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Aljehani A, Baig S, Kew T, Kalla M, Sommerfeld LC, Murukutla VA, Fabritz L, Steeds RP. Structural Progression in Patients with Definite and Non-Definite Arrhythmogenic Right Ventricular Cardiomyopathy and Risk of Major Adverse Cardiac Events. Biomedicines 2024; 12:328. [PMID: 38397930 PMCID: PMC10886648 DOI: 10.3390/biomedicines12020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/17/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited disease characterised by early arrhythmias and structural changes. Still, there are limited echocardiography data on its structural progression. We studied structural progression and its impact on the occurrence of major adverse cardiovascular events (MACE). In this single-centre observational cohort study, structural progression was defined as the development of new major or minor imaging 2010 Task Force Criteria during follow-up. Of 101 patients, a definite diagnosis of ARVC was made in 51 patients, while non-definite 'early' disease was diagnosed in 50 patients. During 4 years of follow-up (IQR: 2-6), 23 (45%) patients with a definite diagnosis developed structural progression while only 1 patient in the non-definite (early) group gained minor imaging Task Force Criteria. Male gender was strongly associated with structural progression (62% of males progressed structurally, while 88% of females remained stable). Patients with structural progression were at higher risk of MACE (64% of patients with MACE had structural progression). Therefore, the rate of structural progression is an essential factor to be considered in ARVC studies.
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Affiliation(s)
- Areej Aljehani
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
- Echocardiography Cardiovascular Technology (ECVT) Program, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Shanat Baig
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| | - Tania Kew
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| | - Manish Kalla
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| | - Laura C. Sommerfeld
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center and University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
| | - Vaishnavi Ameya Murukutla
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center and University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center and University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
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Toso E, De Lio F, Bocchino PP, Raineri C, Fioravanti F, Richiardi EM, Marcelli G, Sacco T, Giustetto C, Gaita F. Risk of cardioembolic ischemic events and relation to atrial fibrillation/flutter in patients with arrhythmogenic cardiomyopathy during a long-term follow-up. Int J Cardiol 2023; 389:131200. [PMID: 37482095 DOI: 10.1016/j.ijcard.2023.131200] [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: 04/26/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is an inherited heart disease characterized by fibro-fatty replacement of myocardium. Limited data is available concerning cardioembolic stroke. This study sought to determine the occurrence of cardioembolic ischemic events (CIEs) in ACM patients and to identify clinical and imaging predictors of CIEs. METHODS Every consecutive ACM patient was enrolled. ECG, Holter monitoring or implantable cardiac devices were used to detect atrial arrhythmias (AAs). CIEs were defined according to TOAST classification. RESULTS In our cohort of 111 patients, CIEs were observed in eleven (10%) over a 12.9-year median follow-up, with an incidence of 7.9 event/1000 patient-year (HR 4.12 compared to general population). Mean age at the event was 42 ± 9 years. Female sex (p = 0.03), T-wave inversion (p = 0.03), RVOT dilatation (p = 0.006) and lower LVEF (p = 0.006) were associated with CIEs. Among patients with AAs (23/111, 20.7%), 5 (21.7%) experienced CIEs. CHA2DS2-VASc did not prove useful to define patients at higher risk of CIEs (p = 0.098). 60% of stroke suffering patients had a pre-event score between 0 and 1 (if female). CONCLUSIONS In ACM patients, CIEs are much more common than in general population and present a high burden at younger age. AAs relate to less than half of these events. In AAs patients, CHA2DS2-VASc is not useful to stratify those requiring oral anticoagulation. As a hypothesis-generating study, our research proposes the role of atrial myopathy, irrespective of AAs, as a pivotal factor in thrombogenesis risk, pointing out a definite unmet need in ACM therapeutic algorithm.
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Affiliation(s)
- Elisabetta Toso
- Advanced Cardiovascular Echography Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Francesca De Lio
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Claudia Raineri
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | | | - Elena Maria Richiardi
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Gianluca Marcelli
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Tania Sacco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Turin, Italy
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3
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Basharat SA, Hsiung I, Garg J, Alsaid A. Arrhythmogenic Cardiomyopathy: Evolving Diagnostic Criteria and Insight from Cardiac Magnetic Resonance Imaging. Heart Fail Clin 2023; 19:429-444. [PMID: 37714585 DOI: 10.1016/j.hfc.2023.03.006] [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] [Indexed: 09/17/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an umbrella term encompassing a wide variety of overlapping hereditary and nonhereditary disorders that can result in malignant ventricular arrhythmias and sudden cardiac death. Cardiac MRI plays a critical role in accurate diagnosis of various ACM entities and is increasingly showing promise in risk stratification that can further guide management particularly in decisions regarding use of implantable cardioverter defibrillator. Genotyping plays an important role in cascade testing but challenges remain due to incomplete penetrance and wide phenotypic variability of ACM as well as the presence of gene-elusive cases.
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Affiliation(s)
- Sohaib Ahmad Basharat
- Division of Cardiology, Loma Linda University Medical Center, 11234 Anderson Street, MC2426, Loma Linda, CA 92354, USA
| | - Ingrid Hsiung
- Department of Cardiology, Baylor Scott & White The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, USA
| | - Jalaj Garg
- Division of Cardiology, Loma Linda University Medical Center, 11234 Anderson Street, MC2426, Loma Linda, CA 92354, USA. https://twitter.com/drjalajgarg
| | - Amro Alsaid
- Department of Cardiology, Baylor Scott & White The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, USA.
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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Wong J, Peters S, Marwick TH. Phenotyping heart failure by genetics and associated conditions. Eur Heart J Cardiovasc Imaging 2023; 24:1293-1301. [PMID: 37279791 DOI: 10.1093/ehjci/jead125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
Heart failure is a highly heterogeneous disease, and genetic testing may allow phenotypic distinctions that are incremental to those obtainable from imaging. Advances in genetic testing have allowed for the identification of deleterious variants in patients with specific heart failure phenotypes (dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and hypertrophic cardiomyopathy), and many of these have specific treatment implications. The diagnostic yield of genetic testing in heart failure is modest, and many rare variants are associated with incomplete penetrance and variable expressivity. Environmental factors and co-morbidities have a large role in the heterogeneity of the heart failure phenotype. Future endeavours should concentrate on the cumulative impact of genetic polymorphisms in the development of heart failure.
