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Mattesi G, Pergola V, Bariani R, Martini M, Motta R, Perazzolo Marra M, Rigato I, Bauce B. Multimodality imaging in arrhythmogenic cardiomyopathy - From diagnosis to management. Int J Cardiol 2024; 407:132023. [PMID: 38583594 DOI: 10.1016/j.ijcard.2024.132023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Arrhythmogenic Cardiomyopathy (AC), an inherited cardiac disorder characterized by myocardial fibrofatty replacement, carries a significant risk of sudden cardiac death (SCD) due to ventricular arrhythmias. A comprehensive multimodality imaging approach, including echocardiography, cardiac magnetic resonance imaging (CMR), and cardiac computed tomography (CCT), allows for accurate diagnosis, effective risk stratification, vigilant monitoring, and appropriate intervention, leading to improved patient outcomes and the prevention of SCD. Echocardiography is primary tool ventricular morphology and function assessment, CMR provides detailed visualization, CCT is essential in early stages for excluding congenital anomalies and coronary artery disease. Echocardiography is preferred for follow-up, with CMR capturing changes over time. The strategic use of these imaging methods aids in confirming AC, differentiating it from other conditions, tracking its progression, managing complications, and addressing end-stage scenarios.
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Affiliation(s)
| | | | - Riccardo Bariani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Marika Martini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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Mariani MV, Pierucci N, Fanisio F, Laviola D, Silvetti G, Piro A, La Fazia VM, Chimenti C, Rebecchi M, Drago F, Miraldi F, Natale A, Vizza CD, Lavalle C. Inherited Arrhythmias in the Pediatric Population: An Updated Overview. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:94. [PMID: 38256355 PMCID: PMC10819657 DOI: 10.3390/medicina60010094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1-1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Francesca Fanisio
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Vincenzo Mirco La Fazia
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, 00165 Rome, Italy;
| | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Andrea Natale
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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3
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Al-Ghamdi BS, Alhadeq F, Alqahtani A, Alruwaili N, Rababh M, Alghamdi S, Almanea W, Alhassnan Z. Clinical and Genetic Characteristics of Arrhythmogenic Right Ventricular Cardiomyopathy Patients: A Single-Center Experience. Cardiol Res 2023; 14:379-386. [PMID: 37936624 PMCID: PMC10627368 DOI: 10.14740/cr1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/22/2023] [Indexed: 11/09/2023] Open
Abstract
Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited progressive cardiomyopathy. We aimed to define the long-term clinical outcome and genetic characteristics of patients and family members with positive genetic tests for ARVC in a single tertiary care cardiac center in Saudi Arabia. Methods We enrolled 46 subjects in the study, including 23 index-patients (probands) with ARVC based on the revised 2010 ARVC Task Force Criteria (TFC) and 23 family members who underwent a genetic test for the ARVC between 2016 and 2020. Results Of the probands, 17 (73.9%) were males with a mean age at presentation of 24.95 ± 13.9 years (7 to 55 years). Predominant symptoms were palpitations in 14 patients (60.9%), and syncope in 10 patients (43.47%). Sustained ventricular tachycardia (VT) was documented in 12 patients (52.2%). The mean left ventricular ejection fraction (LVEF) by echocardiogram was 52.81±6.311% (30-55%), and the mean right ventricular ejection fraction (RVEF) by cardiac MRI was 41.3±11.37% (23-64%). Implantable cardioverter-defibrillator (ICD) implantation was performed in 17 patients (73.9%), and over a mean follow-up of 13.65 ± 6.83 years, appropriate ICD therapy was noted in 12 patients (52.2%). Genetic variants were identified in 33 subjects (71.7%), 16 patients and 17 family members, with the most common variant of plakophilin 2 (PKP2) in 27 subjects (81.8%). Conclusions ARVC occurs during early adulthood in Saudi patients. It is associated with a significant arrhythmia burden in these patients. The PKP2 gene is the most common gene defect in Saudi patients, consistent with what is observed in other nations. We reported in this study two novel variants in PKP2 and desmocollin 2 (DSC2) genes. Genetic counseling is needed to include all first-degree family members for early diagnosis and management of the disease in our country.
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Affiliation(s)
- Bandar Saeed Al-Ghamdi
- Heart Centre Department, King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Faten Alhadeq
- Cardiovascular Genetics Program, Center for Genomic Medicine, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia
| | - Aisha Alqahtani
- Cardiovascular Genetics Program, Center for Genomic Medicine, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia
| | - Nadiah Alruwaili
- Heart Centre Department, King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh, Saudi Arabia
| | | | | | - Waleed Almanea
- Heart Centre Department, King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh, Saudi Arabia
- Pediatric Cardiology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Zuhair Alhassnan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Cardiovascular Genetics Program, Center for Genomic Medicine, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia
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4
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Genetic lineage tracing identifies cardiac mesenchymal-to-adipose transition in an arrhythmogenic cardiomyopathy model. SCIENCE CHINA. LIFE SCIENCES 2023; 66:51-66. [PMID: 36322324 DOI: 10.1007/s11427-022-2176-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is one of the most common inherited cardiomyopathies, characterized by progressive fibrofatty replacement in the myocardium. However, the cellular origin of cardiac adipocytes in ACM remains largely unknown. Unraveling the cellular source of cardiac adipocytes in ACM would elucidate the underlying pathological process and provide a potential target for therapy. Herein, we generated an ACM mouse model by inactivating desmosomal gene desmoplakin in cardiomyocytes; and examined the adipogenic fates of several cell types in the disease model. The results showed that SOX9+, PDGFRa+, and PDGFRb+ mesenchymal cells, but not cardiomyocytes or smooth muscle cells, contribute to the intramyocardial adipocytes in the ACM model. Mechanistically, Bmp4 was highly expressed in the ACM mouse heart and functionally promoted cardiac mesenchymal-to-adipose transition in vitro.
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5
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Truong T, Herron C, Lawrence D, Galas J. Arrhythmogenic right ventricular cardiomyopathy presenting as heart failure in a child. Cardiol Young 2022; 33:1-4. [PMID: 35579085 DOI: 10.1017/s1047951122001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy is an uncommon diagnosis in the paediatric population, most commonly presenting with arrhythmia. We report an 11-year-old male presenting with right heart failure due to biventricular systolic dysfunction found to have arrhythmogenic right ventricular cardiomyopathy with de novo Desmin and MYH7 mutations.
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Affiliation(s)
- Terence Truong
- Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Christopher Herron
- Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - David Lawrence
- Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - James Galas
- Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
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6
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Limongelli G, Adorisio R, Baggio C, Bauce B, Biagini E, Castelletti S, Favilli S, Imazio M, Lioncino M, Merlo M, Monda E, Olivotto I, Parisi V, Pelliccia F, Basso C, Sinagra G, Indolfi C, Autore C. Diagnosis and Management of Rare Cardiomyopathies in Adult and Paediatric Patients. A Position Paper of the Italian Society of Cardiology (SIC) and Italian Society of Paediatric Cardiology (SICP). Int J Cardiol 2022; 357:55-71. [PMID: 35364138 DOI: 10.1016/j.ijcard.2022.03.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 12/20/2022]
Abstract
Cardiomyopathies (CMPs) are myocardial diseases in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease sufficient to cause the observed myocardial abnormality. Thought for a long time to be rare diseases, it is now clear that most of the CMPs can be easily observed in clinical practice. However, there is a group of specific heart muscle diseases that are rare in nature whose clinical/echocardiographic phenotypes resemble those of the four classical morphological subgroups of hypertrophic, dilated, restrictive, arrhythmogenic CMPs. These rare CMPs, often but not solely diagnosed in infants and paediatric patients, should be more properly labelled as specific CMPs. Emerging consensus exists that these conditions require tailored investigation and management. Indeed, an appropriate understanding of these conditions is mandatory for early treatment and counselling. At present, however, the multisystemic and heterogeneous presentation of these entities is a challenge for clinicians, and time delay in diagnosis is a significant concern. The aim of this paper is to define practical recommendations for diagnosis and management of the rare CMPs in paediatric or adult age. A modified Delphi method was adopted to grade the recommendations proposed by each member of the writing committee.
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Affiliation(s)
- Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy; Member of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu).
| | - Rachele Adorisio
- Heart Failure, Transplant and Mechanical Cardiocirculatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart Lung Transplantation, Bambino Gesù Hospital and Research Institute, Rome, Italy
| | - Chiara Baggio
- Cardiothoracovascular and Medical Surgical and Health Science Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34149 Trieste, Italy
| | - Barbara Bauce
- Member of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu); Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elena Biagini
- Member of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu); Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Silvia Castelletti
- Cardiomyopathy Unit and Center for Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Science, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Children's Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Massimo Imazio
- Head of Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Piazzale Santa Maria della Misericordia 15, Udine 33100, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Disease Unit, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Merlo
- Member of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu); Cardiothoracovascular and Medical Surgical and Health Science Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34149 Trieste, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Disease Unit, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi and the University of Florence, Florence, Italy
| | - Vanda Parisi
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Cristina Basso
- Member of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu); Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera, University of Padua Padova, Italy
| | - Gianfranco Sinagra
- Member of ERN GUARD-HEART (European Reference Network for Rare and Complex Diseases of the Heart; http://guardheart.ern-net.eu); Cardiothoracovascular and Medical Surgical and Health Science Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34149 Trieste, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Division of Cardiology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
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Cicenia M, Drago F. Arrhythmogenic Cardiomyopathy: Diagnosis, Evolution, Risk Stratification and Pediatric Population-Where Are We? J Cardiovasc Dev Dis 2022; 9:98. [PMID: 35448074 PMCID: PMC9024428 DOI: 10.3390/jcdd9040098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a cardiomyopathy characterized by the occurrence of a high risk of life-threatening ventricular arrhythmias and sudden cardiac death even at presentation. Diagnosis, evolution and outcomes in adults have been extensively reported, but little data in pediatric population are available. Risk stratification in this particular setting is still a matter of debate and new risk factors are needed in a model of an ever more "individualized medicine".
