mean age 65.3 years; 56.7% women; 243 SCD cases). Lower eGFRcys and eGFRcreat-cys were associated with increased SCD risk [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.12–1.34 and HR 1.17, 95% CI 1.06–1.29, per 10 mL/min/1.73 m2 eGFR decrease]. A significant trend (P = 0.001) across eGFRcys categories was found, with an HR of 2.11 (95% CI 1.19–3.74) for eGFRcys <60 compared with eGFRcys >90 mL/min/1.73 m2. Comparing eGFRcys of 90 to 60 mL/min/1.73 m2, absolute 10-year risk increased from 1.0% to 2.5%. Identified subgroups at increased risk included older participants and participants with atrial fibrillation. The associations were not mediated by coronary heart disease, hypertension or diabetes. Conclusions Reduced kidney function is associated with increased SCD risk in the general population, especially with eGFRcys. eGFRcys could be added to prediction models and screening programmes for SCD prevention.
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Affiliation(s)
- Anna C van der Burgh
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Vähätalo JH, Holmström LTA, Pylkäs K, Skarp S, Porvari K, Pakanen L, Kaikkonen KS, Perkiömäki JS, Kerkelä R, Huikuri HV, Myerburg RJ, Junttila MJ. Genetic Variants Associated With Sudden Cardiac Death in Victims With Single Vessel Coronary Artery Disease and Left Ventricular Hypertrophy With or Without Fibrosis. Front Cardiovasc Med 2022; 8:755062. [PMID: 35087879 PMCID: PMC8788946 DOI: 10.3389/fcvm.2021.755062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: Cardiac hypertrophy with varying degrees of myocardial fibrosis is commonly associated with coronary artery disease (CAD) related sudden cardiac death (SCD), especially in young victims among whom patterns of coronary artery lesions do not entirely appear to explain the cause of SCD. Our aim was to study the genetic background of hypertrophy, with or without fibrosis, among ischemic SCD victims with single vessel CAD. Methods: The study population was derived from the Fingesture study, consisting of all autopsy-verified SCDs in Northern Finland between the years 1998 and 2017 (n = 5,869). We carried out targeted next-generation sequencing using a panel of 174 genes associated with myocardial structure and ion channel function in 95 ischemic-SCD victims (mean age 63.6 ± 10.3 years; 88.4% males) with single-vessel CAD in the absence of previously diagnosed CAD and cardiac hypertrophy with or without myocardial fibrosis at autopsy. Results: A total of 42 rare variants were detected in 43 subjects (45.3% of the study subjects). Five variants in eight subjects (8.4%) were classified as pathogenic or likely pathogenic. We observed 37 variants of uncertain significance in 39 subjects (40.6%). Variants were detected in myocardial structure protein coding genes, associated with arrhythmogenic right ventricular, dilated, hypertrophic and left ventricular non-compaction cardiomyopathies. Also, variants were detected in ryanodine receptor 2 (RYR2), a gene associated with both cardiomyopathies and catecholaminergic polymorphic ventricular tachycardias. Conclusions: Rare variants associated with cardiomyopathies, in the absence of anatomic evidence of the specific inherited cardiomyopathies, were common findings among CAD-related SCD victims with single vessel disease and myocardial hypertrophy found at autopsies, suggesting that these variants may modulate the risk for fatal arrhythmias and SCD in ischemic disease.
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Affiliation(s)
- Juha H. Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- *Correspondence: Juha H. Vähätalo
| | - Lauri T. A. Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Sini Skarp
- Research Unit of Biomedicine and Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Katja Porvari
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Lasse Pakanen
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
| | - Kari S. Kaikkonen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha S. Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Risto Kerkelä
- Research Unit of Biomedicine and Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Heikki V. Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Robert J. Myerburg
- Division of Cardiology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - M. Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
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7
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Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [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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8
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McNamara DA, Bennett AJ, Ayers C, Berry JD, de Lemos JA, Link MS. Relations Between Cardiac Magnetic Resonance Imaging-Derived Left Ventricular Mass, Early Repolarization, and Cardiovascular Events (from the Dallas Heart Study). Am J Cardiol 2021; 161:108-114. [PMID: 34794607 DOI: 10.1016/j.amjcard.2021.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
Early repolarization pattern (ERP) is associated with increased mortality in case-control studies, but the mechanism and role of left ventricular mass (LVM) remain unclear. Our objectives were to understand (1) whether ERP associates with adverse outcomes in a multiethnic population and (2) to explore the role of LVM in these associations. Participants from the Dallas Heart Study with an electrocardiogram interpretable for ERP, defined as J point elevation ≥1 mm in 2 contiguous leads, were included. Combined all-cause mortality and nonfatal cardiovascular disease (CVD) events and individual components were assessed using Cox proportional hazards modeling after adjustment for demographics, traditional CVD risk factors, electrocardiogram intervals, and cardiac magnetic resonance imaging-derived factors. Cardiac magnetic resonance imaging-defined LVM was then added to the most fully adjusted model. Of the 2,686 participants, 240 (8.9%) demonstrated ERP. Participants with ERP were more likely to be male and Black, with lower body mass index, greater left ventricular end-diastolic volumes, and LVM. Over a median follow-up of 11 years, the combined end point occurred in 326 patients. Multivariable modeling demonstrated ERP was associated with the combined end point (HR [95% CI] 1.61 [1.14 to 2.26]), all-cause mortality (1.67 [1.00 to 2.80]). However, further adjusting for LVM attenuated the associations of ERP with the primary end point (HR [95% CI] 1.22 [0.85 to 1.77]) and secondary end points of mortality (1.39 [0.80 to 2.41]) and nonfatal CVD (1.05 [0.68 to 1.64]). ERP was associated with increased mortality and nonfatal CVD events, which was attenuated after adjusting for LVM, a previously under-recognized clinical phenotype. Previous associations of ERP with adverse cardiovascular outcomes may be partially explained by greater LVM in those with ERP.
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Affiliation(s)
- David A McNamara
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan; Division of Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Ari J Bennett
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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9
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Giamouzis G, Dimos A, Xanthopoulos A, Skoularigis J, Triposkiadis F. Left ventricular hypertrophy and sudden cardiac death. Heart Fail Rev 2021; 27:711-724. [PMID: 34184173 DOI: 10.1007/s10741-021-10134-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) is among the leading causes of death worldwide, and it remains a public health problem, as it involves young subjects. Current guideline-directed risk stratification for primary prevention is largely based on left ventricular (LV) ejection fraction (LVEF), and preventive strategies such as implantation of a cardiac defibrillator (ICD) are justified only for documented low LVEF (i.e., ≤ 35%). Unfortunately, only a small percentage of primary prevention ICDs, implanted on the basis of a low LVEF, will deliver life-saving therapies on an annual basis. On the other hand, the vast majority of patients that experience SCD have LVEF > 35%, which is clamoring for better understanding of the underlying mechanisms. It is mandatory that additional variables be considered, both independently and in combination with the EF, to improve SCD risk prediction. LV hypertrophy (LVH) is a strong independent risk factor for SCD regardless of the etiology and the severity of symptoms. Concentric and eccentric LV hypertrophy, and even earlier concentric remodeling without hypertrophy, are all associated with increased risk of SCD. In this paper, we summarize the physiology and physiopathology of LVH, review the epidemiological evidence supporting the association between LVH and SCD, briefly discuss the mechanisms linking LVH with SCD, and emphasize the need to evaluate LV geometry as a potential risk stratification tool regardless of the LVEF.