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Affiliation(s)
- Joshua Wong
- Baker Heart and Diabetes Institute and Department of Cardiometabolic Health, University of Melbourne, PO Box 6492, Melbourne, VIC 3004, Australia
| | - Stacey Peters
- Baker Heart and Diabetes Institute and Department of Cardiometabolic Health, University of Melbourne, PO Box 6492, Melbourne, VIC 3004, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute and Department of Cardiometabolic Health, University of Melbourne, PO Box 6492, Melbourne, VIC 3004, Australia
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6
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Xie Z, Yang C, Xu T. Hesperetin attenuates LPS-induced the inflammatory response and apoptosis of H9c2 by activating the AMPK/P53 signaling pathway. Immun Inflamm Dis 2023; 11:e973. [PMID: 37584301 PMCID: PMC10413818 DOI: 10.1002/iid3.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Hesperetin (HES), whose main pharmacological effects are anti-inflammatory and cardioprotective properties. In our study, we investigated the role of HES in lipopolysaccharide (LPS)-induced inflammation and apoptosis in H9c2 cells. METHODS Cell viability was assessed through MTT assay. Tumor necrosis factor (TNF)-α and interleukin (IL)-β expression were quantified through RT-qPCR assay. Secondly, the apoptosis rate was assessed by Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay. Finally, B-cell lymphoma 2 (Bcl-2)- associated X protein (Bax), adenosine monophosphate-activated protein kinase (AMPK), and P53 expression were quantified through western blot assay. RESULTS Our results demonstrated that LPS stimulation decreased the cell viability, increased IL-1β and TNF-α expression in H9c2 cells. However, HES treatment significantly increased the cell viability, decreased IL-1β and TNF-α expression in LPS-induced H9c2 cells. In addition, HES significantly increased the phosphorylation level of AMPK. Meanwhile, HES prevented against LPS-mediated the P53 and Bax protein upregulation, and Bcl-2 protein downregulation in H9c2 cells. More interestingly, compound C (an AMPK inhibitor) treatment eliminated the protective effects of HES. CONCLUSION Our findings revealed that HES attenuated the LPS-mediated inflammation and apoptosis of H9c2 cells by activating the AMPK/P53 signaling pathway, suggesting that HES may be a potential cardioprotective agent.
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Affiliation(s)
- Zan Xie
- Department of Cardiologythe Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantaiShandongChina
| | - Chunxia Yang
- Department of Cardiologythe Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantaiShandongChina
| | - Tingting Xu
- Department of Cardiologythe Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantaiShandongChina
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7
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Reisqs JB, Moreau A, Sleiman Y, Boutjdir M, Richard S, Chevalier P. Arrhythmogenic cardiomyopathy as a myogenic disease: highlights from cardiomyocytes derived from human induced pluripotent stem cells. Front Physiol 2023; 14:1191965. [PMID: 37250123 PMCID: PMC10210147 DOI: 10.3389/fphys.2023.1191965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by the replacement of myocardium by fibro-fatty infiltration and cardiomyocyte loss. ACM predisposes to a high risk for ventricular arrhythmias. ACM has initially been defined as a desmosomal disease because most of the known variants causing the disease concern genes encoding desmosomal proteins. Studying this pathology is complex, in particular because human samples are rare and, when available, reflect the most advanced stages of the disease. Usual cellular and animal models cannot reproduce all the hallmarks of human pathology. In the last decade, human-induced pluripotent stem cells (hiPSC) have been proposed as an innovative human cellular model. The differentiation of hiPSCs into cardiomyocytes (hiPSC-CM) is now well-controlled and widely used in many laboratories. This hiPSC-CM model recapitulates critical features of the pathology and enables a cardiomyocyte-centered comprehensive approach to the disease and the screening of anti-arrhythmic drugs (AAD) prescribed sometimes empirically to the patient. In this regard, this model provides unique opportunities to explore and develop new therapeutic approaches. The use of hiPSC-CMs will undoubtedly help the development of precision medicine to better cure patients suffering from ACM. This review aims to summarize the recent advances allowing the use of hiPSCs in the ACM context.
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Affiliation(s)
- J. B. Reisqs
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - A. Moreau
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - Y. Sleiman
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - M. Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
- Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Health Sciences University, NY, United States
- Department of Medicine, New York University School of Medicine, NY, United States
| | - S. Richard
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - P. Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France
- Service de Rythmologie, Hospices Civils de Lyon, Lyon, France
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8
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Tadros HJ, Choudhry S, Kearney DL, Hope K, Yesso A, Miyake CY, Price J, Spinner J, Tunuguntla H, Puri K, Dreyer W, Denfield SW. Arrhythmogenic cardiomyopathy is under-recognized in end-stage pediatric heart failure: A 36-year single-center experience. Pediatr Transplant 2023; 27:e14442. [PMID: 36451335 DOI: 10.1111/petr.14442] [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] [Received: 09/25/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Although ventricular failure is a late finding in adults with AC, we hypothesize that this is a presenting symptom in pediatric heart failure patients who undergo HT and that their ventricular arrhythmia burden could differentiate AC from other cardiomyopathies. METHODS We performed a single-center retrospective cohort study reviewing 457 consecutive pediatric (≤18 years) HT recipients at our institution. Explanted hearts were examined to establish the primary diagnosis, based on pathologic findings. Demographic and clinical variables were compared between AC versus non-HCM cardiomyopathy cases. RESULTS Forty-five percent (n = 205/457) had non-HCM cardiomyopathies as the underlying primary diagnosis. Ten cases (10/205 = 4.9%) were diagnosed with AC. All 10 had biventricular disease. In 8/10 patients (80%), AC diagnosis was unrecognized pre-HT. Compared with non-AC cardiomyopathies, the AC group was older at diagnosis (9.3 years vs. 4.3 years, p = .012) and transplant (11.1 years vs. 6.5 years, p = .010), had more ventricular arrhythmias (80.0% vs 32.8%, p = .003), and required more anti-arrhythmic use (80.0% vs 32.3%, p = .001). Genetic testing yielded causative pathogenic variants in all tested individuals (n = 5/5, 100%). CONCLUSION AC is often an unrecognized cardiomyopathy pretransplant in children who undergo HT. Pediatric non-HCM phenotypes with heart failure who have a significant ventricular arrhythmia burden should be investigated for AC.
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Affiliation(s)
- Hanna J Tadros
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Swati Choudhry
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Debra L Kearney
- Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kyle Hope
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abigail Yesso
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Christina Y Miyake
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Jack Price
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Spinner
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Hari Tunuguntla
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kriti Puri
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - William Dreyer
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Susan W Denfield
- Department of Pediatrics, Lille Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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9
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Aljehani A, Kew T, Baig S, Cox H, Sommerfeld LC, Ensam B, Kalla M, Steeds RP, Fabritz L. Characterisation of patients referred to a tertiary-level inherited cardiac condition clinic with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC). BMC Cardiovasc Disord 2023; 23:14. [PMID: 36635648 PMCID: PMC9837886 DOI: 10.1186/s12872-022-03021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) or arrhythmogenic cardiomyopathy is a rare inherited disease with incomplete penetrance and an environmental component. Although a rare disease, ARVC is a common cause of sudden cardiac death in young adults. Data on the different stages of ARVC remains scarce. The purpose of this study is to describe the initial presentation and cardiac phenotype of definite and non-definite ARVC for patients seen at a tertiary service. METHODS This is a single centre, observational cohort study of patients with definite and non-definite ARVC seen at the Inherited Cardiac Conditions services at University Hospital Birmingham (UHB) in the period 2010-2021. Patients were identified by interrogation of digital health records, medical history, imaging and by examining 12-lead electrocardiograms (ECG). RESULT The records of 1451 patients were reviewed; of those, 165 patients were at risk of ARVC (mean age 41 ± 17 years, 56% male). 60 patients fulfilled task force criteria for definite ARVC diagnosis (n = 40, 67% males), and 38 (72%) of them carried a known pathogenic variant. The remaining 105 patients (50% males) were non-definite, and of these 45 (62%) carried a known pathogenic variant. Patients in the definite group were more symptomatic, with palpitations (57% vs. 17%), syncope (35% vs. 6%) and shortness of breath (28% vs. 5%, p < 0.001). T-wave inversion in V1-V3 and epsilon waves were observed only in the definite group. Both PR interval and QRS duration were longer in the definite (170 ± 34 ms and 100 ± 19 ms, p < 0.001) compared to (149 ± 25 and 91 ± 14 ms, p = 0.005). Patients with definite ARVC had significantly larger RV end diastolic areas and significantly reduced biventricular function (RVEDA = 27 ± 10 cm2, RVFAC = 37 ± 11% and EF = 56 ± 12%) compared to the non-definite group (RVEDA = 18 ± 4 cm2, RVFAC 49 ± 6% and LVEF 64 ± 7%, p < 0.001). Sustained ventricular tachycardia (VT) occurred more frequently in the definite group compared to the non-definite group (27% vs. 2%, p < 0.001). Ventricular fibrillation was observed in the definite group only (8 of 60 patients, 13%). CONCLUSION Our study showed differences between definite and non-definite ARVC patients in terms of clinical, electrophysiological and imaging features. Major adverse cardiac events occurred more commonly in the definite group, but also were observed in non-definite ARVC. This single centre observational cohort study forms a basis for further prospective multicentre interventional studies.