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Affiliation(s)
| | - Fabrizio Drago
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
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8
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Vermeer MCSC, Andrei D, Kramer D, Nijenhuis AM, Hoedemaekers YM, Westers H, Jongbloed JDH, Pas HH, van den Berg MP, Silljé HHW, van der Meer P, Bolling MC. Functional investigation of two simultaneous or separately segregating DSP variants within a single family support the theory of a dose-dependent disease severity. Exp Dermatol 2022; 31:970-979. [PMID: 35325485 PMCID: PMC9322008 DOI: 10.1111/exd.14571] [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: 07/29/2021] [Revised: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
Desmoplakin (DP) is an important component of desmosomes, essential in cell–cell connecting structures in stress‐bearing tissues. Over the years, many hundreds of pathogenic variants in DSP have been associated with different cutaneous and cardiac phenotypes or a combination, known as a cardiocutaneous syndrome. Of less than 5% of the reported DSP variants, the effect on the protein has been investigated. Here, we describe and have performed RNA, protein and tissue analysis in a large family where DSPc.273+5G>A/c.6687delA segregated with palmoplantar keratoderma (PPK), woolly hair and lethal cardiomyopathy, while DSPWT/c.6687delA segregated with PPK and milder cardiomyopathy. hiPSC‐derived cardiomyocytes and primary keratinocytes from carriers were obtained for analysis. Unlike the previously reported nonsense variants in the last exon of DSP that bypassed the nonsense‐mediated mRNA surveillance system leading to protein truncation, variant c.6687delA was shown to cause the loss of protein expression. Patients carrying both variants and having a considerably more severe phenotype were shown to have 70% DP protein reduction, while patients carrying only c.6687delA had 50% protein reduction and a milder phenotype. The analysis of RNA from patient cells did not show any splicing effect of the c.273+5G>A variant. However, a minigene splicing assay clearly showed alternative spliced transcripts originating from this variant. This study shows the importance of RNA and protein analyses to pinpoint the exact effect of DSP variants instead of solely relying on predictions. In addition, the particular pattern of inheritance, with simultaneous or separately segregating DSP variants within the same family, strongly supports the theory of a dose‐dependent disease severity.
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Affiliation(s)
- Mathilde C S C Vermeer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daniela Andrei
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Duco Kramer
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albertine M Nijenhuis
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne M Hoedemaekers
- Department of Genetics, Radboud University Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helga Westers
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendri H Pas
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Herman H W Silljé
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria C Bolling
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Clinical Characteristics and Follow-Up of Pediatric-Onset Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:306-318. [PMID: 35331425 DOI: 10.1016/j.jacep.2021.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The goal of this study was to describe characteristics, cascade screening results, and predictors of adverse outcome in pediatric-onset arrhythmogenic right ventricular cardiomyopathy (ARVC). BACKGROUND Although ARVC is increasingly recognized in children, pediatric ARVC cohorts remain underrepresented in the literature. METHODS This study included 12 probands with pediatric-onset ARVC (aged <18 years at diagnosis) and 68 pediatric relatives (aged <18 years at first evaluation) referred for cascade screening. ARVC diagnosis was based on 2010 Task Force Criteria. Clinical presentation, diagnostic testing, and outcomes (sustained ventricular tachycardia [VT]; heart failure) were ascertained. Predictors of adverse outcome were determined by using univariable logistic regression. RESULTS Pediatric-onset ARVC was diagnosed in 12 probands and 12 (18%) relatives at a median age of 16.6 years (interquartile range: 13.8-17.4 years), whereas 12 (18%) relatives reached ARVC diagnosis as adults (median age, 22.0 years; interquartile range: 20.0-26.7 years). Sudden cardiac death/arrest was the first disease manifestation in 3 (25%) probands and 3 (4%) relatives. In patients without ARVC diagnosis at presentation (n = 61), electrocardiogram and Holter monitoring abnormalities occurred before development of imaging Task Force Criteria (7.3 ± 5.0 years vs 8.4 ± 5.0 years). Clinical course was characterized by sustained VT (91%) and heart failure (36%) in probands, which were rare in relatives (2% and 0%, respectively). Male sex (P < 0.01), T-wave inversion V1-V3 (P < 0.01), premature ventricular complexes/runs (P ≤ 0.01), and decrease in biventricular ejection fraction (P ≤ 0.01) were associated with VT occurrence. CONCLUSIONS Pediatric ARVC carries high arrhythmic risk, especially in probands. Disease progression is particularly observed on electrocardiogram or Holter monitoring. Arrhythmic events are associated with male sex, T-wave inversions, premature ventricular complexes/runs, and reduced biventricular ejection fraction.
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10
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Manole S, Pintican R, Popa G, Rancea R, Dadarlat-Pop A, Vulturar R, Palade E. Diagnostic Challenges in Rare Causes of Arrhythmogenic Cardiomyopathy—The Role of Cardiac MRI. J Pers Med 2022; 12:jpm12020187. [PMID: 35207675 PMCID: PMC8878419 DOI: 10.3390/jpm12020187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare genetic condition of the myocardium, with a significantly high risk of sudden death. Recent genetic research and improved understanding of the pathophysiology tend to change the ARVD definition towards a larger spectrum of myocardial involvement, which includes, in various proportions, both the right (RV) and left ventricle (LV), currently referred to as ACM (arrhythmogenic cardiomyopathy). Its pathological substrate is defined by the replacement of the ventricular myocardium with fibrous adipose tissue that further leads to inadequate electrical impulses and translates into varies degrees of malignant ventricular arrythmias and dyskinetic myocardium movements. Particularly, the cardio-cutaneous syndromes of Carvajal/Naxos represent rare causes of ACM that might be suspected from early childhood. The diagnostic is sometimes challenging, even with well-established rTFC or Padua criteria, especially for pediatric patients or ACM with LV involvement. Cardiac MRI gain more and more importance in ACM diagnostic especially in non-classical forms. Furthermore, MRI is useful in highlighting myocardial fibrosis, fatty replacement or wall movement with high accuracy, thus guiding not only the depiction, but also the patient’s stratification and management.
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Affiliation(s)
- Simona Manole
- Department of Radiology and Medical Imaging, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca, 8, Victor Babes St., 400012 Cluj-Napoca, Romania;
- Department of Radiology, “Niculae Stancioiu” Heart Institute, 19-21, Calea Motilor St., 400001 Cluj-Napoca, Romania
| | - Roxana Pintican
- Department of Radiology and Medical Imaging, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca, 8, Victor Babes St., 400012 Cluj-Napoca, Romania;
- Correspondence: (R.P.); (G.P.)
| | - George Popa
- Department of Radiology, “Niculae Stancioiu” Heart Institute, 19-21, Calea Motilor St., 400001 Cluj-Napoca, Romania
- Correspondence: (R.P.); (G.P.)
| | - Raluca Rancea
- Department of Cardiology, “Niculae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania; (R.R.); (A.D.-P.)
| | - Alexandra Dadarlat-Pop
- Department of Cardiology, “Niculae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania; (R.R.); (A.D.-P.)
- Department of Cardiology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca, 8, Victor Babes, St., 400012 Cluj-Napoca, Romania
| | - Romana Vulturar
- Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Emanuel Palade
- Department of Cardiovascular and Thoracic Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca, 8, Victor Babes, St., 400012 Cluj-Napoca, Romania;
- Department of Thoracic Surgery, “Leon Daniello” Pneumophtysiology Hospital Cluj-Napoca, Bogdan Petriceicu Hasdeu Street, Nr 6, 400332 Cluj-Napoca, Romania
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11
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Cicenia M, Cantarutti N, Adorisio R, Silvetti MS, Secinaro A, Ciancarella P, Di Mambro C, Magliozzi M, Novelli A, Amodeo A, Baban A, Drago F. Arrhythmogenic cardiomyopathy in children according to "Padua criteria": Single pediatric center experience. Int J Cardiol 2022; 350:83-89. [PMID: 34998950 DOI: 10.1016/j.ijcard.2022.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/26/2021] [Accepted: 01/02/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to report clinical and arrhythmic features in a pediatric population affected by arrhythmogenic cardiomyopathy (ACM). Moreover, we assessed the concordance between the 2010 International Task Force criteria (ITF) and the 2020 Padua criteria. METHODS Inclusion criteria were "definite" or "borderline" ACM diagnosed according to the "Padua criteria" in patients <18 years old. History, electrocardiograms, ECG-holter monitorings, exercise testings, imaging investigations, electrophysiological studies, genetic testings and follow-up data were collected. RESULTS We enrolled 21 patients (mean age 13.9 ± 2 years). Most of them presented for minor arrhythmias. Premature ventricular complexes burden was 7.9 ± 10%. Cardiac magnetic resonance (19/21, 90.5% patients) showed right ventricular (RV) dilatation, wall motion abnormalities and late gadolinium enhancement (LGE) of both ventricles as predominant features [in 9 patients (52.9%) LGE left ventricle]. Genetic results (19/21 patient) showed compound heterozygous variants in 3/19 patients (15.8%), digenic in 3/19 (15.8%) and single in 6/19 (31.6%). Cardiac defibrillator (ICD) was indicated in 15 patients (71.4%): 6 in class I, 7 in class IIa, 2 in class IIb. Appropriate shocks occurred in 2 patients (13.3%), follow-up 5.46 ± 3.17 years According to 2010 ITF criteria: among the 18 patients with a "definite" ACM diagnosis, one patient would have had a "borderline" diagnosis, three a "possible" diagnosis and one no diagnosis and among the three patients with "borderline" diagnosis two would have had a "possible" diagnosis. CONCLUSIONS Pediatric ACM can be diagnosed in the majority of cases secondary to incidental finding of simple ventricular arrhythmias. PVC burden is low and exercise induced arrhythmias rarely occur. Few patients with ICD experience appropriate shocks. "Padua criteria" improve the diagnostic accuracy.