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Affiliation(s)
- Grigorios Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. .,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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10
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Tripepi G, D'Arrigo G, Mallamaci F, London G, Tangri N, Hsu JY, Feldman HI, Zoccali C. Prognostic values of left ventricular mass index in chronic kidney disease patients. Nephrol Dial Transplant 2021; 36:665-672. [PMID: 31860093 DOI: 10.1093/ndt/gfz254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy is causally implicated in the high risk of death and heart failure (HF) in chronic kidney disease (CKD) patients. Whether the left ventricular mass index (LVMI) adds meaningful predictive power for mortality and de novo HF to simple risk models has not been tested in the CKD population. METHODS We investigated this problem in 1352 CKD patients enrolled in the Chronic Renal Insufficiency Cohort (CRIC). LVMI was measured by echocardiography and the risks for death and HF were estimated by the Study of Heart and Renal Protection (SHARP) score, a well-validated risk score in CKD patients. RESULTS During a median follow-up of 7.7 years, 326 patients died and 208 had de novo HF. The LVMI and the SHARP score and a cross-validated model for HF (CRIC model) were all significantly (P < 0.001) related to the risk of death and HF. LVMI showed a discriminatory power for death (Harrell's C index 66%) inferior to that of the SHARP score (71%) and the same was true for the risk of HF both in the test (LVMI 72%, CRIC model 79%) and in the validation cohort (LVMI 71%, CRIC model 74%). LVMI increased very little the discriminatory (2-3%) and the risk reclassification power (3.0-4.8%) by the SHARP score and the CRIC model for HF for the same outcomes. CONCLUSIONS In CKD, measurement of LVMI solely for the stratification of risk of death and perhaps for the risk of HF does not provide evident prognostic values in this condition.
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Affiliation(s)
- Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Graziella D'Arrigo
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Gerard London
- INSERM U970, Hôpital Européen Georges Pompidou, Paris, France
| | - Navdeep Tangri
- Department of Medicine, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Jesse Yenchih Hsu
- Departments of Medicine and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Harold I Feldman
- Departments of Medicine and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carmine Zoccali
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
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11
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Huang Z, Wang L, Liu Y, Huang K, Xu Y, Chen P, Luo J, Li G, Chen J. Impact of obstructive sleep apnea on left ventricular mass index in men with coronary artery disease. J Clin Sleep Med 2020; 16:1675-1682. [PMID: 32620193 PMCID: PMC7954001 DOI: 10.5664/jcsm.8642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES Left ventricular hypertrophy (LVH) is associated with augmented risk for mortality in patients with coronary artery disease (CAD). These patients often have obstructive sleep apnea (OSA). We aimed to evaluate the relationship between OSA and the left ventricular mass index (LVMI) in men with CAD. METHODS Consecutive patients with CAD were recruited and underwent overnight portable monitoring for the assessment of OSA. LVMI was ascertained using high-resolution echocardiography. Univariate and multivariate regression analyses were conducted to explore the associations between the OSA parameters and the LVMI levels. RESULTS Of the 1,053 examined male patients with CAD, 425 (40.4%) had moderate-to-severe OSA (respiratory event index ≥ 15 events/h). The prevalence of LVH (LVMI > 125 g/m²) was 36.0% (n = 379). The mean LVMI values increased with increasing OSA severity (P < .001). Patients with respiratory event index ≥ 30 events/h had 2.30 (95% confidence interval 1.50-3.54, P < .001) times increased risk of LVH than those without OSA (respiratory event index < 5 events/h) independent of confounders. The minimum oxygen saturation levels were the strongest factor correlated with LVMI (β = -0.299, P = .004) of several OSA indices. Patients with minimum oxygen saturation < 70% had an adjusted odds ratio of 3.62 (95% confidence interval 1.81-7.25, P < .001) for LVH development compared with those with minimum oxygen saturation ≥ 90%. CONCLUSIONS OSA severity was associated with a higher likelihood of LVH in men with CAD, which is partially related to severe nocturnal intermittent hypoxemia. Aggressive effort at managing OSA among patients with CAD may further reduce the cardiovascular risk.
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Affiliation(s)
- Zhihua Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Ling Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kaizhuang Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Ying Xu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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12
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Structural and Physiological Imaging to Predict the Risk of Lethal Ventricular Arrhythmias and Sudden Death. JACC Cardiovasc Imaging 2020; 12:2049-2064. [PMID: 31601379 DOI: 10.1016/j.jcmg.2019.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022]
Abstract
Identifying patients at risk of sudden cardiac death remains a major challenge in cardiovascular medicine. Advances in cardiovascular imaging have identified several anatomic and functional variables that can be quantified as continuous variables to predict the risk of developing lethal ventricular tachyarrhythmias in patients with depressed left ventricular (LV) systolic function. Some, such as LV mass, volume, and the dyssynchrony of contraction, can be derived from currently available echocardiographic and nuclear imaging modalities. Others require advanced cardiac imaging modalities with quantification of myocardial scar with gadolinium-enhanced cardiac magnetic resonance and myocardial sympathetic denervation using norepinephrine analogs and positron emission tomography or single-photon emission computed tomography offering the most promise. There is an immediate need to develop a sequential cost-effective approach that capitalizes on readily available clinical information complemented with advanced imaging modalities in selected patients to improve risk stratification for arrhythmic death beyond LV ejection fraction.
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13
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Sanidas E, Malliaras K, Papadopoulos D, Velliou M, Tsakalis K, Zerva K, Barbetseas J. Antihypertensive therapy and sudden cardiac death, should we expect the unexpected? J Hum Hypertens 2020; 34:339-345. [PMID: 31937855 DOI: 10.1038/s41371-020-0299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/06/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023]
Abstract
Hypertension (HTN) and sudden cardiac death (SCD) constitute major public health problems accounting for millions of deaths each year worldwide. Both HTN and HTN-induced left ventricular hypertrophy (LVH) have been shown to be independent risk factors for SCD. However, the association between antihypertensive pharmacotherapy and risk of SCD has been under-investigated. Given that antihypertensive pharmacotherapy effectively reduces overall cardiovascular mortality, it would be expected to protect patients from SCD. Nevertheless, available data demonstrate that antihypertensive medications (primarily thiazide diuretics), while effective in reducing the incidence of myocardial infarction, do not confer protection from SCD. The purpose of this review was to present the relationship between HTN, LVH, and SCD and to describe the potential association between antihypertensive pharmacotherapy and risk of SCD.
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Affiliation(s)
- Elias Sanidas
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece.
| | - Konstantinos Malliaras
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Dimitrios Papadopoulos
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Maria Velliou
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Konstantinos Tsakalis
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Kanella Zerva
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - John Barbetseas
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
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14
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Kiuchi MG, Ho JK, Nolde JM, Gavidia LML, Carnagarin R, Matthews VB, Schlaich MP. Sympathetic Activation in Hypertensive Chronic Kidney Disease - A Stimulus for Cardiac Arrhythmias and Sudden Cardiac Death? Front Physiol 2020; 10:1546. [PMID: 32009970 PMCID: PMC6974800 DOI: 10.3389/fphys.2019.01546] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Studies have revealed a robust and independent correlation between chronic kidney disease (CKD) and cardiovascular (CV) events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse CV events, including malignant ventricular arrhythmias and sudden cardiac death (SCD). Moreover, other studies point out that cardiac structural and electrophysiological changes are a common occurrence in this population. These processes are likely contributors to the heightened hazard of arrhythmias in CKD population and may be useful indicators to detect patients who are at a higher SCD risk. Sympathetic overactivity is associated with increased CV risk, specifically in the population with CKD, and it is a central feature of the hypertensive state, occurring early in its clinical course. Sympathetic hyperactivity is already evident at the earliest clinical stage of CKD and is directly related to the progression of renal failure, being most pronounced in those with end-stage renal disease. Sympathetic efferent and afferent neural activity in kidney failure is a crucial facilitator for the perpetuation and evolvement of the disease. Here, we will revisit the role of the feedback loop of the sympathetic neural cycle in the context of CKD and how it may aggravate several of the risk factors responsible for causing SCD. Targeting the overactive sympathetic nervous system therapeutically, either pharmacologically or with newly available device-based approaches, may prove to be a pivotal intervention to curb the substantial burden of cardiac arrhythmias and SCD in the high-risk population of patients with CKD.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Janis Marc Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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15
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Amigues I, Russo C, Giles JT, Tugcu A, Weinberg R, Bokhari S, Bathon JM. Myocardial Microvascular Dysfunction in Rheumatoid Arthritis Quantitation by 13N-Ammonia Positron Emission Tomography/Computed Tomography. Circ Cardiovasc Imaging 2019; 12:e007495. [PMID: 30636512 PMCID: PMC6361523 DOI: 10.1161/circimaging.117.007495] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The goal of this study was to assess the prevalence of myocardial microvascular dysfunction in rheumatoid arthritis (RA) patients without clinical cardiovascular disease and its association with RA characteristics and measures of cardiac structure and function. METHODS Participants with RA underwent rest and vasodilator stress N-13 ammonia positron emission tomography and echocardiography. Global myocardial blood flow was quantified at rest and during peak hyperemia. Myocardial flow reserve (MFR) was calculated as peak stress myocardial blood flow/rest myocardial blood flow. A small number of asymptomatic and symptomatic non-RA controls were also evaluated. RESULTS In RA patients, mean±SD MFR was 2.9±0.8, with 29% having reduced MFR (<2.5). Male sex and higher interleukin-6 were significantly associated with lower MFR, while the use of tumor necrosis factor inhibitors was associated with higher MFR. Lower MFR was associated with higher left ventricle mass index and higher left ventricle volumes but not with ejection fraction or diastolic dysfunction. RA and symptomatic controls had comparable MFR (mean±SD: 2.9±0.8 versus 2.55±0.6; P=0.48). In contrast, MFR was higher in the asymptomatic controls (mean±SD: 3.25±0.7) although not statistically different. CONCLUSIONS Reduced MFR was observed in a third of RA patients without clinical cardiovascular disease and was associated with a measure of inflammation and with higher left ventricle mass and volumes. MFR in RA patients was similar to controls referred for clinical scans (symptomatic controls). Whether reduced MFR contributes to the increased risk for heart failure in RA remains unknown.