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Affiliation(s)
- A. Aljehani
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,grid.412149.b0000 0004 0608 0662King Saud Bin Abdulaziz University For Health Sciences, Echocardiography Cardiovascular Technology (ECVT) Program, Riyadh, Saudi Arabia
| | - T. Kew
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S. Baig
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H. Cox
- grid.498025.20000 0004 0376 6175West Midlands Regional Genetics Unit, Clinical Genetics, Birmingham Women’s and Children’s NHS Foundation Trust (BWC) Birmingham, Birmingham, UK
| | - L. C. Sommerfeld
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.13648.380000 0001 2180 3484University Centre of Cardiovascular Science, UKE Hamburg, Hamburg, Germany
| | - B. Ensam
- grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M. Kalla
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. P. Steeds
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L. Fabritz
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Department of Cardiology, University Heart and Vascular Centre Hamburg, UKE Hamburg and DZHK, Hamburg/Kiel/Luebeck, Germany ,grid.13648.380000 0001 2180 3484University Centre of Cardiovascular Science, UKE Hamburg, Hamburg, Germany
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10
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Ammirati E, Raimondi F, Piriou N, Sardo Infirri L, Mohiddin SA, Mazzanti A, Shenoy C, Cavallari UA, Imazio M, Aquaro GD, Olivotto I, Pedrotti P, Sekhri N, Van de Heyning CM, Broeckx G, Peretto G, Guttmann O, Dellegrottaglie S, Scatteia A, Gentile P, Merlo M, Goldberg RI, Reyentovich A, Sciamanna C, Klaassen S, Poller W, Trankle CR, Abbate A, Keren A, Horowitz-Cederboim S, Cadrin-Tourigny J, Tadros R, Annoni GA, Bonoldi E, Toquet C, Marteau L, Probst V, Trochu JN, Kissopoulou A, Grosu A, Kukavica D, Trancuccio A, Gil C, Tini G, Pedrazzini M, Torchio M, Sinagra G, Gimeno JR, Bernasconi D, Valsecchi MG, Klingel K, Adler ED, Camici PG, Cooper LT. Acute Myocarditis Associated With Desmosomal Gene Variants. JACC. HEART FAILURE 2022; 10:714-727. [PMID: 36175056 DOI: 10.1016/j.jchf.2022.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown. OBJECTIVES The purpose of this study was to ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV. METHODS In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV[+]), 25 with AM and negative gene testing (DGV[-]), and 36 with AM without genetics testing. All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance (CMR). In 86 patients, CMR changes in function and structure were re-assessed at follow-up. RESULTS In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular ejection fraction (LVEF) was 56% on CMR (P = NS vs the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared with DGV(-) and without genetics testing patients (62.3% vs 17.5% vs 5.3% at 5 years, respectively; P < 0.0001), driven by myocarditis recurrence and ventricular arrhythmias. At follow-up CMR, a higher number of late gadolinium enhanced segments was found in DGV(+) AM. CONCLUSIONS Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with patients with AM without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.
| | - Francesca Raimondi
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C Hôpital Necker Enfants Malades, APHP Paris Cité, Paris, France
| | - Nicolas Piriou
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | | | - Saidi A Mohiddin
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andrea Mazzanti
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ugo A Cavallari
- Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Hospital, Milano, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, "Santa Maria della Misericordia," Udine, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Firenze, Italy
| | | | - Neha Sekhri
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Giovanni Peretto
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Oliver Guttmann
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Randal I Goldberg
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Alex Reyentovich
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Christopher Sciamanna
- University of Illinois at Chicago, Advocate Christ Medical Center Cardiothoracic and Vascular Surgical Associates, Oak Lawn, Illinois, USA
| | - Sabine Klaassen
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Poller
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Berlin, Germany; Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andre Keren
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Julia Cadrin-Tourigny
- Division of Electrophysiology and Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Rafik Tadros
- Division of Electrophysiology and Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | | | - Claire Toquet
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Pathology Department, CHU Nantes, Nantes University, Nantes, France
| | - Lara Marteau
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Jean Noël Trochu
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Antheia Kissopoulou
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Deni Kukavica
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Trancuccio
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Cristina Gil
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Giacomo Tini
- Clinic of Cardiovascular Disease, Ospedale Policlinico San Martino, Università di Genova, Genova, Italy
| | - Matteo Pedrazzini
- Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Margherita Torchio
- Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Juan Ramón Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Bicocca, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Bicocca, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Eric D Adler
- Department of Cardiology, University of California-San Diego, San Diego, California, USA
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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11
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Jan M, Shillingford MS, Turbendian HK, Ferns SJ. Cardiac arrest secondary to arrhythmogenic right ventricular cardiomyopathy in an adolescent male. Indian Pacing Electrophysiol J 2022; 22:241-244. [PMID: 35716983 PMCID: PMC9463484 DOI: 10.1016/j.ipej.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare, genetically-inherited cardiomyopathy that may be fatal. We present the case of a 17 year old male who presented after a witnessed cardiac arrest with indeterminate echocardiogram and electrocardiogram (ECG) findings for a specific etiology. Genetic testing revealed a mutation in the PKP2 and DSC2 genes, consistent with ARVC. This report outlines the presentation of ARVC as an aborted sudden cardiac death episode in a previously asymptomatic teenager, investigations for ARVC and highlights the importance of adequate cardiopulmonary resuscitation in the overall prognosis. Implantable cardiac defibrillator (ICD) placement for secondary prevention is necessary. The first presentation of ARVC in the young can be a catastrophic arrhythmia. Initial ECGs and echocardiogram abnormalities can be subtle. Genetic screening for first degree relatives is important. First responder CPR plays an important role in the long-term prognosis.