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Affiliation(s)
- Marianna Cicenia
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Adorisio
- Heart Failure and Transplant, Mechanical Circulatory Support Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciancarella
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Di Mambro
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Monia Magliozzi
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure and Transplant, Mechanical Circulatory Support Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anwar Baban
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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12
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Heart Failure in Patients with Arrhythmogenic Cardiomyopathy. J Clin Med 2021; 10:jcm10204782. [PMID: 34682905 PMCID: PMC8540844 DOI: 10.3390/jcm10204782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiomyopathy characterized as fibro-fatty replacement, and a common cause for sudden cardiac death in young athletes. Development of heart failure (HF) has been an under-recognized complication of ACM for a long time. The current clinical management guidelines for HF in ACM progression have nowadays been updated. Thus, a comprehensive review for this great achievement in our understanding of HF in ACM is necessary. In this review, we aim to describe the research progress on epidemiology, clinical characteristics, risk stratification and therapeutics of HF in ACM.
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13
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Lutokhina YA, Blagova OV, Nedostup AV, Alexandrova SA, Evseeva EV, Shestak AG, Zaklyazminskaya EV. Contribution of concomitant myocarditis to the development of various clinical types of arrhythmogenic right ventricular cardiomyopathy. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess the contribution of genetic and inflammatory factors to the development of arrhythmogenic right ventricular cardiomyopathy (ARVC).Material and methods. The study involved 54 patients with ARVC (age, 38,7±14,1 years; men, 42,6%; mean follow-up period, 21 [6; 60] months). All patients underwent electrocardiography (ECG), 24-hour ECG monitoring, echocardiography, determination of anticardiac antibodies and DNA of cardiotropic viruses in the blood, molecular genetic ARVC testing, as well as cardiac magnetic resonance imaging (n=49), high-resolution ECG (n=18), right ventricular endomyocardial biopsy (n=2), and autopsy (n=2).Results. Following four clinical types of ARVC were identified: I. Latent arrhythmic form: characterized by frequent premature ventricular contractions and/or nonsustained ventricular tachycardia (VT). II. Manifested arrhythmic form (n=11) — SVT/ventricular fibrillation (VF). III. ARVC with progressive heart failure (HF, n=8). IV. Combination of ARVC with left ventricular noncompaction (LVNC, n=8). Superimposed myocarditis was identified in 74%, 36%, 87,5% and 85,7% of patients in forms I-IV, respectively. Mutations were detected in 11%, 46%, 50%, and 38% of patients in forms I-IV, respectively. Clinical forms were stable: there was no transition from one clinical form to another during follow-up period.Conclusion. The contribution of genetic and inflammatory mechanisms to the clinical picture is different: in the latent arrhythmic form, the leading role belongs to inflammation; in the manifested arrhythmic form, the contribution of pathogenic mutations prevails, and in ARVC with progressive HF and in combination with LVNC, the contribution of genetic and inflammatory factors is equally important.
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Affiliation(s)
| | | | | | - S. A. Alexandrova
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery
| | | | - A. G Shestak
- B.V. Petrovsky Russian Research Center of Surgery
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14
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Liu Y, Yu J, Liu J, Wu B, Cui Q, Shen W, Xia S. Prognostic value of late gadolinium enhancement in arrhythmogenic right ventricular cardiomyopathy: a meta-analysis. Clin Radiol 2021; 76:628.e9-628.e15. [PMID: 34024635 DOI: 10.1016/j.crad.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
AIM To assess systematically the prognostic value of cardiac magnetic resonance imaging (CMRI) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). MATERIALS AND METHODS The full text of studies of the clinical efficacy of late gadolinium enhancement (LGE) in ARVC was retrieved in multiple databases. Stata 14 was adopted for meta-analysis and bias analysis. Heterogeneity was assessed with the I2 statistic. RESULTS After exclusions, 561 patients were included in five studies, and the eligibility criteria were met. The meta-analysis suggested that there was a significant difference between LGE positive and negative patients with ARVC in all-cause mortality (relative risk [RR] = 4.78, 95% confidence interval [CI] = 1.41, 16.23, p=0.012; p for heterogeneity = 0.692, I2 = 0%); major adverse cardiovascular events (MACE) (RR=2.48, 95% CI = 1.24, 4.96, p=0.010; p for heterogeneity = 0.596, I2 = 0%); ventricular tachycardia (RR=3.13, 95% CI = 1.69, 5.78, p<0.001; p for heterogeneity = 0.825, I2 = 0%); implanted cardiac defibrillators (RR=3.15, 95% CI = 1.69, 5.87], p<0.001; p for heterogeneity = 0.353, I2 = 9.4%). CONCLUSION LGE in ARVC patients is a predictor of all-cause mortality and MACE.
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Affiliation(s)
- Y Liu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - J Yu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - J Liu
- Outpatient Department, Tianjin Third Central Hospital, No. 83, Jintang Road, Hedong District, Tianjin, 300000, China
| | - B Wu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - Q Cui
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - W Shen
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China.
| | - S Xia
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China.
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15
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Hoover CA, Ott KL, Manring HR, Dew T, Borzok MA, Wright NT. Creating a 'Molecular Band-Aid'; Blocking an Exposed Protease Target Site in Desmoplakin. J Pers Med 2021; 11:jpm11050401. [PMID: 34065787 PMCID: PMC8151963 DOI: 10.3390/jpm11050401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
Desmoplakin (DSP) is a large (~260 kDa) protein found in the desmosome, a subcellular complex that links the cytoskeleton of one cell to its neighbor. A mutation ‘hot-spot’ within the NH2-terminal third of the DSP protein (specifically, residues 299–515) is associated with both cardiomyopathies and skin defects. In select DSP variants, disease is linked specifically to the uncovering of a previously-occluded calpain target site (residues 447–451). Here, we partially stabilize these calpain-sensitive DSP clinical variants through the addition of a secondary single point mutation—tyrosine for leucine at amino acid position 518 (L518Y). Molecular dynamic (MD) simulations and enzymatic assays reveal that this stabilizing mutation partially blocks access to the calpain target site, resulting in restored DSP protein levels. This ‘molecular band-aid’ provides a novel way to maintain DSP protein levels, which may lead to new strategies for treating this subset of DSP-related disorders.
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Affiliation(s)
- Catherine A. Hoover
- Department of Natural Sciences, Mansfield University of Pennsylvania, Mansfield, PA 16933, USA;
| | - Kendahl L. Ott
- Department of Chemistry and Biochemistry, James Madison University, Harrisonburg, VA 22807, USA;
| | - Heather R. Manring
- Department of Physiology and Cell Biology, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA; (H.R.M.); (T.D.)
| | - Trevor Dew
- Department of Physiology and Cell Biology, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA; (H.R.M.); (T.D.)
| | - Maegen A. Borzok
- Department of Natural Sciences, Mansfield University of Pennsylvania, Mansfield, PA 16933, USA;
- Correspondence: (M.A.B.); (N.T.W.)
| | - Nathan T. Wright
- Department of Chemistry and Biochemistry, James Madison University, Harrisonburg, VA 22807, USA;
- Correspondence: (M.A.B.); (N.T.W.)
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16
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Lopez-Ayala JM, Gimeno-Blanes J, Lopez-Cuenca D, Molina MS, Gimeno-Blanes JR. Electrocardiographic Screening of Arrhythmogenic Cardiomyopathy in Genotype-Positive and Phenotype-Negative Relatives. Front Cardiovasc Med 2021; 8:646391. [PMID: 34026867 PMCID: PMC8137826 DOI: 10.3389/fcvm.2021.646391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Arrhythmogenic cardiomyopathy is a hereditary cause of ventricular arrhythmias and sudden death. Identifying the healthy genetic carriers who will develop the disease remains a challenge. A novel approach to the analysis of the digital electrocardiograms of mutation carriers through signal processing may identify early electrocardiographic abnormalities. Methods: A retrospective case–control study included a population of healthy genetics carriers and their wild-type relatives. Genotype-positive/phenotype-negative individuals bore mutations associated with the development of arrhythmogenic cardiomyopathy. The relatives included had a non-pathological 12-lead electrocardiogram, echocardiogram, and a cardiac magnetic resonance. Automatic digital electrocardiographic analyses comprised QRS and terminal activation delay duration, the number of QRS fragmentations, ST slope, and T-wave voltage. Results: Digital 12-lead electrocardiograms from 41 genotype-positive/ phenotype-negative (29 simple carriers and 12 double mutation carriers) and 73 wild-type relatives were analyzed. No differences in the QRS length, the number of QRS fragmentations, and the voltage of the T-wave were observed. After adjusting for potential confounders, double carriers showed an average ST-slope flatter than those of the simple carriers and wild type [5.18° (0.73–8.01), 7.15° (5.14–11.05), and 11.46° (3.94–17.49), respectively, p = 0.005]. There was a significant negative correlation between the ST slope and the age in genotype-positive/phenotype-negative relatives (r = 0.376, p = 0.021) not observed in their wild-type counterparts (r = 0.074, p = 0.570). Conclusions: A flattened ST segment may be an early sign of electrical remodeling that precedes T-wave inversion in healthy genetic carriers. A thorough analysis of the digital electrocardiographic signal may help identify and measure early electrical abnormalities.