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Affiliation(s)
- Isabelle Amigues
- Division of Rheumatology (I.A., J.T.G., J.M.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
| | - Cesare Russo
- Division of Cardiology (C.R., A.T., R.W., S.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
- Current address for Cesare Russo: Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Jon T Giles
- Division of Rheumatology (I.A., J.T.G., J.M.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
| | - Aylin Tugcu
- Division of Cardiology (C.R., A.T., R.W., S.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
- Current address for Aylin Tugcu: Bristol Myers Squibb, Lawrenceville, NJ
| | - Richard Weinberg
- Division of Cardiology (C.R., A.T., R.W., S.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
- Nuclear Cardiology Laboratory (R.W., S.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
| | - Sabahat Bokhari
- Division of Cardiology (C.R., A.T., R.W., S.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
- Nuclear Cardiology Laboratory (R.W., S.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
| | - Joan M Bathon
- Division of Rheumatology (I.A., J.T.G., J.M.B.), Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital
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16
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Pandat S, Nagaura T, Nair SG, Uy-Evanado A, Stecker EC, Nichols GA, Jui J, Shiota T, Chugh SS, Reinier K. An association between right ventricular dysfunction and sudden cardiac death. Heart Rhythm 2019; 17:169-174. [PMID: 31634617 DOI: 10.1016/j.hrthm.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The effectiveness of severely reduced left ventricular ejection fraction (LVEF <35%) as a predictor of sudden cardiac death (SCD) has diminished, and improvements in risk stratification await discovery of novel markers. Right ventricular (RV) abnormalities can be observed in conditions such as chronic obstructive pulmonary disease and sleep apnea, which have been linked to SCD. OBJECTIVE The purpose of this study was to evaluate whether RV abnormalities were associated with SCD after accounting for LVEF and other patient characteristics. METHODS In a large, prospective ongoing community-based study of SCD in the Portland, Oregon, metropolitan area, SCD cases (age ≥18 years; 2002-2014) were compared to controls with coronary artery disease but no SCD. Using a novel archive of digital echocardiograms, a standardized approach was used to evaluate RV basal diameter, RV end-diastolic area, and right ventricular fractional area change (RVFAC). RESULTS A total of 350 subjects were studied, including 81 SCD cases (age 68.7 ± 13.6 years; 73% male) and 269 controls (age 66.5 ± 10.2 years; 69% male). In multivariate analysis, RVFAC was significantly associated with SCD (odds ratio 1.14 for each 5% decrease; 95% confidence interval 1.03-1.25; P = .01). When modeled with LVEF ≤35%, RVFAC ≤35% was significantly associated with increased risk of SCD. Individuals with both left ventricular and RV dysfunction had a 3× higher odds of SCD than those with neither (odds ratio 3.19; 95% confidence interval 1.33-7.68; P = .01). CONCLUSION RV dysfunction was associated with a significantly increased risk of SCD independent of LVEF and, when combined with LVEF, had additive effects on SCD risk.
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Affiliation(s)
- Summit Pandat
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Nagaura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sandeep G Nair
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Audrey Uy-Evanado
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sumeet S Chugh
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kyndaron Reinier
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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17
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Li J, Cao Y, Liu C, Li J, Yao F, Dong Y, Huang H. Nocturnal systolic hypertension is a risk factor for cardiac damage in the untreated masked hypertensive patients. J Clin Hypertens (Greenwich) 2019; 21:1666-1674. [PMID: 31556221 DOI: 10.1111/jch.13711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/13/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Jianhao Li
- Department of Cardiology Central Hospital of Panyu District Guangzhou China
| | - Yalin Cao
- Department of Cardiology Guizhou Provincial People's Hospital Guiyang China
| | - Chen Liu
- Department of Cardiology The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
- NHC Key Laboratory of Assisted Circulation Sun Yat‐sen University Guangzhou China
| | - Jiayong Li
- Department of Cardiology The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
- NHC Key Laboratory of Assisted Circulation Sun Yat‐sen University Guangzhou China
| | - Fengjuan Yao
- Department of Cardiac Ultrasound The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Yugang Dong
- Department of Cardiology The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
- NHC Key Laboratory of Assisted Circulation Sun Yat‐sen University Guangzhou China
| | - Huiling Huang
- Department of Cardiology The First Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
- NHC Key Laboratory of Assisted Circulation Sun Yat‐sen University Guangzhou China
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18
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Buja LM, Ottaviani G, Mitchell RN. Pathobiology of cardiovascular diseases: an update. Cardiovasc Pathol 2019; 42:44-53. [PMID: 31255975 DOI: 10.1016/j.carpath.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023] Open
Abstract
This article introduces the Second Special Issue of Cardiovascular Pathology (CVP), the official journal of the Society for Cardiovascular Pathology (SCVP). This CVP Special Issue showcases a series of commemorative review articles in celebration of the 25th anniversary of CVP originally published in 2016 and now compiled into a virtual collection with online access for the cardiovascular pathology community. This overview also provides updates on the major categories of cardiovascular diseases from the perspective of cardiovascular pathologists, highlighting publications from CVP, as well as additional important review articles and clinicopathologic references.
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Affiliation(s)
- L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA.
| | - Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and sudden infant death syndrome, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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19
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Li J, Cao Y, Liu C, Li J, Yao F, Dong Y, Huang H. Diastolic Reverse Dipping Pattern Is the Predictor for the Echocardiographic Changes in the Untreated Masked Hypertensive Patients. Am J Hypertens 2019; 32:588-596. [PMID: 30899956 DOI: 10.1093/ajh/hpz041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The prognostic value of the dipping categories of diastolic blood pressure (DBP) is unknown. This study aimed to investigate the association between DBP dipping categories of diastolic blood pressure and echocardiographic changes in untreated masked hypertension (MH) patients. METHODS This retrospective study included 721 untreated MH patients between June 2006 and June 2016. Nocturnal dipping categories were defined according to the percentage decrease in nocturnal blood pressure (BP) compared to daytime BP as follows: non-dipping: decrease 0% to <10%, dipping: decrease 10% to 20%, reverse dipping: decrease <0%, and extreme dipping: decrease >20%. The echocardiographic findings were analyzed. RESULTS The 4 echocardiographic parameters (left atrium [LA] dimension, interventricular septum [IVS] thickness, linear left ventricular end-diastolic dimension [LVEDD], and left ventricular [LV] mass) were significantly different among the 4 DBP dipping categories. Multivariate linear regression analysis showed that DBP reverse dipping pattern was associated with higher IVS thickness (B: 0.53, 95% CI: 0.24 to 0.82; P < 0.001) and LV mass (B: 12.36, 95% CI: 2.38 to 22.35; P = 0.015), whereas DBP extreme dipping was associated with lower LVEDD (B: -7.05, 95% CI: -11.30 to -2.80; P = 0.001).The nocturnal systolic hypertension was associated with higher IVS thickness (B: 0.42, 95% CI: 0.14 to 0.71; P = 0.003) and LV mass (B:14.21, 95% CI: 4.54 to 23.88; P = 0.004). The nocturnal systolic blood pressure was associated with LA dimension, IVS thickness, left ventricular posterior wall thickness, and LV mass (all Ps < 0.05). CONCLUSIONS These results suggest that specific DBP dipping categories and nocturnal systolic hypertension were the predictive factors for the echocardiographic changes in untreated MH patients.