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Affiliation(s)
- Meryam Jan
- Wolfson Children's Hospital, Jacksonville, FL, USA
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12
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Liang LW, Kalia I, Latif F, Waase MP, Shimada YJ, Sayer G, Reilly MP, Uriel N. The use of telemedicine in cardiogenetics clinical practice during the COVID-19 pandemic. Mol Genet Genomic Med 2022; 10:e1946. [PMID: 35388985 PMCID: PMC9184656 DOI: 10.1002/mgg3.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background The COVID‐19 pandemic has necessitated the rapid and widespread adoption of novel mechanisms of service delivery, including the use of telemedicine. The aim of this study was to examine the impact of COVID‐19 on cardiogenetics practices. Methods We retrospectively analyzed the clinical characteristics of patients who were seen for cardiogenetics visits pre‐pandemic (1 April–23 December 2019) and during the pandemic (1 April–23 December 2020) at Columbia University Irving Medical Center. Results Six percent (n = 6) of visits in 2019 were remote telemedicine encounters, whereas 80% (n = 106) of visits in 2020 were telemedicine encounters. In 2019, only 18% (n = 19) of the patients seen for genetic counseling were family members of probands; this percentage increased to 34% in 2020 (n = 45; p = .01). In 2020, the geographic reach of genetic counseling also extended far beyond New York State, reaching a total of 11 states as well as one patient in Puerto Rico. Genetic testing results were similar in 2019 and 2020. Conclusion Despite the health‐care delivery barriers created by the COVID‐19 pandemic, the use of telemedicine allowed us to expand the reach of cardiovascular genetic counseling and testing.
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Affiliation(s)
- Lusha W. Liang
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Isha Kalia
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Irving Institute for Clinical and Translational ResearchColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Farhana Latif
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Marc P. Waase
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Yuichi J. Shimada
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Gabriel Sayer
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Muredach P. Reilly
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Irving Institute for Clinical and Translational ResearchColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nir Uriel
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
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13
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Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:533-553. [PMID: 35450611 DOI: 10.1016/j.jacep.2021.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) encompasses a group of conditions characterized by right ventricular fibrofatty infiltration, with a predominant arrhythmic presentation. First described in the late 1970s and early 1980s, it is now frequently recognized to have biventricular involvement. The prevalence is ∼1:2,000 to 1:5,000, depending on geographic location, and it has a slight male predominance. The diagnosis of ARVC is determined on the basis of fulfillment of task force criteria incorporating electrophysiological parameters, cardiac imaging findings, genetic factors, and histopathologic features. Risk stratification of patients with ARVC aims to identify those who are at increased risk of sudden cardiac death or sustained ventricular tachycardia. Factors including age, sex, electrophysiological features, and cardiac imaging investigations all contribute to risk stratification. The current management of ARVC includes exercise restriction, β-blocker therapy, consideration for implantable cardioverter-defibrillator insertion, and catheter ablation. This review summarizes our current understanding of ARVC and provides clinicians with a practical approach to diagnosis and management.
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14
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Analysis of buccal mucosa as a prognostic tool in children with arrhythmogenic cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2022; 64:None. [PMID: 35300203 PMCID: PMC8917042 DOI: 10.1016/j.ppedcard.2021.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Background The diagnosis of arrhythmogenic cardiomyopathy (ACM) is challenging especially in children at risk of adverse events. Analysis of cardiac myocyte junctional protein distribution may have diagnostic and prognostic implications, but its utility is limited by the need for a myocardial sample. We previously reported that buccal mucosa cells show junctional protein redistribution similar to that seen in cardiac myocytes of adult patients with ACM. Objectives We aimed to determine when junctional protein distribution abnormalities first occur in children with ACM variants and whether they correlate with progression of clinically apparent disease. Methods We analyzed buccal mucosa samples of children and adolescents with a family history of ACM (n = 13) and age-matched controls (n = 13). Samples were immunostained for plakoglobin, desmoplakin, plakophilin-1 and connexin43 and analyzed by confocal microscopy. All participants were swabbed at least twice with an average interval of 12–18 months between samplings. Results Junctional protein re-localization in buccal mucosa cells did not correlate with the presence of ACM-causing variants but instead occurred with clinical onset of disease. No changes in protein distribution were seen unless and until there was clinical evidence of disease. In addition, progressive shifts in the distribution of key proteins correlated with worsening of the disease phenotype. Finally, we observed restoration of junctional signal for Cx43 in patient with a favorable response to anti-arrhythmic therapy. Conclusions Due to ethical concerns about obtaining heart biopsies in children with no apparent disease, it has not been possible to analyze molecular changes in cardiac myocytes with the onset/progression of clinical disease. Using buccal smears as a surrogate for the myocardium may facilitate future studies of mechanisms and pathophysiological consequences of junctional protein redistribution in ACM. Buccal cells may also be a safe and inexpensive tool for risk stratification and potentially monitoring response to treatment in children bearing ACM variants.
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15
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Lou J, Chen H, Huang S, Chen P, Yu Y, Chen F. Update on risk factors and biomarkers of sudden unexplained cardiac death. J Forensic Leg Med 2022; 87:102332. [DOI: 10.1016/j.jflm.2022.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023]
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16
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Abstract
PURPOSE OF REVIEW Review the current state of the art of arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis and risk stratification in the pediatric population. RECENT FINDINGS ARVC is an inherited cardiomyopathy characterized by progressive myocyte loss and fibrofatty replacement of predominantly the right ventricle and high risk of ventricular arrhythmias and sudden cardiac death (SCD). ARVC is one of the leading causes of arrhythmic cardiac arrest in young people. Early diagnosis and accurate risk assessment are challenging, especially in children who often exhibit little to no phenotype, even if genotype positive. Multimodal imaging provides more detailed assessment of the right ventricle and has been shown in pediatric patients to identify earlier preclinical disease expression. Identification of patients with ARVC allows the clinician to intervene early with appropriate exercise restrictions, even if genotype positive only without phenotypic expression. Emphasis should be placed on stratifying the patient's risk of ventricular arrhythmias and SCD. SUMMARY ARVC is a challenging diagnosis to make in adolescents who often do not exhibit clinical symptoms. Newer multimodal imaging techniques and improvements in genetic testing and biomarkers should help improve early diagnosis. Exercise restriction for children with ARVC has been shown to reduce disease advancement and decreases the risk of a life-threatening event.
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17
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Kim KH, Pereira NL. Genetics of Cardiomyopathy: Clinical and Mechanistic Implications for Heart Failure. Korean Circ J 2021; 51:797-836. [PMID: 34327881 PMCID: PMC8484993 DOI: 10.4070/kcj.2021.0154] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022] Open
Abstract
Genetic cardiomyopathies are an important cause of sudden cardiac death across all age groups. Genetic testing in heart failure clinics is useful for family screening and providing individual prognostic insight. Obtaining a family history of at least three generations, including the creation of a pedigree, is recommended for all patients with primary cardiomyopathy. Additionally, when appropriate, consultation with a genetic counsellor can aid in the success of a genetic evaluation. Clinical screening should be performed on all first-degree relatives of patients with genetic cardiomyopathy. Genetics has played an important role in the understanding of different cardiomyopathies, and the field of heart failure (HF) genetics is progressing rapidly. Much research has also focused on distinguishing markers of risk in patients with cardiomyopathy using genetic testing. While these efforts currently remain incomplete, new genomic technologies and analytical strategies provide promising opportunities to further explore the genetic architecture of cardiomyopathies, afford insight into the early manifestations of cardiomyopathy, and help define the molecular pathophysiological basis for cardiac remodeling. Cardiovascular physicians should be fully aware of the utility and potential pitfalls of incorporating genetic test results into pre-emptive treatment strategies for patients in the preliminary stages of HF. Future work will need to be directed towards elucidating the biological mechanisms of both rare and common gene variants and environmental determinants of plasticity in the genotype-phenotype relationship. This future research should aim to further our ability to identify, diagnose, and treat disorders that cause HF and sudden cardiac death in young patients, as well as prioritize improving our ability to stratify the risk for these patients prior to the onset of the more severe consequences of their disease.