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Affiliation(s)
| | - Javier Gimeno-Blanes
- Department of Signal Theory and Communications, Miguel Hernández University, Alicante, Spain
| | - David Lopez-Cuenca
- Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Maria Sabater Molina
- Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain
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17
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Te Riele ASJM, James CA, Calkins H, Tsatsopoulou A. Arrhythmogenic Right Ventricular Cardiomyopathy in Pediatric Patients: An Important but Underrecognized Clinical Entity. Front Pediatr 2021; 9:750916. [PMID: 34926342 PMCID: PMC8678603 DOI: 10.3389/fped.2021.750916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by fibrofatty infiltration of predominantly the right ventricular (RV) myocardium. Affected patients typically present as young adults with hemodynamically stable ventricular tachycardia, although pediatric cases are increasingly recognized. These young subjects often have a more severe phenotype with a high risk of sudden cardiac death (SCD) and progression toward heart failure. Diagnosis of ARVC is made by combining multiple sources of information as prescribed by the consensus-based Task Force Criteria. The description of Naxos disease, a fully penetrant autosomal recessive disorder that is associated with ARVC and a cutaneous phenotype of palmoplantar keratoderma and wooly hair facilitated the identification of the genetic cause of ARVC. At present, approximately 60% of patients are found to carry a pathogenic variant in one of five genes associated with the cardiac desmosome. The incomplete penetrance and variable expressivity of these variants however implies an important role for environmental factors, of which participation in endurance exercise is a strong risk factor. Since there currently is no definite cure for ARVC, disease management is directed toward symptom reduction, delay of disease progression, and prevention of SCD. This clinically focused review describes the spectrum of ARVC among children and adolescents, the genetic architecture underlying this disease, the cardio-cutaneous syndromes that led to its identification, and current diagnostic and therapeutic strategies in pediatric ARVC subjects.
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Affiliation(s)
- Anneline S J M Te Riele
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Adalena Tsatsopoulou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
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18
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy: Executive summary. Heart Rhythm 2020; 16:e373-e407. [PMID: 31676023 DOI: 10.1016/j.hrthm.2019.09.019] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Indexed: 01/14/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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19
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Established and Emerging Mechanisms in the Pathogenesis of Arrhythmogenic Cardiomyopathy: A Multifaceted Disease. Int J Mol Sci 2020; 21:ijms21176320. [PMID: 32878278 PMCID: PMC7503882 DOI: 10.3390/ijms21176320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/13/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heritable myocardial disease that manifests with cardiac arrhythmias, syncope, sudden cardiac death, and heart failure in the advanced stages. The pathological hallmark of ACM is a gradual replacement of the myocardium by fibroadiposis, which typically starts from the epicardium. Molecular genetic studies have identified causal mutations predominantly in genes encoding for desmosomal proteins; however, non-desmosomal causal mutations have also been described, including genes coding for nuclear proteins, cytoskeleton componentsand proteins involved in excitation-contraction coupling. Despite the poor prognosis, currently available treatments can only partially control symptoms and to date there is no effective therapy for ACM. Inhibition of the canonical Wnt/β-catenin pathway and activation of the Hippo and the TGF-β pathways have been implicated in the pathogenesis of ACM. Yet, our understanding of the molecular mechanisms involved in the development of the disease and the cell source of fibroadiposis remains incomplete. Elucidation of the pathogenesis of the disease could facilitate targeted approaches for treatment. In this manuscript we will provide a comprehensive review of the proposed molecular and cellular mechanisms of the pathogenesis of ACM, including the emerging evidence on abnormal calcium homeostasis and inflammatory/autoimmune response. Moreover, we will propose novel hypothesis about the role of epicardial cells and paracrine factors in the development of the phenotype. Finally, we will discuss potential innovative therapeutic approaches based on the growing knowledge in the field.
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20
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Lubos N, van der Gaag S, Gerçek M, Kant S, Leube RE, Krusche CA. Inflammation shapes pathogenesis of murine arrhythmogenic cardiomyopathy. Basic Res Cardiol 2020; 115:42. [PMID: 32529556 PMCID: PMC7289786 DOI: 10.1007/s00395-020-0803-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is an incurable genetic disease, whose pathogenesis is poorly understood. AC is characterized by arrhythmia, fibrosis, and cardiodilation that may lead to sudden cardiac death or heart failure. To elucidate AC pathogenesis and to design possible treatment strategies of AC, multiple murine models have been established. Among them, mice carrying desmoglein 2 mutations are particularly valuable given the identification of desmoglein 2 mutations in human AC and the detection of desmoglein 2 auto-antibodies in AC patients. Using two mouse strains producing either a mutant desmoglein 2 or lacking desmoglein 2 in cardiomyocytes, we test the hypothesis that inflammation is a major component of disease pathogenesis. We show that multifocal cardiomyocyte necrosis initiates a neutrophil-dominated inflammatory response, which also involves macrophages and T cells. Increased expression of Ccl2/Ccr2, Ccl3/Ccr5, and Cxcl5/Cxcr2 mRNA reflects the observed immune cell recruitment. During the ensuing acute disease phase, Mmp12+ and Spp1+ macrophages and T cells accumulate in scars, which mature from cell- to collagen-rich. The expression of Cx3cl1/Cx3cr1, Ccl2/Ccr2, and Cxcl10/Cxcr3 dominates this disease phase. We furthermore find that during chronic disease progression macrophages and T cells persist within mature scars and are present in expanding interstitial fibrosis. Ccl12 and Cx3cl1 are predominant chemokines in this disease phase. Together, our observations provide strong evidence that specific immune cell populations and chemokine expression profiles modulate inflammatory and repair processes throughout AC progression.
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Affiliation(s)
- Nadine Lubos
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074, Aachen, Germany
| | - Svenja van der Gaag
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074, Aachen, Germany
| | - Muhammed Gerçek
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074, Aachen, Germany
| | - Sebastian Kant
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074, Aachen, Germany
| | - Rudolf E Leube
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074, Aachen, Germany.
| | - Claudia A Krusche
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074, Aachen, Germany.
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DeWitt ES, Chandler SF, Hylind RJ, Beausejour Ladouceur V, Blume ED, VanderPluym C, Powell AJ, Fynn-Thompson F, Roberts AE, Sanders SP, Bezzerides V, Lakdawala NK, MacRae CA, Abrams DJ. Phenotypic Manifestations of Arrhythmogenic Cardiomyopathy in Children and Adolescents. J Am Coll Cardiol 2020; 74:346-358. [PMID: 31319917 DOI: 10.1016/j.jacc.2019.05.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is a variably penetrant disease increasingly identified in young patients. OBJECTIVES This study sought to describe the diverse phenotype, genotype, and outcomes in pediatric and adolescent patients. METHODS Records from 1999 to 2016 were reviewed for individuals age <21 years with a consistent personal or family history. Patients were categorized by right ventricular (RV), left dominant (LD), or biventricular subtypes using 2010 Task Force Criteria or proposed features of LD disease, encompassing electrocardiographic, structural, histological, and arrhythmic characteristics. Genetic variants classified as pathogenic and/or likely pathogenic by 2015 American College of Medical Genetics and Genomics criteria in recognized disease-associated genes were included. RESULTS Manifest disease was evident in 32 patients (age 15.1 ± 3.8 years), of whom 22 were probands, including 16 RV, 7 LD, and 9 biventricular ACM. Nondiagnostic features were seen in 5 of 15 family members. RV disease was associated with cardiac arrest and ventricular tachycardia (p = 0.02) and prevalence of PKP2 variants (p < 0.01), whereas biventricular disease was associated with a younger age of onset (p = 0.02). LD ACM was associated with variants in DSP and LMNA, and biventricular ACM with more a diverse etiology in desmosomal genes. Cardiac arrest was observed in 5 probands (age 15.3 ± 1.9 years) and ventricular tachycardia in 10 (age 16.6 ± 2.7 years), 6 probands, and 4 family members. Features suggestive of myocardial inflammation were seen in 6 patients, with ventricular tachycardia and/or cardiac arrest in 3 patients. Cardiac transplantation was performed in 10 patients. There were no deaths. In RV and biventricular disease, electrocardiographic preceded imaging features, whereas the reverse was seen in LD disease. CONCLUSIONS ACM in the young has highly varied phenotypic expression incorporating life-threatening arrhythmia, heart failure, and myocardial inflammation. Increased awareness of early onset, aggressive disease has important implications for patient management and familial screening.
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Affiliation(s)
- Elizabeth S DeWitt
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie F Chandler
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robyn J Hylind
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Virginie Beausejour Ladouceur
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christina VanderPluym
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis Fynn-Thompson
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen P Sanders
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vassilios Bezzerides
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal K Lakdawala
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Calum A MacRae
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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23
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Abstract
Arrhythmogenic cardiomyopathy is a genetic disorder characterized by the risk of life-threatening arrhythmias, myocardial dysfunction and fibrofatty replacement of myocardial tissue. Mutations in genes that encode components of desmosomes, the adhesive junctions that connect cardiomyocytes, are the predominant cause of arrhythmogenic cardiomyopathy and can be identified in about half of patients with the condition. However, the molecular mechanisms leading to myocardial destruction, remodelling and arrhythmic predisposition remain poorly understood. Through the development of animal, induced pluripotent stem cell and other models of disease, advances in our understanding of the pathogenic mechanisms of arrhythmogenic cardiomyopathy over the past decade have brought several signalling pathways into focus. These pathways include canonical and non-canonical WNT signalling, the Hippo-Yes-associated protein (YAP) pathway and transforming growth factor-β signalling. These studies have begun to identify potential therapeutic targets whose modulation has shown promise in preclinical models. In this Review, we summarize and discuss the reported molecular mechanisms underlying the pathogenesis of arrhythmogenic cardiomyopathy.