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Affiliation(s)
- Jianhao Li
- Department of Cardiology, Central Hospital of Panyu District, Guangzhou, China
| | - Yalin Cao
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Jiayong Li
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Fengjuan Yao
- Department of Cardiac Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Huiling Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
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20
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Early Repolarization Pattern Is Associated With Increased Left Ventricular Mass: Insights From the Dallas Heart Study. JACC Clin Electrophysiol 2019; 5:395-397. [PMID: 30898244 DOI: 10.1016/j.jacep.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 01/12/2023]
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21
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Porthan K, Kenttä T, Niiranen TJ, Nieminen MS, Oikarinen L, Viitasalo M, Hernesniemi J, Jula AM, Salomaa V, Huikuri HV, Albert CM, Tikkanen JT. ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death. Int J Cardiol 2019; 276:125-129. [DOI: 10.1016/j.ijcard.2018.09.104] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
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22
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Smith DL, Haller JM, Korre M, Fehling PC, Sampani K, Grossi Porto LG, Christophi CA, Kales SN. Pathoanatomic Findings Associated With Duty-Related Cardiac Death in US Firefighters: A Case-Control Study. J Am Heart Assoc 2018; 7:e009446. [PMID: 30371185 PMCID: PMC6222959 DOI: 10.1161/jaha.118.009446] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022]
Abstract
Background Sudden cardiac death accounts for the greatest proportion of duty-related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence-based screening recommendations. Methods and Results Using autopsy data for duty-related firefighter fatalities occurring between 1999 and 2014, this retrospective case-control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac-related causes with those who died of noncardiac trauma-related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6-10.4), 9.3 (95% confidence interval, 5.3-16.1), and 6.2 (95% confidence interval, 3.4-11.3), respectively. Conclusions The majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty-related cardiac deaths among firefighters.
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Affiliation(s)
- Denise L. Smith
- Department of Health and Human Physiological SciencesSkidmore CollegeSaratoga SpringsNY
| | - Jeannie M. Haller
- Department of Health and Human Physiological SciencesSkidmore CollegeSaratoga SpringsNY
| | - Maria Korre
- Environmental and Occupational Medicine and Epidemiology ProgramDepartment of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
- Cambridge Health AllianceHarvard Medical SchoolCambridgeMA
| | - Patricia C. Fehling
- Department of Health and Human Physiological SciencesSkidmore CollegeSaratoga SpringsNY
| | - Konstantina Sampani
- Environmental and Occupational Medicine and Epidemiology ProgramDepartment of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
- Beetham Eye InstituteJoslin Diabetes CenterBostonMA
| | - Luiz Guilherme Grossi Porto
- Environmental and Occupational Medicine and Epidemiology ProgramDepartment of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
- Faculty of Physical Education and Cardiovascular Laboratory of the Faculty of MedicineUniversity of BrasiliaBrazil
| | - Costas A. Christophi
- Environmental and Occupational Medicine and Epidemiology ProgramDepartment of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
- Cyprus International Institute for Environmental and Public HealthCyprus University of TechnologyLimassolCyprus
| | - Stefanos N. Kales
- Environmental and Occupational Medicine and Epidemiology ProgramDepartment of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
- Cambridge Health AllianceHarvard Medical SchoolCambridgeMA
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Aro AL, Reinier K, Phan D, Teodorescu C, Uy-Evanado A, Nichols GA, Gunson K, Jui J, Chugh SS. Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction. Europace 2017; 19:1146-1152. [PMID: 27256423 PMCID: PMC6075451 DOI: 10.1093/europace/euw126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/10/2016] [Indexed: 01/19/2023] Open
Abstract
AIMS The majority of sudden cardiac arrests (SCAs) occur in patients with left-ventricular (LV) ejection fraction (LVEF) >35%, yet there are no methods for effective risk stratification in this sub-group. Since abnormalities of LV geometry can be identified even with preserved LVEF, we investigated the potential impact of LV geometry as a novel risk marker for this patient population. METHODS AND RESULTS In the ongoing Oregon Sudden Unexpected Death Study, SCA cases with archived echocardiographic data available were prospectively identified during 2002-15, and compared with geographical controls. Analysis was restricted to subjects with LVEF >35%. Based on established measures of LV mass and relative wall thickness (ratio of wall thickness to cavity diameter), four different LV geometric patterns were identified: normal geometry, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Sudden cardiac arrest cases (n = 307) and controls (n = 280) did not differ in age, sex, or LVEF, but increased LV mass was more common in cases. Twenty-nine percent of SCA cases presented with normal LV geometry, 35% had concentric remodelling, 25% concentric hypertrophy, and 11% eccentric hypertrophy. In multivariate model, concentric remodelling (OR 1.76; 95%CI 1.18-2.63; P = 0.005), concentric hypertrophy (OR 3.20; 95%CI 1.90-5.39; P < 0.001), and eccentric hypertrophy (OR 2.47; 95%CI 1.30-4.66; P = 0.006) were associated with increased risk of SCA. CONCLUSION Concentric and eccentric LV hypertrophy, but also concentric remodelling without hypertrophy, are associated with increased risk of SCA. These novel findings suggest the potential utility of evaluating LV geometry as a potential risk stratification tool in patients with preserved or moderately reduced LVEF.
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Affiliation(s)
- Aapo L. Aro
- Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Kyndaron Reinier
- Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
| | - Derek Phan
- Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
| | - Carmen Teodorescu
- Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
| | - Audrey Uy-Evanado
- Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
| | | | - Karen Gunson
- Oregon Health and Science University, Portland, OR, USA
| | - Jonathan Jui
- Oregon Health and Science University, Portland, OR, USA
| | - Sumeet S. Chugh
- Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
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Chugh SS. Sudden cardiac death in 2017: Spotlight on prediction and prevention. Int J Cardiol 2017; 237:2-5. [PMID: 28365183 DOI: 10.1016/j.ijcard.2017.03.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 01/22/2023]
Abstract
This commentary will provide a brief synopsis of the progress made in prediction and prevention of sudden cardiac death (SCD), the challenges that remain, and the opportunities available to make a real impact in this field. The dawning of the new millennium saw the prophylactic implantable defibrillator (ICD) firmly established as the major primary prevention modality, poised to make a major impact on the burden of SCD. More than a decade and a half later, has this expectation been realized? The modest impact of the primary prevention ICD on SCD burden is largely due to the now well-recognized inadequate performance of the left ventricular ejection fraction as a risk stratification tool. Consequently, the field has transitioned from a focus on the "high-risk ejection fraction" to the broader concept of the "high-risk patient". There are currently no effective means of stratifying SCD risk in patients with preserved EF, who constitute the majority (at least 70%) of all patients who will suffer SCD. Can the field be disrupted and novel predictors of SCD identified? In addition to the ongoing quest for identification of the high-risk patient early in the nature history of SCD, a new paradigm for preventing SCD in the "near-term", within several weeks of the lethal event, has been proposed. While rapid advances in technology, data warehousing and analysis will accelerate the process of enhancing SCD prediction and prevention; regulatory, funding and clinical implementation strategies will need to keep pace if these expectations are to be realized.