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Affiliation(s)
- Kyung Hee Kim
- Division of Cardiology, Incheon Sejong General Hospital, Incheon, Korea.
| | - Naveen L Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
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18
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Omotoye S, Junpaparp P, McHugh J, Silva J, Kuk R, Sackett M, Tandri H. Cardiac Sarcoidosis With Prominent Epsilon Waves: A Perfect Phenocopy of ARVC. JACC Case Rep 2021; 3:1097-1102. [PMID: 34317691 PMCID: PMC8311457 DOI: 10.1016/j.jaccas.2021.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
Cardiac sarcoidosis (CS) overlaps in clinical presentation with arrhythmogenic right ventricular cardiomyopathy and shares phenotypic classification, including the presence of epsilon waves. The presence of conduction disease is seen exclusively in CS, as an important phenotypic difference. We present a case of ventricular tachycardia and epsilon waves due to CS, without conduction disease. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Samuel Omotoye
- Stroobants Cardiovascular Center, Lynchburg, Virginia, USA
| | | | - Julia McHugh
- Stroobants Cardiovascular Center, Lynchburg, Virginia, USA
| | - Jose Silva
- Stroobants Cardiovascular Center, Lynchburg, Virginia, USA
| | - Richard Kuk
- Stroobants Cardiovascular Center, Lynchburg, Virginia, USA
| | - Mathew Sackett
- Stroobants Cardiovascular Center, Lynchburg, Virginia, USA
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19
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Augusto JB, Eiros R, Nakou E, Moura-Ferreira S, Treibel TA, Captur G, Akhtar MM, Protonotarios A, Gossios TD, Savvatis K, Syrris P, Mohiddin S, Moon JC, Elliott PM, Lopes LR. Dilated cardiomyopathy and arrhythmogenic left ventricular cardiomyopathy: a comprehensive genotype-imaging phenotype study. Eur Heart J Cardiovasc Imaging 2021; 21:326-336. [PMID: 31317183 DOI: 10.1093/ehjci/jez188] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS Myocardial scar detected by cardiovascular magnetic resonance has been associated with sudden cardiac death in dilated cardiomyopathy (DCM). Certain genetic causes of DCM may cause a malignant arrhythmogenic phenotype. The concepts of arrhythmogenic left ventricular (LV) cardiomyopathy (ALVC) and arrhythmogenic DCM are currently ill-defined. We hypothesized that a distinctive imaging phenotype defines ALVC. METHODS AND RESULTS Eighty-nine patients with DCM-associated mutations [desmoplakin (DSP) n = 25, filamin C (FLNC) n = 7, titin n = 30, lamin A/C n = 12, bcl2-associated athanogene 3 n = 3, RNA binding motif protein 20 n = 3, cardiac sodium channel NAv1.5 n = 2, and sarcomeric genes n = 7] were comprehensively phenotyped. Clustering analysis resulted in two groups: 'DSP/FLNC genotypes' and 'non-DSP/FLNC'. There were no significant differences in age, sex, symptoms, baseline electrocardiography, arrhythmia burden, or ventricular volumes between the two groups. Subepicardial LV late gadolinium enhancement with ring-like pattern (at least three contiguous segments in the same short-axis slice) was observed in 78.1% of DSP/FLNC genotypes but was absent in the other DCM genotypes (P < 0.001). Left ventricular ejection fraction (LVEF) and global longitudinal strain were lower in other DCM genotypes (P = 0.053 and P = 0.015, respectively), but LV regional wall motion abnormalities were more common in DSP/FLNC genotypes (P < 0.001). DSP/FLNC patients with non-sustained ventricular tachycardia (NSVT) had more LV scar (P = 0.010), whereas other DCM genotypes patients with NSVT had lower LVEF (P = 0.001) than patients without NSVT. CONCLUSION DSP/FLNC genotypes cause more regionality in LV impairment. The most defining characteristic is a subepicardial ring-like scar pattern in DSP/FLNC, which should be considered in future diagnostic criteria for ALVC.
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Affiliation(s)
- João B Augusto
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Rocio Eiros
- Cardiovascular Imaging Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Eleni Nakou
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Sara Moura-Ferreira
- Cardiology Department, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK.,NIHR University College London Hospitals, Biomedical Research Center, Tottenham Court Road, London, UK
| | - Mohammed M Akhtar
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | | | | | - Konstantinos Savvatis
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, London, UK
| | - Saidi Mohiddin
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK.,NIHR University College London Hospitals, Biomedical Research Center, Tottenham Court Road, London, UK
| | - Perry M Elliott
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Luis R Lopes
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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20
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Wichter T, Milberg P, Wichter HD, Dechering DG. Pregnancy in arrhythmogenic cardiomyopathy. Herzschrittmacherther Elektrophysiol 2021; 32:186-198. [PMID: 34032905 PMCID: PMC8166670 DOI: 10.1007/s00399-021-00770-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a rare heart muscle disease with a genetic background and autosomal dominant mode of transmission. The clinical manifestation is characterized by ventricular arrhythmias (VA), heart failure (HF) and the risk of sudden cardiac death (SCD). Pregnancy in young female patients with AC represents a challenging condition for the life and family planning of young affected women. In addition to genetic mechanisms that influence the complex pathophysiology of AC, experimental and clinical data have confirmed the pathogenetic role of strenuous exercise and competitive sports in the early onset and rapid progression of AC symptoms and complications. Pregnancy and exercise share a number of physiological aspects of adaptation. In AC, both result in ventricular volume overload and myocardial stretch. Therefore, pregnancy has been postulated as a potential risk factor for HF, VA, SCD, and pregnancy-related obstetric complications in patients with AC. However, the available evidence on pregnancy in AC does not confirm this hypothesis. In most women with AC, pregnancies are well tolerated, uneventful, and follow a benign course. Pregnancy-related symptoms (VA, syncope, HF) and mortality, as well as obstetric complications, are uncommon in AC patients and range in the order of background populations and cohorts with AC and no pregnancy. The number of completed pregnancies is not associated with an acceleration of AC pathology or an increased risk of VA or HF during pregnancy and follow-up. Accordingly, there is no medical indication to advise against pregnancy in patients with AC. Preconditions include stability of rhythm and hemodynamics at baseline, as well as clinical follow-ups and the availability of multidisciplinary expert consultation during pregnancy and postpartum. Genetic counseling is recommended prior to pregnancy for all couples and their families affected by AC.
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Affiliation(s)
- Thomas Wichter
- Klinik für Innere Medizin / Kardiologie, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Herzzentrum Osnabrück/Bad Rothenfelde, Bischofsstr. 1, 49074, Osnabrück, Germany.