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Pourrier M, Fedida D. The Emergence of Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes (hiPSC-CMs) as a Platform to Model Arrhythmogenic Diseases. Int J Mol Sci 2020; 21:ijms21020657. [PMID: 31963859 PMCID: PMC7013748 DOI: 10.3390/ijms21020657] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022] Open
Abstract
There is a need for improved in vitro models of inherited cardiac diseases to better understand basic cellular and molecular mechanisms and advance drug development. Most of these diseases are associated with arrhythmias, as a result of mutations in ion channel or ion channel-modulatory proteins. Thus far, the electrophysiological phenotype of these mutations has been typically studied using transgenic animal models and heterologous expression systems. Although they have played a major role in advancing the understanding of the pathophysiology of arrhythmogenesis, more physiological and predictive preclinical models are necessary to optimize the treatment strategy for individual patients. Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) have generated much interest as an alternative tool to model arrhythmogenic diseases. They provide a unique opportunity to recapitulate the native-like environment required for mutated proteins to reproduce the human cellular disease phenotype. However, it is also important to recognize the limitations of this technology, specifically their fetal electrophysiological phenotype, which differentiates them from adult human myocytes. In this review, we provide an overview of the major inherited arrhythmogenic cardiac diseases modeled using hiPSC-CMs and for which the cellular disease phenotype has been somewhat characterized.
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Affiliation(s)
- Marc Pourrier
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- IonsGate Preclinical Services Inc., Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - David Fedida
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
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25
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm 2019; 16:e301-e372. [PMID: 31078652 DOI: 10.1016/j.hrthm.2019.05.007] [Citation(s) in RCA: 436] [Impact Index Per Article: 87.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 02/08/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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26
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Arrhythmogenic Ventricular Cardiomyopathy Associated With Fibromuscular Dysplasia of Ostial Right Main Coronary Artery. Am J Forensic Med Pathol 2019; 40:183-187. [PMID: 30844837 DOI: 10.1097/paf.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this article, we report the autopsy findings of a 23-year-old woman, who was found unconscious at home by her relatives. During the transportation to the hospital, the woman was handed over to the ambulance personnel, who were the first to provide cardiopulmonary resuscitation. In the hospital, after an hour-lasting asystole, the heart activity was restored. Prolonged cardiac arrest led to hypoxic brain injury, which resulted in a persistent coma. Examinations carried out during hospitalization detected hypokinetic interventricular septum, frequent ventricular extrasystoles and ventricular fibrillation. The patient died within 35 hours of admission to the hospital. Gross findings of the heart included a noticeable increase of the adipose tissue in the right ventricular wall, where histologically focal myocardial atrophy with focal transmural lipomatosis reaching endocardium were detected. Death was attributed to arrhythmogenic ventricular cardiomyopathy. Pathogenic variants in JUP gene and KCNH2 gene confirmed the diagnosis. Other finding of note was fibromuscular dysplasia of ostial right main coronary artery causing a significant luminal narrowing.
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27
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Ghorayeb N, Stein R, Daher DJ, Silveira ADD, Ritt LEF, Santos DFPD, Sierra APR, Herdy AH, Araújo CGSD, Colombo CSSDS, Kopiler DA, Lacerda FFRD, Lazzoli JK, Matos LDNJD, Leitão MB, Francisco RC, Alô ROB, Timerman S, Carvalho TD, Garcia TG. The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019. Arq Bras Cardiol 2019; 112:326-368. [PMID: 30916199 PMCID: PMC6424031 DOI: 10.5935/abc.20190048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nabil Ghorayeb
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Programa de Pós-Graduação em Medicina do Esporte da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, SP - Brazil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Daniel Jogaib Daher
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | - Cléa Simone Sabino de Souza Colombo
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Sports Cardiology, Cardiology Clinical Academic Group - St George's University of London,14 London - UK
| | - Daniel Arkader Kopiler
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brazil
| | - Filipe Ferrari Ribeiro de Lacerda
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | - José Kawazoe Lazzoli
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Federação Internacional de Medicina do Esporte (FIMS), Lausanne - Switzerland
| | | | - Marcelo Bichels Leitão
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
| | - Ricardo Contesini Francisco
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Rodrigo Otávio Bougleux Alô
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital Geral de São Mateus, São Paulo, SP - Brazil
| | - Sérgio Timerman
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, SP - Brazil
- Universidade Anhembi Morumbi, Laureate International Universities, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brasileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Thiago Ghorayeb Garcia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
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28
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James CA, Calkins H. Arrhythmogenic Right Ventricular Cardiomyopathy: Progress Toward Personalized Management. Annu Rev Med 2019; 70:1-18. [DOI: 10.1146/annurev-med-041217-010932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease characterized by fibrofatty replacement of the ventricular myocardium, a high risk of ventricular arrhythmias, and progressive ventricular dysfunction. The clinical course is highly variable, and optimal approaches to management remain undefined. ARVC is associated with pathogenic variants in genes encoding the cardiac desmosome. Genetic testing facilitates identification of at-risk family members, but penetrance of ARVC in pathogenic variant carriers is difficult to predict. Participation in endurance exercise is a known key risk factor. However, there remains significant uncertainty about which family member will develop disease and how best to approach longitudinal screening. Our clinically focused review describes how new insights gained from natural history studies, improved understanding of pathogenic mechanisms, and appreciation of genetic and environmental modifiers have set the stage for developing personalized approaches to managing both ARVC patients and their at-risk family members.
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Affiliation(s)
- Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;,
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;,
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29
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Aquaro GD, Pingitore A, Di Bella G, Piaggi P, Gaeta R, Grigoratos C, Altinier A, Pantano A, Strata E, De Caterina R, Sinagra G, Emdin M. Prognostic Role of Cardiac Magnetic Resonance in Arrhythmogenic Right Ventricular Cardiomyopathy. Am J Cardiol 2018; 122:1745-1753. [PMID: 30220419 DOI: 10.1016/j.amjcard.2018.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022]
Abstract
We sought to evaluate the prognostic role of cardiac magnetic resonance (CMR) in patients with definite, borderline and possible diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) as defined by the International Task Force (TF) in 2010. CMR was performed in 175 patients: 52 with definite, 50 with borderline and 73 possible ARVC. Abnormal-CMR was defined as the presence of ≥1 CMR abnormalities (including abnormalities of right ventricular and left ventricular wall motion, fat infiltration, late gadolinium enhancement, dilation and dysfunction of either ventricles). During the follow-up time 35 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter defibrillator shock and resuscitated cardiac arrest), and 34 of them occurred in patients with abnormal-CMR (negative predictive value = 96.9%). At the multivariate Cox-regression analysis LV involvement at CMR (fat infiltration and/or late gadolinium enhancement), and episode of nonsustained ventricular tachycardia (NSVT) were independent predictors of cardiac events in both the whole population (LV involvement: HR 3.69, 95% CI 1.57-8.65, p = 0.0002; NSVT: HR 5.8, 95% CI 2.82-11.9, p < 0.0001), and in the group of patients with definite ARVC (LV involvement: HR 3.03, 95% CI 1.15 to 8.02, p = 0.02; NSVT: HR 12.1, 95% CI 4.02-36.5, p < 0.0001). In conclusion, CMR evidence of LV involvement is a strong independent predictor of cardiac events in patients with definite, borderline or possible ARVC diagnosis. Abnormal CMR has very high negative predictive value for hard cardiac events.
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Affiliation(s)
| | | | - Gianluca Di Bella
- Clinical and Experimental Department of Medicine. University of Messina, Messina, Italy
| | - Paolo Piaggi
- Department of Energy and Systems Engineering, University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | | | - Michele Emdin
- G. Monasterio CNR-Tuscany Foundation, Pisa, Italy; Scuola Universitaria Superiore Sant'Anna, Pisa, Italy
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30
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Cho Y. Arrhythmogenic right ventricular cardiomyopathy. J Arrhythm 2018; 34:356-368. [PMID: 30167006 PMCID: PMC6111474 DOI: 10.1002/joa3.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive cardiomyopathy characterized by fibrofatty infiltration of the myocardium, ventricular arrhythmias, sudden death, and heart failure. ARVC may be an important cause of syncope, sudden death, ventricular arrhythmias, and/or wall motion abnormalities, especially in the young. As the first symptom is sudden death or cardiac arrest in many cases, an early diagnosis and risk stratification are important. Recent advances in diagnostic modalities will be helpful in the early diagnosis and proper management of patients at risk. Restriction of strenuous exercise and implantation of implantable cardioverter-defibrillators are important in addition to medical treatment and catheter ablation of ventricular tachycardia. Recently introduced genetic screening may help to identify asymptomatic carriers with a risk of a disease progression and sudden death.
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Affiliation(s)
- Yongkeun Cho
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
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31
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Lucky AW, Dagaonkar N, Lammers K, Husami A, Kissell D, Zhang K. A comprehensive next-generation sequencing assay for the diagnosis of epidermolysis bullosa. Pediatr Dermatol 2018; 35:188-197. [PMID: 29334134 DOI: 10.1111/pde.13392] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Historically, diagnosis of epidermolysis bullosa has required skin biopsies for electron microscopy, direct immunofluorescence to determine which gene(s) to choose for genetic testing, or both. METHODS To avoid these invasive tests, we developed a high-throughput next-generation sequencing (NGS)-based diagnostic assay called EBSEQ that allows simultaneous detection of mutations in 21 genes with known roles in epidermolysis bullosa pathogenicity. Mutations are confirmed with traditional Sanger sequencing. RESULTS We present our EBSEQ assay and preliminary studies on the first 43 subjects tested. We identified 11 cases of epidermolysis bullosa simplex, five cases of junctional epidermolysis bullosa, 11 cases of dominant dystrophic epidermolysis bullosa, 15 cases of recessive dystrophic epidermolysis bullosa, and one case that remains without diagnosis. We also found an additional 52 variants of uncertain clinical significance in 17 of the 21 epidermolysis bullosa-associated genes tested. Three of the variants of uncertain clinical significance were also found in three other patients, for a total of 49 unique variants of uncertain clinical significance. We found the clinical sensitivity of the assay to be 75% to 98% and the analytical sensitivity to be 99% in identifying base substitutions and small deletions and duplications. Turnaround time was 3 to 6 weeks. CONCLUSIONS EBSEQ is a sensitive, relatively rapid, minimally invasive, comprehensive genetic assay for the diagnosis of epidermolysis bullosa.