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Affiliation(s)
- Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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25
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Tripepi G, Pannier B, D’Arrigo G, Mallamaci F, Zoccali C, London G. Reappraisal in two European cohorts of the prognostic power of left ventricular mass index in chronic kidney failure. Kidney Int 2017; 91:704-710. [DOI: 10.1016/j.kint.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 01/17/2023]
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27
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GANESHA BABU GIRISH, WEBBER MATTHEW, PROVIDENCIA RUI, KUMAR SANJEEV, GOPALAMURUGAN AERAKONDAL, ROGERS DOMINICP, DAW HOLLYLOUISE, AHSAN SYED, KHAN FAKHAR, CHOW ANTHONY, LOWE MARTIN, ROWLAND EDWARD, LAMBIASE PIER, SEGAL OLIVERR. Ventricular Arrhythmia Burden in Patients With Heart Failure and Cardiac Resynchronization Devices: The Importance of Renal Function. J Cardiovasc Electrophysiol 2016; 27:1328-1336. [DOI: 10.1111/jce.13080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - SANJEEV KUMAR
- Biomedical Sciences/Regenerative Medicine, David Geffen School of Medicine, UCLA; Cedars Sinai Medical Center; Los Angeles California USA
| | | | | | | | - SYED AHSAN
- Barts Heart Centre, St. Bartholomew; s Hospital; London UK
| | - FAKHAR KHAN
- Barts Heart Centre, St. Bartholomew; s Hospital; London UK
| | - ANTHONY CHOW
- Barts Heart Centre, St. Bartholomew; s Hospital; London UK
| | - MARTIN LOWE
- Barts Heart Centre, St. Bartholomew; s Hospital; London UK
| | - EDWARD ROWLAND
- Barts Heart Centre, St. Bartholomew; s Hospital; London UK
| | - PIER LAMBIASE
- Barts Heart Centre, St. Bartholomew; s Hospital; London UK
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Kidney function and sudden cardiac death in the community: The Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 2016; 180:46-53. [PMID: 27659882 DOI: 10.1016/j.ahj.2016.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Individuals with chronic kidney disease, particularly those requiring dialysis, are at high risk of sudden cardiac death (SCD). However, comprehensive data for the full spectrum of kidney function and SCD risk in the community are sparse. Furthermore, newly developed equations for estimated glomerular filtration rate (eGFR) and novel filtration markers might add further insight to the role of kidney function in SCD. METHODS We investigated the associations of baseline eGFRs using serum creatinine, cystatin C, or both (eGFRcr, eGFRcys, and eGFRcr-cys); cystatin C itself; and β2-microglobulin (B2M) with SCD (205 cases through 2001) among 13,070 black and white ARIC participants at baseline during 1990-1992 using Cox regression models accounting for potential confounders. RESULTS Low eGFR was independently associated with SCD risk: for example, hazard ratio for eGFR <45 versus ≥90mL/(min 1.73m(2)) was 3.71 (95% CI 1.74-7.90) with eGFRcr, 5.40 (2.97-9.83) with eGFRcr-cys, and 5.24 (3.01-9.11) with eGFRcys. When eGFRcr and eGFRcys were included together in a single model, the association was only significant for eGFRcys. When three eGFRs, cystatin C, and B2M were divided into quartiles, B2M demonstrated the strongest association with SCD (hazard ratio for fourth quartile vs first quartile 3.48 (2.03-5.96) vs ≤2.7 for the other kidney markers). CONCLUSIONS Kidney function was independently and robustly associated with SCD in the community, particularly when cystatin C or B2M was used. These results suggest the potential value of kidney function as a risk factor for SCD and the advantage of novel filtration markers over eGFRcr in this context.
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29
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Phan D, Aro AL, Reinier K, Teodorescu C, Uy-Evanado A, Gunson K, Jui J, Chugh SS. Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction. J Am Heart Assoc 2016; 5:JAHA.116.003715. [PMID: 27930286 PMCID: PMC5015291 DOI: 10.1161/jaha.116.003715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter‐defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population. Methods and Results Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08–4.29, P=0.03). Conclusions Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device‐implanted and non‐implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.
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Affiliation(s)
- Derek Phan
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aapo L Aro
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | | | | | - Karen Gunson
- Oregon Health and Science University, Portland, OR
| | - Jonathan Jui
- Oregon Health and Science University, Portland, OR
| | - Sumeet S Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Chugh SS, Uy-Evanado A. Improved Prediction of Sudden Cardiac Death Risk: Staying Within the Echocardiogram but Extending Beyond the Ejection Fraction. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005133. [PMID: 27496551 DOI: 10.1161/circimaging.116.005133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sumeet S Chugh
- From the The Heart Institute, Cedars-Sinai, Los Angeles, CA.
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31
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Aro AL, Chugh SS. Clinical Diagnosis of Electrical Versus Anatomic Left Ventricular Hypertrophy: Prognostic and Therapeutic Implications. Circ Arrhythm Electrophysiol 2016; 9:e003629. [PMID: 27009417 DOI: 10.1161/circep.115.003629] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/24/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Aapo L Aro
- From the The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sumeet S Chugh
- From the The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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32
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Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016; 217:16-27. [PMID: 27174593 DOI: 10.1016/j.ijcard.2016.04.170] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
| | - R Rivera
- Division of Nephrology, S. Gerardo Hospital, Monza, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Naples, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy
| | - D Banerjee
- Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK
| | - F Floccari
- Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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Suzuki T, Nazarian S, Jerosch-Herold M, Chugh SS. Imaging for assessment of sudden death risk: current role and future prospects. Europace 2016; 18:1491-1500. [PMID: 27098112 DOI: 10.1093/europace/euv456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Abstract
Sudden cardiac death (SCD) remains a major public health problem and there is an urgent need to maximize the impact of primary prevention using the implantable defibrillator. While implantable defibrillators are of utility for prevention of SCD, current methods of selecting candidates have significant shortcomings. Major advancements have occurred in the field of cardiac imaging, with significant potential to identify novel cardiac substrates for improved prediction. While assessment of the left ventricular ejection fraction remains the current major predictor, it is likely that several novel imaging markers will be incorporated into future risk stratification approaches. The goal of this review is to discuss the current status and future potential of cardiac imaging modalities to enhance risk stratification for SCD.
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Affiliation(s)
- Takeki Suzuki
- Division of Cardiology, Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Saman Nazarian
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sumeet S Chugh
- The Heart Institute, Advanced Health Sciences Pavilion Suite A3100, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA
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Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope? Kidney Res Clin Pract 2015; 35:3-9. [PMID: 27069851 PMCID: PMC4811986 DOI: 10.1016/j.krcp.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/11/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023] Open
Abstract
Several studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known.
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Reinier K, Narayanan K, Uy-Evanado A, Teodorescu C, Chugh H, Mack WJ, Gunson K, Jui J, Chugh SS. Electrocardiographic Markers and the Left Ventricular Ejection Fraction have Cumulative Effects on Risk of Sudden Cardiac Death. JACC Clin Electrophysiol 2015; 1:542-550. [PMID: 26949741 DOI: 10.1016/j.jacep.2015.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess potential improvement in SCD risk prediction by adding selected risk markers from the 12-lead ECG to measurement of the left ventricular ejection fraction (LVEF). BACKGROUND Novel strategies to improve risk stratification for sudden cardiac death (SCD) are needed. Given the modest odds associated with most individual risk markers, combining multiple markers may be a useful approach. METHODS From the ongoing Oregon Sudden Unexpected Death Study, SCD cases with pre-event LVEF available were compared to matched control subjects with coronary artery disease. Resting heart rate, QRS duration (QRSD), and JTc intervals were measured from archived ECGs prior and unrelated to the SCD event. Independent odds of SCD for individual and combined ECG markers were calculated. RESULTS SCD cases (n= 317; 67.9 ± 12.9 years) were more likely than controls (n=317; 67.9 ± 12.8 years) to have LVEF ≤ 35% (26% vs. 11%). Mean heart rate, QRSD, and JTc were significantly higher in cases (all p<0.0001). In adjusted analyses, higher heart rate [OR 2.6 (1.8 - 3.7)], QRSD [OR 1.5 (1.0 - 2.5)] and JTc [OR 2.3 (1.6 - 3.4)] were independently associated with SCD. When ECG markers were combined, SCD odds progressively increased with one [OR 3.4 (2.1 - 5.4)] and ≥ 2 elevated markers [OR 6.3 (3.3 - 12.1)]. Addition of ECG markers to an adjusted model with LVEF improved discrimination (C statistic 0.724 vs. 0.642) and net reclassification (by 22.7%) (p<0.0001). CONCLUSIONS Combining selected 12-lead ECG markers with LVEF improves SCD risk prediction, and warrants further investigation in prospective studies.