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21
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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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22
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Corrado D, van Tintelen PJ, McKenna WJ, Hauer RNW, Anastastakis A, Asimaki A, Basso C, Bauce B, Brunckhorst C, Bucciarelli-Ducci C, Duru F, Elliott P, Hamilton RM, Haugaa KH, James CA, Judge D, Link MS, Marchlinski FE, Mazzanti A, Mestroni L, Pantazis A, Pelliccia A, Marra MP, Pilichou K, Platonov PGA, Protonotarios A, Rampazzo A, Saffitz JE, Saguner AM, Schmied C, Sharma S, Tandri H, Te Riele ASJM, Thiene G, Tsatsopoulou A, Zareba W, Zorzi A, Wichter T, Marcus FI, Calkins H. Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis. Eur Heart J 2021; 41:1414-1429. [PMID: 31637441 PMCID: PMC7138528 DOI: 10.1093/eurheartj/ehz669] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/04/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Peter J van Tintelen
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands.,Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - William J McKenna
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, 7GR5+RW Doha, Qatar.,Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Richard N W Hauer
- Department of Cardiology, Netherlands Heart Institute, University Medical Center Utrecht, Moreelsepark 1, 3511 EP Utrecht, Netherlands
| | - Aris Anastastakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece
| | - Angeliki Asimaki
- Molecular and Clinical Sciences Research Institute, St. George's University of London NHS Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation, Trust Headquarters, Marlborough St, Bristol BS1 3NU, UK
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Robert M Hamilton
- The Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Daniel Judge
- Department of Medicine, Medical University of South Carolina (MUSC), 30 Courtenay Drive Room 326 Gazes, Charleston, MSC 592, USA
| | - Mark S Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Francis E Marchlinski
- Cardiac Electrophysiology Program, Cardiovascular Division Hospital of the University of Pennsylvania, 9 Founders Pavilion - Cardiology, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Corso Str. Nuova 25, Pavia, Italy
| | - Luisa Mestroni
- Molecular Genetics, Cardiovascular Institute, University of Colorado, Denver Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Antonis Pantazis
- Inherited Cardiovascular Conditions services, The Royal Brompton and Harefield Hospitals, Sydney St, Chelsea, London SW3 6NP, UK
| | - Antonio Pelliccia
- Department of Cardiology, Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Roma, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Pyotr G A Platonov
- Department of Cardiology, Lund University Arrhythmia Clinic, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden
| | - Alexandros Protonotarios
- Inherited Cardiovascular Disease Unit, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| | - Alessandra Rampazzo
- Department of Biology, University of Padua, Viale Giuseppe Colombo, 3, 35131 Padova PD, Italy
| | - Jeffry E Saffitz
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | - Hari Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Anneline S J M Te Riele
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Moreelsepark 1, 3511 EP Utrecht, Netherlands
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | | | - Wojciech Zareba
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 150 Lucius Gordon Dr, West Henrietta, NY 14586, USA
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Thomas Wichter
- Heart Center Osnabrück, Bad Rothenfelde Niels-Stensen-Kliniken Marienhospital Osnabrück, Ulmenallee 5 - 11, 49214 Bad Rothenfelde, Germany
| | - Frank I Marcus
- Sarver Heart Center, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
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23
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Daş T, Buğra A, Buğra AK. Evaluation of histopathological findings of cardiac deaths in forensic autopsies. Ir J Med Sci 2021; 191:937-944. [PMID: 33973126 DOI: 10.1007/s11845-021-02646-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The vast majority of sudden and unexpected natural deaths are related to cardiovascular diseases, especially coronary artery diseases. AIMS In this study, we aimed to reveal the epidemiological differences between men and women and to investigate the most common pathologies that cause cardiac deaths. METHODS Five thousand seven hundred sixty-eight autopsy cases that were done in 2016 were reviewed for the autopsy information and histopathological findings. Of the 5768 autopsies performed, 866 were due to cardiac causes. Eight hundred thirty-two cases were reviewed due to lack of autopsy information in 34 cases. RESULTS One hundred sixteen (13.9%) were female, and 716 (86.1%) were male. Coronary artery disease was detected in 760 of 832 cases. There were findings of acute or previous myocardial infarction in 595 (71.5%), perivascular and interstitial fibrosis in 159 (19.1%), myocardial rupture and tamponade in 31 (%3.7), valvular disease in 6 (0.7%), cardiomyopathy in 4 (0.5%), and congenital heart disease in 3 (0.4%). In the study, it was observed that the mean age of death due to cardiac pathology other than coronary artery disease was significantly lower than deaths due to coronary artery disease (p < 0.05). The presence of coronary artery disease in men was found to be significantly higher than in women (p < 0.001). CONCLUSION In our study, it was found that deaths due to coronary artery disease are seen at an older age than cardiac deaths other than coronary artery disease. In addition, in line with current knowledge, it has been confirmed that the mortality rate of coronary artery disease is higher in men than in women.
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Affiliation(s)
- Taner Daş
- Morgue Department, Histopathology Unit, The Council of Forensic Medicine, Istanbul, Turkey.
| | - Aytül Buğra
- Morgue Department, Histopathology Unit, The Council of Forensic Medicine, Istanbul, Turkey
| | - Abdul Kerim Buğra
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training And Research Hospital, University Of Health Sciences, Istanbul, Turkey
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24
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Volani C, Rainer J, Hernandes VV, Meraviglia V, Pramstaller PP, Smárason SV, Pompilio G, Casella M, Sommariva E, Paglia G, Rossini A. Metabolic Signature of Arrhythmogenic Cardiomyopathy. Metabolites 2021; 11:metabo11040195. [PMID: 33805952 PMCID: PMC8064316 DOI: 10.3390/metabo11040195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/06/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic-based cardiac disease accompanied by severe ventricular arrhythmias and a progressive substitution of the myocardium with fibro-fatty tissue. ACM is often associated with sudden cardiac death. Due to the reduced penetrance and variable expressivity, the presence of a genetic defect is not conclusive, thus complicating the diagnosis of ACM. Recent studies on human induced pluripotent stem cells-derived cardiomyocytes (hiPSC-CMs) obtained from ACM individuals showed a dysregulated metabolic status, leading to the hypothesis that ACM pathology is characterized by an impairment in the energy metabolism. However, despite efforts having been made for the identification of ACM specific biomarkers, there is still a substantial lack of information regarding the whole metabolomic profile of ACM patients. The aim of the present study was to investigate the metabolic profiles of ACM patients compared to healthy controls (CTRLs). The targeted Biocrates AbsoluteIDQ® p180 assay was used on plasma samples. Our analysis showed that ACM patients have a different metabolome compared to CTRLs, and that the pathways mainly affected include tryptophan metabolism, arginine and proline metabolism and beta oxidation of fatty acids. Altogether, our data indicated that the plasma metabolomes of arrhythmogenic cardiomyopathy patients show signs of endothelium damage and impaired nitric oxide (NO), fat, and energy metabolism.
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Affiliation(s)
- Chiara Volani
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
- Correspondence:
| | - Johannes Rainer
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
| | - Vinicius Veri Hernandes
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
| | - Viviana Meraviglia
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
| | - Peter Paul Pramstaller
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
| | - Sigurður Vidir Smárason
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy; (G.P.); (E.S.)
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20138 Milan, Italy
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy; (G.P.); (E.S.)
| | - Giuseppe Paglia
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 20854 Vedano al Lambro, Italy;
| | - Alessandra Rossini
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy; (J.R.); (V.V.H.); (V.M.); (P.P.P.); (S.V.S.); (A.R.)