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Affiliation(s)
- Anne W Lucky
- Division of General and Community Pediatrics and Cincinnati Children's Epidermolysis Bullosa Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Neha Dagaonkar
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Karen Lammers
- Division of General and Community Pediatrics and Cincinnati Children's Epidermolysis Bullosa Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Ammar Husami
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Diane Kissell
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Kejian Zhang
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH, USA
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32
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Gilotra NA, Bhonsale A, James CA, Te Riele ASJ, Murray B, Tichnell C, Sawant A, Ong CS, Judge DP, Russell SD, Calkins H, Tedford RJ. Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003819. [PMID: 28874384 DOI: 10.1161/circheartfailure.116.003819] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/25/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure (HF) prevalence in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) varies depending on study cohort and is not well characterized. This study sought to determine prevalence and predictors of HF in ARVC/D. METHODS AND RESULTS Clinical HF, defined as at least 1 HF sign or symptom, was retrospectively adjudicated for 289 patients meeting ARVC/D Task Force Criteria. HF was present in 142 patients (49%): 113 had isolated RV involvement and 29 had evidence of LV dysfunction. Average age of HF onset was 40±14 years. Most commonly reported symptoms were exertional dyspnea (78%) and fatigue (73%). Only 40% (n=57/142) had signs of volume overload. Left-sided HF signs were rare. Patients with clinical HF before ARVC/D diagnosis (n=31) were older (P=0.005) and met fewer Task Force Criteria (P=0.013) than those who developed HF after ARVC/D presentation. Female sex (odds ratio, 2.2; 95% confidence interval, 1.21-4.01; P=0.01) and lateral precordial T-wave inversions (odds ratio, 9.87; 95% confidence interval, 1.07-91.1; P=0.043) were associated with increased odds of HF. Additionally, patients with symptomatic LV dysfunction had higher odds of lateral precordial T-wave inversions (odds ratio, 18.4; 95% confidence interval, 2.92-116.18; P=0.002). Patients with HF were more likely to undergo heart transplantation (15/142 versus 1/147; P<0.001) or die during study follow-up period (7 versus 0; P=0.007). CONCLUSIONS HF symptoms, especially exertional dyspnea, are common in ARVC/D; yet, classic left-sided signs are typically absent and less than half have evidence of volume overload. Given the unique predominately right-sided phenotype, a large portion of patients with HF may be under-recognized.
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Affiliation(s)
- Nisha A Gilotra
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.).
| | - Aditya Bhonsale
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Cynthia A James
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Anneline S J Te Riele
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Brittney Murray
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Crystal Tichnell
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Abhishek Sawant
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Chin Siang Ong
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Daniel P Judge
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Stuart D Russell
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Hugh Calkins
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
| | - Ryan J Tedford
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (N.A.G., A.B., C.A.J., B.M., C.T., C.S.O., D.P.J., S.D.R., H.C., R.J.T.); Division of Cardiology, University Medical Center Utrecht, The Netherlands (A.S.J.t.R.); and Division of Cardiology, Department of Medicine, University at Buffalo, State University of New York (A.S.)
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te Rijdt WP, van der Klooster ZJ, Hoorntje ET, Jongbloed JD, van der Zwaag PA, Asselbergs FW, Dooijes D, de Boer RA, van Tintelen JP, van den Berg MP, Vink A, Suurmeijer AJ. Phospholamban immunostaining is a highly sensitive and specific method for diagnosing phospholamban p.Arg14del cardiomyopathy. Cardiovasc Pathol 2017; 30:23-26. [DOI: 10.1016/j.carpath.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022] Open
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Co-inheritance of mutations associated with arrhythmogenic cardiomyopathy and hypertrophic cardiomyopathy. Eur J Hum Genet 2017; 25:1165-1169. [PMID: 28699631 DOI: 10.1038/ejhg.2017.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/05/2017] [Accepted: 06/13/2017] [Indexed: 12/31/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) and hypertrophic cardiomyopathy (HCM) are genetically and phenotypically distinct disorders of the myocardium. Here we describe for the first time co-inheritance of mutations in genes associated with ACM or HCM in two families with recurrence of both cardiomyopathies. Among the double heterozygotes for mutations in desmoplakin (DSP) and myosin binding protein C (MYBPC3) genes identified in Family A, two were diagnosed with ACM and two with HCM. In Family B, one patient was identified to carry mutations in α-T-catenin (CTTNA3) and β-myosin (MYH7) genes, but he does not fulfill the current diagnostic criteria neither for ACM nor for HCM. Interestingly, the double heterozygotes showed a variable clinical expression of both cardiomyopathies and they do not exhibit a more severe phenotype than family members carrying only one of the two mutations.
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Gerçek M, Gerçek M, Kant S, Simsekyilmaz S, Kassner A, Milting H, Liehn EA, Leube RE, Krusche CA. Cardiomyocyte Hypertrophy in Arrhythmogenic Cardiomyopathy. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:752-766. [PMID: 28183531 DOI: 10.1016/j.ajpath.2016.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 12/28/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a hereditary disease leading to sudden cardiac death or heart failure. AC pathology is characterized by cardiomyocyte loss and replacement fibrosis. Our goal was to determine whether cardiomyocytes respond to AC progression by pathological hypertrophy. To this end, we examined tissue samples from AC patients with end-stage heart failure and tissue samples that were collected at different disease stages from desmoglein 2-mutant mice, a well characterized AC model. We find that cardiomyocyte diameters are significantly increased in right ventricles of AC patients. Increased mRNA expression of the cardiac stress marker natriuretic peptide B is also observed in the right ventricle of AC patients. Elevated myosin heavy chain 7 mRNA expression is detected in left ventricles. In desmoglein 2-mutant mice, cardiomyocyte diameters are normal during the concealed disease phase but increase significantly after acute disease onset on cardiomyocyte death and fibrotic myocardial remodeling. Hypertrophy progresses further during the chronic disease stage. In parallel, mRNA expression of myosin heavy chain 7 and natriuretic peptide B is up-regulated in both ventricles with right ventricular preference. Calcineurin/nuclear factor of activated T cells (Nfat) signaling, which is linked to pathological hypertrophy, is observed during AC progression, as evidenced by Nfatc2 and Nfatc3 mRNA in cardiomyocytes and increased mRNA of the Nfat target regulator of calcineurin 1. Taken together, we demonstrate that pathological hypertrophy occurs in AC and is secondary to cardiomyocyte loss and cardiac remodeling.
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Affiliation(s)
- Mustafa Gerçek
- Institutes for Molecular and Cellular Anatomy, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Muhammed Gerçek
- Institutes for Molecular and Cellular Anatomy, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Sebastian Kant
- Institutes for Molecular and Cellular Anatomy, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Sakine Simsekyilmaz
- Institute of Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Astrid Kassner
- Heart and Diabetes Center North Rhine-Westphalia, Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Heart and Diabetes Center North Rhine-Westphalia, Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Bad Oeynhausen, Germany
| | - Elisa A Liehn
- Institute for Molecular Cardiovascular Research and Interdisciplinary Center for Clinical Research Aachen, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Rudolf E Leube
- Institutes for Molecular and Cellular Anatomy, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Claudia A Krusche
- Institutes for Molecular and Cellular Anatomy, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany.
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Xu Z, Zhu W, Wang C, Huang L, Zhou Q, Hu J, Cheng X, Hong K. Genotype-phenotype relationship in patients with arrhythmogenic right ventricular cardiomyopathy caused by desmosomal gene mutations: A systematic review and meta-analysis. Sci Rep 2017; 7:41387. [PMID: 28120905 PMCID: PMC5264593 DOI: 10.1038/srep41387] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022] Open
Abstract
The relationship between clinical phenotypes and desmosomal gene mutations in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly characterized. Therefore, we performed a meta-analysis to explore the genotype-phenotype relationship in patients with ARVC. Any studies reporting this genotype-phenotype relationship were included. In total, 11 studies involving 1,113 patients were included. The presence of desmosomal gene mutations was associated with a younger onset age of ARVC (32.7 ± 15.2 versus 43.2 ± 13.3 years; P = 0.001), a higher incidence of T wave inversion in V1–3 leads (78.5% versus 51.6%; P = 0.0002) or a family history of ARVC (39.5% versus 27.1%; P = 0.03). There was no difference in the proportion of males between desmosomal-positive and desmosomal-negative patients (68.3% versus 68.9%; P = 0.60). The presence of desmosomal gene mutations was not associated with global or regional structural and functional alterations (63.5% versus 60.5%; P = 0.37), epsilon wave (29.4% versus 26.2%; P = 0.51) or ventricular tachycardia of left bundle-branch morphology (62.6% versus 57.2%; P = 0.30). Overall, patients with desmosomal gene mutations are characterized by an earlier onset age, a higher incidence of T wave inversion in V1–3 leads and a strong family history of ARVC.
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Affiliation(s)
- Zhenyan Xu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Wengen Zhu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Cen Wang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Lin Huang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Qiongqiong Zhou
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Jinzhu Hu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, 330006, China
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Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy is an inherited cardiomyopathy characterised by ventricular arrhythmias and an increased risk of sudden cardiac death. Arrhythmogenic right ventricular dysplasia/cardiomyopathy diagnosis is based on criteria that take into account electrical and structural cardiac abnormalities, as well as mutation analysis. Appropriate pharmacological therapy and the prevention of sudden death with implantable defibrillators are important in the management of these patients. Exercise is considered an important environmental factor for the development and progression of the disease.