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Affiliation(s)
| | - Kumar Narayanan
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | | | | | - Harpriya Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California
| | - Karen Gunson
- Department of Pathology, Oregon Health and Science University, Portland OR
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland OR
| | - Sumeet S Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA
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36
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Suzuki G. Translational research of adult stem cell therapy. World J Cardiol 2015; 7:707-718. [PMID: 26635920 PMCID: PMC4660467 DOI: 10.4330/wjc.v7.i11.707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/12/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Congestive heart failure (CHF) secondary to chronic coronary artery disease is a major cause of morbidity and mortality world-wide. Its prevalence is increasing despite advances in medical and device therapies. Cell based therapies generating new cardiomyocytes and vessels have emerged as a promising treatment to reverse functional deterioration and prevent the progression to CHF. Functional efficacy of progenitor cells isolated from the bone marrow and the heart have been evaluated in preclinical large animal models. Furthermore, several clinical trials using autologous and allogeneic stem cells and progenitor cells have demonstrated their safety in humans yet their clinical relevance is inconclusive. This review will discuss the clinical therapeutic applications of three specific adult stem cells that have shown particularly promising regenerative effects in preclinical studies, bone marrow derived mesenchymal stem cell, heart derived cardiosphere-derived cell and cardiac stem cell. We will also discuss future therapeutic approaches.
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Kiuchi MG, Graciano ML, de Queiroz Carreira MAM, Kiuchi T, Chen S, Andrea BR, Lugon JR. Effects of renal sympathetic denervation in left ventricular hypertrophy in CKD refractory hypertensive patients. Int J Cardiol 2015; 202:121-3. [PMID: 26386937 DOI: 10.1016/j.ijcard.2015.08.206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/22/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Márcio Galindo Kiuchi
- Renal Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil; Hospital Regional Darcy Vargas, Rio Bonito, RJ, Brazil
| | - Miguel Luis Graciano
- Renal Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | | | | | - Shaojie Chen
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bruno Rustum Andrea
- Renal Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Jocemir Ronaldo Lugon
- Renal Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.
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Reinier K, Nichols GA, Huertas-Vazquez A, Uy-Evanado A, Teodorescu C, Stecker EC, Gunson K, Jui J, Chugh SS. Distinctive Clinical Profile of Blacks Versus Whites Presenting With Sudden Cardiac Arrest. Circulation 2015; 132:380-7. [PMID: 26240262 PMCID: PMC4526124 DOI: 10.1161/circulationaha.115.015673] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sudden cardiac arrest (SCA) is a major contributor to mortality, but data are limited among nonwhites. Identification of differences in clinical profile based on race may provide opportunities for improved SCA prevention. METHODS AND RESULTS In the ongoing Oregon Sudden Unexpected Death Study (SUDS), individuals experiencing SCA in the Portland, OR, metropolitan area were identified prospectively. Patient demographics, arrest circumstances, and pre-SCA clinical profile were compared by race among cases from 2002 to 2012 (for clinical history, n=126 blacks, n=1262 whites). Incidence rates were calculated for cases from the burden assessment phase (2002-2005; n=1077). Age-adjusted rates were 2-fold higher among black men and women (175 and 90 per 100 000, respectively) compared with white men and women (84 and 40 per 100 000, respectively). Compared with whites, blacks were >6 years younger at the time of SCA and had a higher prearrest prevalence of diabetes mellitus (52% versus 33%; P<0.0001), hypertension (77% versus 65%; P=0.006), and chronic renal insufficiency (34% versus 19%; P<0.0001). There were no racial differences in previously documented coronary artery disease or left ventricular dysfunction, but blacks had more prevalent congestive heart failure (43% versus 34%; P=0.04) and left ventricular hypertrophy (77% versus 58%; P=0.02) and a longer QTc interval (466±36 versus 453±41 milliseconds; P=0.03). CONCLUSIONS In this US community, the burden of SCA was significantly higher in blacks compared with whites. Blacks with SCA had a higher prearrest prevalence of risk factors beyond established coronary artery disease, providing potential targets for race-specific prevention.
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MESH Headings
- Aged
- Aged, 80 and over
- Black People/ethnology
- Black People/statistics & numerical data
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/ethnology
- Death, Sudden, Cardiac/etiology
- Diabetes Complications/complications
- Diabetes Complications/epidemiology
- Diabetes Complications/ethnology
- Female
- Humans
- Hypertension/complications
- Hypertension/epidemiology
- Hypertension/ethnology
- Incidence
- Male
- Middle Aged
- Oregon
- Prevalence
- Prospective Studies
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/ethnology
- Retrospective Studies
- Risk Factors
- White People/ethnology
- White People/statistics & numerical data
- Black or African American
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Affiliation(s)
- Kyndaron Reinier
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Gregory A Nichols
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Adriana Huertas-Vazquez
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Audrey Uy-Evanado
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Carmen Teodorescu
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Eric C Stecker
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Karen Gunson
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Jonathan Jui
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland
| | - Sumeet S Chugh
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles CA (K.R., A.H.-V., A.U.-E., C.T., S.S.C.); Kaiser Permanente Center for Health Research, Portland, OR (G.A.N.); and Knight Cardiovascular Institute (E.C.S.), Department of Pathology (K.G.), and Department of Emergency Medicine (J.J.), Oregon Health and Science University, Portland.
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Aleong RG, Mulvahill MJ, Halder I, Carlson NE, Singh M, Bloom HL, Dudley SC, Ellinor PT, Shalaby A, Weiss R, Gutmann R, Sauer WH, Narayanan K, Chugh SS, Saba S, London B. Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function. J Am Heart Assoc 2015; 4:e001566. [PMID: 26231842 PMCID: PMC4599449 DOI: 10.1161/jaha.114.001566] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Methods and Results Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N =930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P =0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P =0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P =0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P =0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P =0.0009). Conclusions LV dilatation may complement ejection fraction to predict ventricular arrhythmias. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02045043.
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Affiliation(s)
- Ryan G Aleong
- University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.)
| | | | | | | | | | - Heather L Bloom
- Emory University and Atlanta VA Medical Center, Atlanta, GA (H.L.B.)
| | - Samuel C Dudley
- Lifespan Cardiovascular Institute and the Warren Alpert School of Medicine at Brown University, Providence, RI (S.C.D.)
| | | | - Alaa Shalaby
- University of Pittsburgh, PA (I.H., M.S., A.S., S.S.) Pittsburgh VA Healthcare System, Pittsburgh, PA (A.S.)
| | - Raul Weiss
- Ohio State University, Columbus, OH (R.W.)
| | | | - William H Sauer
- University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.)
| | - Kumar Narayanan
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (K.N., S.S.C.)
| | - Sumeet S Chugh
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (K.N., S.S.C.)
| | - Samir Saba
- University of Pittsburgh, PA (I.H., M.S., A.S., S.S.)
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40
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Niemeijer MN, Leening MJG, van den Berg ME, Hofman A, Franco OH, Deckers JW, Rijnbeek PR, Stricker BH, Eijgelsheim M. Subclinical Abnormalities in Echocardiographic Parameters and Risk of Sudden Cardiac Death in a General Population: The Rotterdam Study. J Card Fail 2015; 22:17-23. [PMID: 26093333 DOI: 10.1016/j.cardfail.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Subclinical cardiac dysfunction has been associated with increased mortality, and heart failure increases the risk of sudden cardiac death (SCD). Less well known is whether subclinical cardiac dysfunction is also a risk factor for SCD. Our objective was to assess the association between echocardiographic parameters and SCD in a community-dwelling population free of heart failure. METHODS AND RESULTS We computed hazard ratios (HRs) for left atrium diameter, left ventricular (LV) end-diastolic dimension, LV end-systolic dimension, LV mass, qualitative LV systolic function, LV fractional shortening, and diastolic function. During a median follow-up of 6.3 years in 4,686 participants, 68 participants died because of SCD. Significant associations with SCD were observed for qualitative LV systolic function and LV fractional shortening. For moderate/poor qualitative LV systolic function, the HR for SCD was 2.54 (95% confidence interval [CI] 1.10-5.87). Each standard deviation decrease in LV fractional shortening was associated with an HR of 1.36 (95% CI 1.09-1.70). CONCLUSIONS Subclinical abnormalities in LV systolic function were associated with SCD risk in this general population. Although prediction of SCD remains difficult and traditional cardiovascular risk factors are of greatest importance, this knowledge might guide future directions to prevent SCD in persons with subclinical cardiac dysfunction.