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25
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Deciphering the Role of Wnt and Rho Signaling Pathway in iPSC-Derived ARVC Cardiomyocytes by In Silico Mathematical Modeling. Int J Mol Sci 2021; 22:ijms22042004. [PMID: 33670616 PMCID: PMC7923182 DOI: 10.3390/ijms22042004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic Right Ventricular cardiomyopathy (ARVC) is an inherited cardiac muscle disease linked to genetic deficiency in components of the desmosomes. The disease is characterized by progressive fibro-fatty replacement of the right ventricle, which acts as a substrate for arrhythmias and sudden cardiac death. The molecular mechanisms underpinning ARVC are largely unknown. Here we propose a mathematical model for investigating the molecular dynamics underlying heart remodeling and the loss of cardiac myocytes identity during ARVC. Our methodology is based on three computational models: firstly, in the context of the Wnt pathway, we examined two different competition mechanisms between β-catenin and Plakoglobin (PG) and their role in the expression of adipogenic program. Secondly, we investigated the role of RhoA-ROCK pathway in ARVC pathogenesis, and thirdly we analyzed the interplay between Wnt and RhoA-ROCK pathways in the context of the ARVC phenotype. We conclude with the following remark: both Wnt/β-catenin and RhoA-ROCK pathways must be inactive for a significant increase of PPARγ expression, suggesting that a crosstalk mechanism might be responsible for mediating ARVC pathogenesis.
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26
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Rieder M, Castiglione A, Asatryan B, Odening KE. [Why do we need genetics in cardiac rhythmology?]. Herzschrittmacherther Elektrophysiol 2020; 31:394-400. [PMID: 32661562 DOI: 10.1007/s00399-020-00697-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 06/11/2023]
Abstract
A variety of arrhythmogenic cardiac diseases such as channelopathies and cardiomyopathies are caused by genetic alterations. In patients with these diseases, malignant arrhythmias or sudden cardiac death frequently manifest already during young adulthood. Early recognition, risk stratification and adequate therapy is therefore essential to avoid sudden cardiac death. This review summarizes the implications of genetic testing for diagnosis, risk stratification and therapy of patients with cardiac channelopathies (long-QT syndrome, short-QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia) and inherited cardiomyopathies (hypertrophic, dilatative or arrhythmogenic right ventricular cardiomyopathy).
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Affiliation(s)
- Marina Rieder
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern, Freiburgstrasse 8, 3010, Bern, Schweiz
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg, Freiburg, Deutschland
| | - Alessandro Castiglione
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern, Freiburgstrasse 8, 3010, Bern, Schweiz
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg, Freiburg, Deutschland
| | - Babken Asatryan
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern, Freiburgstrasse 8, 3010, Bern, Schweiz
| | - Katja E Odening
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern, Freiburgstrasse 8, 3010, Bern, Schweiz.
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg, Freiburg, Deutschland.
- Institut für Physiologie, Universität Bern, Bühlplatz 5, 3012, Bern, Schweiz.
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27
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Costa S, Medeiros-Domingo A, Gasperetti A, Akdis D, Berger W, James CA, Ruschitzka F, Brunckhorst CB, Duru F, Saguner AM. Impact of Genetic Variant Reassessment on the Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy Based on the 2010 Task Force Criteria. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 14:e003047. [PMID: 33232181 DOI: 10.1161/circgen.120.003047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy, which is associated with life-threatening ventricular arrhythmias. Approximately 60% of patients carry a putative disease-causing genetic variant, but interpretation of genetic test results can be challenging. The aims of this study were to systematically reclassify genetic variants in patients with ARVC and to assess the impact on ARVC diagnosis. METHODS This study included patients from the Multicenter Zurich ARVC Registry who hosted a genetic variant deemed to be associated with the disease. Reclassification of pathogenicity was performed according to the modified 2015 American College of Medical Genetics criteria. ARVC diagnosis (categories: definite, borderline, possible) based on the 2010 Task Force Criteria was reclassified after genetic readjudication. RESULTS In 79 patients bearing 80 unique genetic variants, n=47 (58.8%) genetic variants were reclassified, and reclassification was judged to be clinically relevant in n=33 (41.3%). Variants in plakophilin-2 (PKP2) were shown to reclassify less frequently as compared with other genes (PKP2, n=1, 8.3%; desmosomal non-PKP2, n=20, 66.7%; nondesmosomal, n=26, 68.4%; P=0.001for overall comparison; PKP2 versus desmosomal non-PKP2, P=0.001; PKP2 versus nondesmosomal, P<0.001). Genetic reclassification impacted ARVC diagnosis. Eight patients (10.1%) were downgraded from definite to borderline/possible disease at the time of initial genetic testing as well as last follow-up, respectively. Separate genetic reclassification in family members led to downgrading of n=5 (38.5%) variants. CONCLUSIONS Given that approximately half of genetic variants were reclassified, with 10.1% of patients losing their definite disease status, accurate determination of variant pathogenicity is of utmost importance in the diagnosis of ARVC.
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Affiliation(s)
- Sarah Costa
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.)
| | | | - Alessio Gasperetti
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.)
| | - Deniz Akdis
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.)
| | - Wolfgang Berger
- Institute of Molecular Genetics, University of Zurich, Schlieren, Switzerland (W.B.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (C.A.J.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.)
| | - Corinna B Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.).,Zurich Center for Integrative Human Physiology (ZIHP), Switzerland (W.B., F.D.)
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (S.C., A.G., D.A., F.R., C.B.B., F.D., A.M.S.)
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28
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Weisbrod D. Small and Intermediate Calcium Activated Potassium Channels in the Heart: Role and Strategies in the Treatment of Cardiovascular Diseases. Front Physiol 2020; 11:590534. [PMID: 33329039 PMCID: PMC7719780 DOI: 10.3389/fphys.2020.590534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022] Open
Abstract
Calcium-activated potassium channels are a heterogeneous family of channels that, despite their different biophysical characteristics, structures, and pharmacological signatures, play a role of transducer between the ubiquitous intracellular calcium signaling and the electric variations of the membrane. Although this family of channels was extensively described in various excitable and non-excitable tissues, an increasing amount of evidences shows their functional role in the heart. This review aims to focus on the physiological role and the contribution of the small and intermediate calcium-activated potassium channels in cardiac pathologies.
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29
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Patel V, Asatryan B, Siripanthong B, Munroe PB, Tiku-Owens A, Lopes LR, Khanji MY, Protonotarios A, Santangeli P, Muser D, Marchlinski FE, Brady PA, Chahal CAA. State of the Art Review on Genetics and Precision Medicine in Arrhythmogenic Cardiomyopathy. Int J Mol Sci 2020; 21:ijms21186615. [PMID: 32927679 PMCID: PMC7554944 DOI: 10.3390/ijms21186615] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterised by ventricular arrhythmia and an increased risk of sudden cardiac death (SCD). Numerous genetic determinants and phenotypic manifestations have been discovered in ACM, posing a significant clinical challenge. Further to this, wider evaluation of family members has revealed incomplete penetrance and variable expressivity in ACM, suggesting a complex genotype-phenotype relationship. This review details the genetic basis of ACM with specific genotype-phenotype associations, providing the reader with a nuanced perspective of this condition; whilst also proposing a future roadmap to delivering precision medicine-based management in ACM.
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Affiliation(s)
- Viraj Patel
- Department of Cardiology, Royal Papworth Hospital, Cambridge CB2 0AY, UK;
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | | | - Patricia B. Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Anjali Tiku-Owens
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; (A.T.-O.); (P.S.); (D.M.); (F.E.M.)
| | - Luis R. Lopes
- Department of Cardiology, St Bartholomew’s Hospital, London EC1A 7BE, UK; (L.R.L.); (M.Y.K.); (A.P.)