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Akdis D, Brunckhorst C, Duru F, Saguner AM. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes. Arrhythm Electrophysiol Rev 2016; 5:90-101. [PMID: 27617087 PMCID: PMC5013177 DOI: 10.15420/aer.2016.4.3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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The Impending Dilemma of Electrocardiogram Screening in Athletic Children. Pediatr Cardiol 2016; 37:1-13. [PMID: 26289947 DOI: 10.1007/s00246-015-1239-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
Sudden cardiac death (SCD) affects 2/100,000 young, active athletes per year of which 40% are less than 18 years old. In 2004, the International Olympic Committee accepted the Lausanne Recommendations, including a 12-lead electrocardiogram (ECG), as a pre-participation screening tool for adult Olympic athletes. The debate on extending those recommendations to the pediatric population has recently begun. The aims of our study were to highlight the characteristics of the young athlete ECG, phenotypical manifestations of SCD-related disease in children, and challenges of implanting ECG screening in athletic children. A systematic review of the literature is performed. We searched available electronic medical databases for articles relevant to SCD, ECG, silent cardiac diseases, and athletic children. We focused on ECG screening and description in a pediatric population. We identified 2240 studies. Sixty-two relevant articles and one book were selected. In children, prepubertal ECG and the ECG phenotype of most SCD-related diseases differ notably from adults. The characteristics of the prepubertal ECG and of the phenotypical manifestation of SCD-related disease in children will result in less specific and less sensitive ECG-based screening programs. Those limitations advise against extending the adult recommendation to children, without further studies. Until then, history and physical exam should remain the cornerstone of screening for SCD-related pathologies in children.
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Te Riele ASJM, James CA, Sawant AC, Bhonsale A, Groeneweg JA, Mast TP, Murray B, Tichnell C, Dooijes D, van Tintelen JP, Judge DP, van der Heijden JF, Crosson J, Hauer RNW, Calkins H, Tandri H. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy in the Pediatric Population: Clinical Characterization and Comparison With Adult-Onset Disease. JACC Clin Electrophysiol 2015; 1:551-560. [PMID: 29759408 DOI: 10.1016/j.jacep.2015.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/27/2015] [Accepted: 08/20/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aims of this study were to determine the clinical characteristics and outcomes of pediatric-onset arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to compare these with those of adult-onset ARVD/C. BACKGROUND Improved early detection and increased awareness of ARVD/C have led to a growing group of pediatric patients seeking management recommendations. Prior studies have mainly included adults with ARVD/C; however, clinical features and outcomes may differ in pediatric subjects. METHODS Among 502 subjects fulfilling task force criteria for ARVD/C, we identified 75 (15%) with pediatric-onset disease (diagnosis at <18 years of age or probands presenting symptomatically at <18 years of age). Clinical characteristics and outcomes (sustained ventricular tachycardia, cardiac transplantation, and death) were compared between pediatric and adult patients. RESULTS Pediatric patients presented at 15.3 ± 2.4 years of age. Most pediatric patients were male (55%) and ARVD/C-associated mutation carriers (80%). One-fourth of pediatric patients presented with sudden cardiac death (15%) or resuscitated sudden cardiac arrest (11%). Compared with adults, pediatric patients were disproportionately mutation carriers (p = 0.002) but not more often male (p = 0.696) or probands (p = 0.371). Pediatric patients were more likely to present with sudden cardiac death (p = 0.003), whereas adults more often presented with sustained ventricular tachycardia (p = 0.017). There were no other phenotypic differences between the groups. During 8.4 ± 7.5 years of follow-up, survival free from sustained ventricular tachycardia (p = 0.359), cardiac transplantation (p = 0.523), and death (p = 0.359) was similar between pediatric and adult patients. CONCLUSIONS Pediatric patients with ARVD/C are typically male mutation carriers presenting in adolescence. Pediatric patients disproportionately present with sudden cardiac death. However, once diagnosed, clinical characteristics and outcomes are similar between pediatric and adult patients.
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Affiliation(s)
- Anneline S J M Te Riele
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abhishek C Sawant
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aditya Bhonsale
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judith A Groeneweg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Thomas P Mast
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Peter van Tintelen
- ICIN-Netherlands Heart Institute, Utrecht, the Netherlands; Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Jane Crosson
- Department of Pediatrics, Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Abstract
There has been a progressive evolution in systems of classification for cardiomyopathy, driven by advances in imaging modalities, disease recognition, and genetics, following initial clinical descriptions in the 1960s. A pathophysiological classification emerged and was endorsed by World Health Organisation Task Forces in 1980 and 1995: dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathies; subdivided into idiopathic and disease-specific cardiomyopathies. Genetic advances have increasingly linked "idiopathic" phenotypes to specific mutations, although most linkages exhibit highly variable or little genotype-phenotype correlation, confounded by age-dependent changes and varying penetrance. The following two dominant classification systems are currently in use, with advocates in both continents. First, American Heart Association (2006): "A heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilatation due to a variety of causes that frequently are genetic". These are subdivided to those predominantly involving the heart - primary - due to genetic mutation, including ion channelopathies, acquired disease, or mixed; and those with systemic involvement in other organ systems - secondary. Second, European Society of Cardiology (2008): "A myocardial disorder in which heart muscle is structurally and functionally abnormal… sufficient to cause the observed myocardial abnormality", with subdivision to familial and non-familial, excluding ion channelopathies, and split to specific disease subtypes and idiopathic. Further differences exist in the definitions for hypertrophic cardiomyopathy; however, whichever high-level classification is used, the clinical reality remains phenotype driven. Clinical evaluation and diagnostic imaging dominate initial patient contact, revealing diagnostic red flags that determine further specific tests. Genetic testing is undertaken early. A recent attempt to harmonise these competing systems named the MOGE(S) system, based on descriptive logical nosology, currently remains unproven as a fully practical solution.
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Groeneweg JA, Bhonsale A, James CA, te Riele AS, Dooijes D, Tichnell C, Murray B, Wiesfeld AC, Sawant AC, Kassamali B, Atsma DE, Volders PG, de Groot NM, de Boer K, Zimmerman SL, Kamel IR, van der Heijden JF, Russell SD, Jan Cramer M, Tedford RJ, Doevendans PA, van Veen TA, Tandri H, Wilde AA, Judge DP, van Tintelen JP, Hauer RN, Calkins H. Clinical Presentation, Long-Term Follow-Up, and Outcomes of 1001 Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Patients and Family Members. ACTA ACUST UNITED AC 2015; 8:437-46. [DOI: 10.1161/circgenetics.114.001003] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/12/2015] [Indexed: 12/16/2022]
Abstract
Background—
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a progressive cardiomyopathy. We aimed to define long-term outcome in a transatlantic cohort of 1001 individuals.
Methods and Results—
Clinical and genetic characteristics and follow-up data of ARVD/C index-patients (n=439, fulfilling of 2010 criteria in all) and family members (n=562) were assessed. Mutations were identified in 276 index-patients (63%). Index-patients presented predominantly with sustained ventricular arrhythmias (268; 61%). During a median follow-up of 7 years, 301 of the 416 index-patients presenting alive (72%) experienced sustained ventricular arrhythmias. Sudden cardiac death during follow-up occurred more frequently among index-patients without an implantable cardioverter-defibrillator (10/63, 16% versus 2/335, 0.6%). Overall, cardiac mortality and the need for cardiac transplantation were low (6% and 4%, respectively). Clinical characteristics and outcomes were similar in index-patients with and without mutations, as well as in those with familial and nonfamilial ARVD/C. ARVD/C was diagnosed in 207 family members (37%). Symptoms at first evaluation correlated with disease expression. Family members with mutations were more likely to meet Task Force Criteria for ARVD/C (40% versus 18%), experience sustained ventricular arrhythmias (11% versus 1%), and die from a cardiac cause (2% versus 0%) than family members without mutations.
Conclusions—
Long-term outcome was favorable in diagnosed and treated ARVD/C index-patients and family members. Outcome in index-patients was modulated by implantable cardioverter-defibrillator implantation, but not by mutation status and familial background of disease. One third of family members developed ARVD/C. Outcome in family members was determined by symptoms at first evaluation and mutations.
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Affiliation(s)
- Kyla E. Dunn
- From the Center for Inherited Cardiovascular Disease, Departments of Medicine and Genetics, Stanford University School of Medicine, Stanford, CA (K.E.D., E.A.A.), and Pediatric Heart Center, Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA (K.E.D.)
| | - Euan A. Ashley
- From the Center for Inherited Cardiovascular Disease, Departments of Medicine and Genetics, Stanford University School of Medicine, Stanford, CA (K.E.D., E.A.A.), and Pediatric Heart Center, Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA (K.E.D.)
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Patel DM, Dubash AD, Kreitzer G, Green KJ. Disease mutations in desmoplakin inhibit Cx43 membrane targeting mediated by desmoplakin-EB1 interactions. ACTA ACUST UNITED AC 2014; 206:779-97. [PMID: 25225338 PMCID: PMC4164953 DOI: 10.1083/jcb.201312110] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mechanisms by which microtubule plus ends interact with regions of cell-cell contact during tissue development and morphogenesis are not fully understood. We characterize a previously unreported interaction between the microtubule binding protein end-binding 1 (EB1) and the desmosomal protein desmoplakin (DP), and demonstrate that DP-EB1 interactions enable DP to modify microtubule organization and dynamics near sites of cell-cell contact. EB1 interacts with a region of the DP N terminus containing a hotspot for pathogenic mutations associated with arrhythmogenic cardiomyopathy (AC). We show that a subset of AC mutations, in addition to a mutation associated with skin fragility/woolly hair syndrome, impair gap junction localization and function by misregulating DP-EB1 interactions and altering microtubule dynamics. This work identifies a novel function for a desmosomal protein in regulating microtubules that affect membrane targeting of gap junction components, and elucidates a mechanism by which DP mutations may contribute to the development of cardiac and cutaneous diseases.