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Affiliation(s)
- Maartje N Niemeijer
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Marten E van den Berg
- Department of Medical Informatics, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
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41
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Saeed M, Hetts SW, Jablonowski R, Wilson MW. Magnetic resonance imaging and multi-detector computed tomography assessment of extracellular compartment in ischemic and non-ischemic myocardial pathologies. World J Cardiol 2014; 6:1192-1208. [PMID: 25429331 PMCID: PMC4244616 DOI: 10.4330/wjc.v6.i11.1192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/15/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume (ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular (approximately 10% of tissue volume), interstitium (approximately 15%) and intracellular (approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types I/III collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis (e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy (hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging (MRI) has the ability to characterize tissue proton relaxation times (T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI (DE-MRI) and multi-detector computed tomography (DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet’s disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.
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42
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Laukkanen JA, Khan H, Kurl S, Willeit P, Karppi J, Ronkainen K, Di Angelantonio E. Left ventricular mass and the risk of sudden cardiac death: a population-based study. J Am Heart Assoc 2014; 3:e001285. [PMID: 25376188 PMCID: PMC4338721 DOI: 10.1161/jaha.114.001285] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Left ventricular (LV) mass ascertained using echocardiography may enhance risk stratification for sudden cardiac death. The objective of this study was to assess the association between left ventricular mass and the risk of sudden cardiac death in a population-based cohort and determine its incremental value beyond conventional risk predictors. METHODS AND RESULTS Assessment of LV mass was based on echocardiography in a sample of 905 middle-aged men representative of the general population (aged 42 to 61 years). During the follow-up period of 20 years, there were a total of 63 sudden cardiac deaths. In a comparison of the top versus the bottom quartile of LV mass adjusted by body surface area (>120 versus <89 g/m(2)), the multivariable adjusted hazard ratio was 2.57 (95% CI 1.24 to 5.31, P=0.010). Further adjustment for LV function only modestly attenuated the risk of sudden cardiac death among men with LV mass of >120 g/m(2) (hazard ratio 2.29, 95% CI 1.10 to 4.74, P=0.026). Addition of LV mass adjusted by body surface area to a conventional risk factor model for sudden cardiac death improved the integrated discrimination index by 0.033 (95% CI 0.009 to 0.057, P=0.007) and the category-free net reclassification index by 0.501 (95% CI 0.092 to 0.911, P=0.016). CONCLUSIONS Indexed LV mass by body surface area is an independent predictor of sudden cardiac death and may help improve the risk prediction of sudden cardiac death beyond conventional cardiovascular risk factors.
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Affiliation(s)
- Jari A. Laukkanen
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | | | - Sudhir Kurl
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | - Peter Willeit
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (P.W., E.D.A.)
| | - Jouni Karppi
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | - Kimmo Ronkainen
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (P.W., E.D.A.)
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43
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Electrocardiographic versus echocardiographic left ventricular hypertrophy and sudden cardiac arrest in the community. Heart Rhythm 2014; 11:1040-6. [PMID: 24657425 DOI: 10.1016/j.hrthm.2014.03.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is associated with increased risk of sudden cardiac arrest (SCA). Whether LVH diagnosed by 12-lead ECG vs echocardiogram conveys identical or distinct risk information has not been previously evaluated. OBJECTIVE The purpose of this study was to compare the association between ECG vs echocardiographic LVH and SCA in the community. METHODS In a large, prospective population-based study (The Oregon Sudden Unexpected Death Study; population approximately 1 million), cases of SCA were compared to controls recruited from the same geographical area. The association between LVH and SCA was evaluated, specifically comparing LVH diagnosed by ECG vs echocardiogram. RESULTS Cases (n = 132, age 66.9 ± 13.5 years, 58.3% male) compared to controls (n = 211; age 66.2 ± 12 years, 59.2% male) were more likely to have both ECG LVH (12.1% vs 5.7%, P = .03) and echocardiographic LVH (35.0% vs 15.5%, P <.001). However, there was poor agreement between the tests (kappa statistic = 0.128). A large subgroup of patients with ECG LVH (57.1%) did not have echocardiographic LVH; conversely, 83.6% of patients with echocardiographic LVH did not have ECG LVH. In multivariate analysis, ECG LVH was significantly associated with SCA (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-6.0, P = .04). When echocardiographic LVH was added to the model, this association was only mildly attenuated (OR 2.4, 95% CI 1.0-6.0, P= .05), and echocardiographic LVH was also independently associated with SCA (OR 2.7, 95% CI 1.5-4.9, P = .001). CONCLUSION ECG and echocardiographic LVH may convey distinct risk information in patients with SCA, reflecting electrical vs anatomic remodeling. These findings have potential implications for SCA mechanisms and risk stratification.
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Havmoeller R, Reinier K, Teodorescu C, Ahmadi N, Kwok D, Uy-Evanado A, Chen YDI, Rotter JI, Gunson K, Jui J, Chugh SS. Elevated plasma free fatty acids are associated with sudden death: a prospective community-based evaluation at the time of cardiac arrest. Heart Rhythm 2014; 11:691-6. [PMID: 24418168 DOI: 10.1016/j.hrthm.2014.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND In cohort studies, elevated levels of plasma nonesterified free fatty acids (NEFAs) have been associated with increased risk of sudden cardiac death (SCD) in men, but blood samples were drawn several years before SCD. OBJECTIVE To confirm this relationship by evaluating levels of plasma NEFAs at the time of the SCD event in a group of both men and women. METHODS From the ongoing Oregon Sudden Unexpected Death Study, we compared levels of plasma NEFAs in 149 SCD cases presenting with ventricular fibrillation (mean age 64 ± 12 years; 73% men) and 149 age- and sex-matched controls with coronary artery disease. Plasma was processed from blood drawn at the time of arrest (cases) and at a routine visit (controls). The levels of plasma NEFAs were compared after categorizing into quartiles on the basis of control values. Conditional logistic regression was used to predict adjusted odds ratio for SCD associated with plasma NEFA levels per increased quartile. RESULTS The plasma NEFA levels were significantly higher in SCD cases than in controls (median 0.39 mmol/L [interquartile range 0.28-0.60 mmol/L] vs 0.32 mmol/L [interquartile range 0.20-0.49 mmol/L]; P = .002). There were no significant differences in body mass index, smoking, and diabetes. The odds ratio for SCD was 1.42 (95% confidence interval 1.14-1.78) per quartile increase in the plasma NEFA level (P = .002). Individuals with plasma NEFA levels above the prespecified cutoff point of 0.32 mmol/L were at increased risk of SCD (odds ratio 2.00; 95% confidence interval 1.20-3.34; P = .008). CONCLUSION These findings strengthen the role of plasma NEFA as a potential biomarker for the assessment of SCD risk.