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Affiliation(s)
- Dipal M Patel
- Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - Adi D Dubash
- Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| | - Geri Kreitzer
- Department of Cell and Developmental Biology, Weill Cornell Medical College of Cornell University, New York, NY 10065
| | - Kathleen J Green
- Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 Department of Pathology and Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
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Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
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Saguner AM, Brunckhorst C, Duru F. Arrhythmogenic ventricular cardiomyopathy: A paradigm shift from right to biventricular disease. World J Cardiol 2014; 6:154-174. [PMID: 24772256 PMCID: PMC3999336 DOI: 10.4330/wjc.v6.i4.154] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic ventricular cardiomyopathy (AVC) is generally referred to as arrhythmogenic right ventricular (RV) cardiomyopathy/dysplasia and constitutes an inherited cardiomyopathy. Affected patients may succumb to sudden cardiac death (SCD), ventricular tachyarrhythmias (VTA) and heart failure. Genetic studies have identified causative mutations in genes encoding proteins of the intercalated disk that lead to reduced myocardial electro-mechanical stability. The term arrhythmogenic RV cardiomyopathy is somewhat misleading as biventricular involvement or isolated left ventricular (LV) involvement may be present and thus a broader term such as AVC should be preferred. The diagnosis is established on a point score basis according to the revised 2010 task force criteria utilizing imaging modalities, demonstrating fibrous replacement through biopsy, electrocardiographic abnormalities, ventricular arrhythmias and a positive family history including identification of genetic mutations. Although several risk factors for SCD such as previous cardiac arrest, syncope, documented VTA, severe RV/LV dysfunction and young age at manifestation have been identified, risk stratification still needs improvement, especially in asymptomatic family members. Particularly, the role of genetic testing and environmental factors has to be further elucidated. Therapeutic interventions include restriction from physical exercise, beta-blockers, sotalol, amiodarone, implantable cardioverter-defibrillators and catheter ablation. Life-long follow-up is warranted in symptomatic patients, but also asymptomatic carriers of pathogenic mutations.
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Rigato I, Bauce B, Rampazzo A, Zorzi A, Pilichou K, Mazzotti E, Migliore F, Marra MP, Lorenzon A, De Bortoli M, Calore M, Nava A, Daliento L, Gregori D, Iliceto S, Thiene G, Basso C, Corrado D. Compound and digenic heterozygosity predicts lifetime arrhythmic outcome and sudden cardiac death in desmosomal gene-related arrhythmogenic right ventricular cardiomyopathy. ACTA ACUST UNITED AC 2013; 6:533-42. [PMID: 24070718 DOI: 10.1161/circgenetics.113.000288] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mutations in genes encoding for desmosomal proteins are the most common cause of arrhythmogenic right ventricular cardiomyopathy (ARVC). We assessed the value of genotype for prediction of lifetime major arrhythmic events and sudden cardiac death (SCD) in desmosomal gene-related ARVC. METHODS AND RESULTS The overall study population included 134 desmosomal gene mutation carriers (68 men; median age 36 years [22-52]) from 44 consecutive ARVC families undergoing comprehensive genetic screening. The probability of experiencing a first major arrhythmic event or SCD during a lifetime was determined by using date of birth as start point for the time-to-event analysis, and was stratified by sex, desmosomal genes, mutation types, and genotype complexity (single versus multiple mutations). One hundred thirteen patients (84%) carried a single desmosomal gene mutation in desmoplakin (n=44; 39%), plakophilin-2 (n=38; 34%), desmoglein-2 (n=30; 26%), and desmocollin-2 (n=1; 1%), whereas 21 patients (16%) had a complex genotype with compound heterozygosity in 7 and digenic heterozygosity in 14. Over a median observation period of 39 (22-52) years, 22 patients (16%) from 20 different families had arrhythmic events, such as SCD (n=1), aborted SCD because of ventricular fibrillation (n=6), sustained ventricular tachycardia (n=14), and appropriate defibrillator intervention (n=1). Multiple desmosomal gene mutations and male sex were independent predictors of lifetime arrhythmic events with a hazard ratio of 3.71 (95% confidence interval, 1.54-8.92; P=0.003) and 2.76 (95% confidence interval, 1.19-6.41; P=0.02), respectively. CONCLUSIONS Compound/digenic heterozygosity was identified in 16% of ARVC-causing desmosomal gene mutation carriers and was a powerful risk factor for lifetime major arrhythmic events and SCD. These results support the use of comprehensive genetic screening of desmosomal genes for arrhythmic risk stratification in ARVC.
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Affiliation(s)
- Ilaria Rigato
- Departments of Cardiac, Thoracic, and Vascular Sciences, and Biology, University of Padua, Padova, Italy
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Al-Jassar C, Bikker H, Overduin M, Chidgey M. Mechanistic basis of desmosome-targeted diseases. J Mol Biol 2013; 425:4006-22. [PMID: 23911551 PMCID: PMC3807649 DOI: 10.1016/j.jmb.2013.07.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/21/2022]
Abstract
Desmosomes are dynamic junctions between cells that maintain the structural integrity of skin and heart tissues by withstanding shear forces. Mutations in component genes cause life-threatening conditions including arrhythmogenic right ventricular cardiomyopathy, and desmosomal proteins are targeted by pathogenic autoantibodies in skin blistering diseases such as pemphigus. Here, we review a set of newly discovered pathogenic alterations and discuss the structural repercussions of debilitating mutations on desmosomal proteins. The architectures of native desmosomal assemblies have been visualized by cryo-electron microscopy and cryo-electron tomography, and the network of protein domain interactions is becoming apparent. Plakophilin and desmoplakin mutations have been discovered to alter binding interfaces, structures, and stabilities of folded domains that have been resolved by X-ray crystallography and NMR spectroscopy. The flexibility within desmoplakin has been revealed by small-angle X-ray scattering and fluorescence assays, explaining how mechanical stresses are accommodated. These studies have shown that the structural and functional consequences of desmosomal mutations can now begin to be understood at multiple levels of spatial and temporal resolution. This review discusses the recent structural insights and raises the possibility of using modeling for mechanism-based diagnosis of how deleterious mutations alter the integrity of solid tissues.
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Affiliation(s)
- Caezar Al-Jassar
- School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Ohno S, Nagaoka I, Fukuyama M, Kimura H, Itoh H, Makiyama T, Shimizu A, Horie M. Age-dependent clinical and genetic characteristics in Japanese patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ J 2013; 77:1534-42. [PMID: 23514727 DOI: 10.1253/circj.cj-12-1446] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a heart muscle disease caused by desmosomal gene mutations, and presents as ventricular tachycardia and sudden cardiac death. Although the mean age at onset or diagnosis of ARVC/D are reported to be around the 30-40s, the age-dependent clinical and genetic differences remain unknown. METHODS AND RESULTS A total of 35 consecutive Japanese probands (23 male) who were clinically diagnosed with ARVC/D were enrolled in the present study, and genetic analysis of PKP2, DSP, DSG2, and DSC2 was done. The mean age at the first symptom and at diagnosis was 38.6±14.8 years and 40.5±17.7 years, respectively. Probands in whom the onset was cardiopulmonary arrest were significantly younger (22.3±15.3 years) than those with arrhythmia (41.1±13.2 years) or congestive heart failure (45.7±8.5 years). On genetic screening, 19 mutation carriers were identified. Although there was no age dependence for each gene mutation carrier, carriers with PKP2 premature stop codon developed the disease at a significantly younger age than other mutation carriers. CONCLUSIONS The initial clinical manifestations in some young probands were very severe, and PKP2 mutations with a premature stop codon would be associated with disease onset at a younger age.
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Affiliation(s)
- Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
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Histological and ultrastructural abnormalities in murine desmoglein 2-mutant hearts. Cell Tissue Res 2012; 348:249-59. [PMID: 22293975 DOI: 10.1007/s00441-011-1322-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 12/16/2011] [Indexed: 12/21/2022]
Abstract
Mice carrying a deletion of the adhesive extracellular domain of the desmosomal cadherin desmoglein 2 develop an arrhythmogenic right ventricular cardiomyopathylike phenotype with ventricular dilation, fibrosis and arrhythmia. To unravel the sequence of myocardial alterations and to identify potential pathomechanisms, histological analyses were performed on mutant hearts from the juvenile to the adult state, i.e., between 2 and 13 weeks. At an age of 2 weeks 30% of mutants presented lesions,which were visible as white plaques on the heart surface or in the septum. From 4 weeks onwards, all mutants displayed a cardiac phenotype. Dying cardiomyocytes with calcification were found in lesions of all ages. But lesions of young mutant animals contained high amounts of CD45+ immune cells and little collagen fibers, whereas lesions of the older animals were collagen-rich and harbored only a small but still significantly increased number of CD45+ cells. Electron microscopy further showed that distinct desmosomes cannot be distinguished in intercalated discs of mutant hearts. Widening of the intercellular cleft and even complete dissociation of intercalated discs were often observed close to lesions. Disturbed sarcomer structure, altered Z-discs, multiple autophagic vacuoles and swollen mitochondria were other prominent pathological features. Taken together, the following scenario is suggested: mutant desmoglein 2 cannot fully support the increased mechanical requirements placed on intercalated disc adhesion during postnatal heart development, resulting in compromised adhesion and cell stress. This induces cardiomyocyte death, aseptic inflammation and fibrotic replacement. The acute stage of scar formation is followed by permanent impairment of the cardiac function.
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