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Affiliation(s)
- Rasmus Havmoeller
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Kyndaron Reinier
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carmen Teodorescu
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Naser Ahmadi
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dorothy Kwok
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Audrey Uy-Evanado
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yii-Der I Chen
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jerome I Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karen Gunson
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - Sumeet S Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Angiotensin II type 1 receptor blockade restores angiotensin-(1–7)-induced coronary vasodilation in hypertrophic rat hearts. Clin Sci (Lond) 2013; 125:449-59. [DOI: 10.1042/cs20120519] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim of the present study was to investigate the coronary effects of Ang-(1–7) [angiotensin-(1–7)] in hypertrophic rat hearts. Heart hypertrophy was induced by abdominal aorta CoA (coarctation). Ang-(1–7) and AVE 0991, a non-peptide Mas-receptor agonist, at picomolar concentration, induced a significant vasodilation in hearts from sham-operated rats. These effects were blocked by the Mas receptor antagonist A-779. Pre-treatment with L-NAME (NG-nitro-L-arginine methyl ester) or ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinozalin-1-one) [NOS (NO synthase) and soluble guanylate cyclase inhibitors respectively] also abolished the effect of Ang-(1–7) in control hearts. The coronary vasodilation produced by Ang-(1–7) and AVE 0991 was completely blunted in hypertrophic hearts. Chronic oral administration of losartan in CoA rats restored the coronary vasodilation effect of Ang-(1–7). This effect was blocked by A-779 and AT2 receptor (angiotensin II type 2 receptor) antagonist PD123319. Acute pre-incubation with losartan also restored the Ang-(1–7)-induced, but not BK (bradykinin)-induced, coronary vasodilation in hypertrophic hearts. This effect was inhibited by A-779, PD123319 and L-NAME. Chronic treatment with losartan did not change the protein expression of Mas and AT2 receptor and ACE (angiotensin-converting enzyme) and ACE2 in coronary arteries from CoA rats, but induced a slight increase in AT2 receptor in aorta of these animals. Ang-(1–7)-induced relaxation in aortas from sham-operated rats was absent in aortas from CoA rats. In vitro pre-treatment with losartan restored the Ang-(1–7)-induced relaxation in aortic rings of CoA rats, which was blocked by the Mas antagonist A-779 and L-NAME. These data demonstrate that Mas is strongly involved in coronary vasodilation and that AT1 receptor (angiotensin II type 1 receptor) blockade potentiates the vasodilatory effects of Ang-(1–7) in the coronary beds of pressure-overloaded rat hearts through NO-related AT2- and Mas-receptor-dependent mechanisms. These data suggest the association of Ang-(1–7) and AT1 receptor antagonists as a potential therapeutic avenue for coronary artery diseases.
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Friedman DJ, Bender SR, Markowitz SM, Lerman BB, Okin PM. T-wave alternans and ST depression assessment identifies low risk individuals with ischemic cardiomyopathy in the absence of left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2013; 18:359-68. [PMID: 23879276 DOI: 10.1111/anec.12051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although ECG left ventricular hypertrophy (LVH) by Cornell product (CP) predicts increased mortality in patients with ischemic cardiomyopathy (ICM), those without CP LVH remain at relatively high risk. We examined whether T-wave alternans (TWA) testing and ST depression can improve risk stratification in these patients. METHODS AND RESULTS This study examined 317 patients with ICM, nonsustained ventricular tachycardia, and a resting ECG in sinus rhythm, who presented for electrophysiology and TWA testing, and potential implantable cardioverter defibrillator (ICD) implantation. LVH was defined by CP :[(RaVL + SV3 ) +6 mm in women] × QRS duration > 2440 mm * msec. ST depression was examined as a categorical variable using an established threshold of depression of ≥50 μV in V5 or V6 . In Cox multivariate models, abnormal TWA testing and ST depression were independent predictors of mortality in patients without CP LVH (HR 2.52, CI 1.09-5.80, P = 0.030 and HR 2.87, CI 1.41-5.81, P = 0.004, respectively). Individuals with no LVH by CP, normal TWA, and no significant ST depression, comprised 23% of the study population and had a 5.6% 3-year mortality, compared to an overall 20% mortality. CONCLUSIONS TWA and ST depression testing are strong predictors of mortality among ICM patients without CP LVH, with normal testing conversely predicting low 3-year mortality. Thus, risk assessment with TWA testing and a resting ECG can identify ICM patients at low risk who may be less likely to benefit from ICD implantation.
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Affiliation(s)
- Daniel J Friedman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
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Stevens SM, Reinier K, Chugh SS. Increased left ventricular mass as a predictor of sudden cardiac death: is it time to put it to the test? Circ Arrhythm Electrophysiol 2013; 6:212-7. [PMID: 23424223 DOI: 10.1161/circep.112.974931] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Steven M Stevens
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Whitman IR, Feldman HI, Deo R. CKD and sudden cardiac death: epidemiology, mechanisms, and therapeutic approaches. J Am Soc Nephrol 2012; 23:1929-39. [PMID: 23100219 DOI: 10.1681/asn.2012010037] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple studies demonstrate a strong independent association between CKD and cardiovascular events including death, heart failure, and myocardial infarction. This review focuses on recent clinical studies that expand this spectrum of adverse cardiovascular events to include ventricular arrhythmias and sudden cardiac death. In addition, experimental models suggest structural remodeling of the heart and electrophysiologic changes in this population. These processes may explain the increased arrhythmic risk in kidney disease and aid in identifying patients who are at higher risk for sudden cardiac death. Finally, we review here the data to support the use of pharmacologic and device-based therapies for both the primary and secondary prevention of sudden cardiac death.
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Affiliation(s)
- Isaac R Whitman
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Chalkias A, Stroumpoulis K, Xanthos T. Cardiac arrest and cardiopulmonary resuscitation after ischemic stroke. Am J Emerg Med 2012; 30:1311-2. [DOI: 10.1016/j.ajem.2012.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022] Open
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Tamarappoo BK, John BT, Reinier K, Teodorescu C, Uy-Evanado A, Gunson K, Jui J, Chugh SS. Vulnerable myocardial interstitium in patients with isolated left ventricular hypertrophy and sudden cardiac death: a postmortem histological evaluation. J Am Heart Assoc 2012; 1:e001511. [PMID: 23130141 PMCID: PMC3487319 DOI: 10.1161/jaha.112.001511] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/24/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Concentric left ventricular hypertrophy (LVH) is independently associated with increased risk of sudden cardiac death (SCD). Some animal models of LVH display specific alterations of the myocardial interstitium that could increase myocardial vulnerability to ventricular arrhythmias, but these merit evaluation in humans with LVH and SCD. METHODS AND RESULTS Twelve consecutive patients with isolated LVH and SCD (LVH+SCD) in the absence of hypertrophic cardiomyopathy, coronary disease, or other cardiac structural abnormality were ascertained in the Oregon Sudden Unexpected Death Study. Detailed postmortem comparisons were conducted with 18 controls who had isolated LVH and unnatural deaths (Control Group A) and 6 controls who had structurally normal hearts and unnatural deaths (Control Group B). Postmortem left ventricular myocardial sections were obtained for measurement of collagen volume fraction, characterization of gap junctions, and quantification of collagen subtypes. Heart weight normalized to body weight was higher in LVH+SCD cases (6.9±1.2 g/kg) than in Control Group A (5.3±1.4 g/kg) and Control Group B (4.2±0.3 g/kg); P=0.001. Collagen volume fraction was also higher in LVH+SCD cases (3.1±0.4) than in Control Group A (2.3±0.4) and Control Group B (1.6±0.3); P=0.0002. The relative amount of collagen III was significantly higher in LVH+SCD cases (33.0±4.4%) than in Control Group A (20.9±4.3%) and Control Group B (13.4±3.5%); P=0.0001. There was an overall increase in the number of connexin 43-labeled gap junctions with increasing myocyte size. No subject was found to have high-risk hypertrophic cardiomyopathy mutations. CONCLUSIONS In addition to the expected increase in myocardial mass and overall collagen content, SCD with isolated LVH was associated with relative abundance of type III collagen, a novel finding that warrants further mechanistic evaluation. (J Am Heart Assoc. 2012;1:e001511 doi: 10.1161/JAHA.111.001511.).
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Affiliation(s)
- Balaji K. Tamarappoo
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T.,
A.U.-E., S.S.C.)
- Cleveland Clinic Foundation, Cleveland OH (B.K.T.)
| | - Benjamin T. John
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T.,
A.U.-E., S.S.C.)
- Vancouver Clinic, Vancouver, WA (B.T.J)
| | - Kyndaron Reinier
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T.,
A.U.-E., S.S.C.)
| | - Carmen Teodorescu
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T.,
A.U.-E., S.S.C.)
| | - Audrey Uy-Evanado
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T.,
A.U.-E., S.S.C.)
| | - Karen Gunson
- Department of Pathology, Oregon Health and Science University, Portland, OR (K.G.)
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR (J.J.)
| | - Sumeet S. Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T.,
A.U.-E., S.S.C.)
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