- Centre for Heart Muscle Disease, UCL Institute of Cardiovascular Science, London WC1E 6BT, UK
| | - Mohammed Y. Khanji
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Cardiology, St Bartholomew’s Hospital, London EC1A 7BE, UK; (L.R.L.); (M.Y.K.); (A.P.)
| | - Alexandros Protonotarios
- Department of Cardiology, St Bartholomew’s Hospital, London EC1A 7BE, UK; (L.R.L.); (M.Y.K.); (A.P.)
- Centre for Heart Muscle Disease, UCL Institute of Cardiovascular Science, London WC1E 6BT, UK
| | - Pasquale Santangeli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; (A.T.-O.); (P.S.); (D.M.); (F.E.M.)
| | - Daniele Muser
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; (A.T.-O.); (P.S.); (D.M.); (F.E.M.)
| | - Francis E. Marchlinski
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; (A.T.-O.); (P.S.); (D.M.); (F.E.M.)
| | - Peter A. Brady
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Division of Cardiology, Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - C. Anwar A. Chahal
- Department of Cardiology, Royal Papworth Hospital, Cambridge CB2 0AY, UK;
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; (A.T.-O.); (P.S.); (D.M.); (F.E.M.)
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: ; Tel.: +1-267-252-3461
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Musunuru K, Hershberger RE, Day SM, Klinedinst NJ, Landstrom AP, Parikh VN, Prakash S, Semsarian C, Sturm AC. Genetic Testing for Inherited Cardiovascular Diseases: A Scientific Statement From the American Heart Association. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e000067. [DOI: 10.1161/hcg.0000000000000067] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in human genetics are improving the understanding of a variety of inherited cardiovascular diseases, including cardiomyopathies, arrhythmic disorders, vascular disorders, and lipid disorders such as familial hypercholesterolemia. However, not all cardiovascular practitioners are fully aware of the utility and potential pitfalls of incorporating genetic test results into the care of patients and their families. This statement summarizes current best practices with respect to genetic testing and its implications for the management of inherited cardiovascular diseases.
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Arrhythmogenic cardiomyopathy: An in-depth look at molecular mechanisms and clinical correlates. Trends Cardiovasc Med 2020; 31:395-402. [PMID: 32738304 DOI: 10.1016/j.tcm.2020.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a familial disease, with approximately 60% of patients displaying a pathogenic variant. The majority of genes linked to ACM code for components of the desmosome: plakophilin-2 (PKP2), desmoglein-2 (DSG2) and desmocollin-2 (DSC2), plakoglobin (JUP) and desmoplakin (DSP). Genetic variants involving the desmosomes are known to cause dysfunction of cell-to-cell adhesions and intercellular gap junctions. In turn, this may result in failure to mechanically hold together the cardiomyocytes, fibrofatty myocardial replacement, cardiac conduction delay and ventricular arrhythmias. It is becoming clearer that pathogenic variants in desmosomal genes such as PKP2 are not only responsible for a mechanical dysfunction of the intercalated disc (ID), but are also the cause of various pro-arrhythmic mechanisms. In this review, we discuss in detail the different molecular interactions associated with desmosomal pathogenic variants, and their contribution to various ACM phenotypes.
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Prognostic Value of Magnetic Resonance Phenotype in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Coll Cardiol 2020; 75:2753-2765. [DOI: 10.1016/j.jacc.2020.04.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/20/2022]
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Abstract
Intercalated discs (ICDs) are highly orchestrated structures that connect neighboring cardiomyocytes in the heart. Three major complexes are distinguished in ICD: desmosome, adherens junction (AJ), and gap junction (GJ). Desmosomes are major cell adhesion junctions that anchor cell membrane to the intermediate filament network; AJs connect the actin cytoskeleton of adjacent cells; and gap junctions metabolically and electrically connect the cytoplasm of adjacent cardiomyocytes. All these complexes work as a single unit, the so-called area composita, interdependently rather than individually. Mutation or altered expression of ICD proteins results in various cardiac diseases, such as ARVC (arrhythmogenic right ventricular cardiomyopathy), dilated cardiomyopathy, and hypotrophy cardiomyopathy, eventually leading to heart failure. In this article, we first review the recent findings on the structural organization of ICD and their functions and then focus on the recent advances in molecular pathogenesis of the ICD-related heart diseases, which include two major areas: i) the ICD gene mutations in cardiac diseases, and ii) the involvement of ICD proteins in signal transduction pathways leading to myocardium remodeling and eventual heart failure. These major ICD-related signaling pathways include Wnt/β-catenin pathway, p38 MAPK cascade, Rho-dependent serum response factor (SRF) signaling, calcineurin/NFAT signaling, Hippo kinase cascade, etc., which are differentially regulated in pathological conditions.
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Lin X, Ma Y, Cai Z, Wang Q, Wang L, Huo Z, Hu D, Wang J, Xiang M. Next-generation sequencing identified novel Desmoplakin frame-shift variant in patients with Arrhythmogenic cardiomyopathy. BMC Cardiovasc Disord 2020; 20:74. [PMID: 32046637 PMCID: PMC7011609 DOI: 10.1186/s12872-020-01369-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background Arrhythmogenic cardiomyopathy (AC) is one of the leading causes for sudden cardiac death (SCD). Recent studies have identified mutations in cardiac desmosomes as key players in the pathogenesis of AC. However, the specific etiology in individual families remains largely unknown. Methods A 4-generation family presenting with syncope, lethal ventricular arrhythmia and SCD was recruited. Targeted next generation sequencing (NGS) was performed and validated by Sanger sequencing. Plasmids containing the mutation and wild type (WT) were constructed. Real-time PCR, western-blot and immunofluorescence were performed to detect the functional change due to the mutation. Results The proband, a 56-year-old female, presented with recurrent palpitations and syncope. An ICD was implanted due to her family history of SCD/ aborted SCD. NGS revealed a novel heterozygous frame-shift variant (c.832delG) in Desmoplakin (DSP) among 5 family members. The variant led to frame-shift and premature termination, producing a truncated protein. Cardiac magnetic resonance (CMR) of the family members carrying the same variant shown myocardium thinning and fatty infiltration in the right ventricular, positive bi-ventricular late gadolinium enhancement and severe RV dysfunction, fulfilling the diagnostic criteria of AC. HEK293T cells transfected with mutant plasmids expressed truncated DSP mRNA and protein, upregulation of nuclear junction plakoglobin (JUP) and downregulation of β-catenin, when compared with WT. Conclusion We infer that the novel c.832delG variant in DSP was associated with AC in this family, likely through Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Xiaoping Lin
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yuankun Ma
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Zhejun Cai
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Qiyuan Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Hangzhou, 310009, Zhejiang, China
| | - Lihua Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Hangzhou, 310009, Zhejiang, China
| | - Zhaoxia Huo
- Experimental Teaching Center, School of Basic Medical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China
| | - Jian'an Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Provincial Key Lab of Cardiovascular Research, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Meixiang Xiang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Provincial Key Lab of Cardiovascular Research, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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Nucleoside Diphosphate Kinase B Contributes to Arrhythmogenesis in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes from a Patient with Arrhythmogenic Right Ventricular Cardiomyopathy. J Clin Med 2020; 9:jcm9020486. [PMID: 32050722 PMCID: PMC7073527 DOI: 10.3390/jcm9020486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare, inheritable cardiac disorder characterized by ventricular tachyarrhythmias, progressive loss of cardiomyocytes with fibrofatty replacement and sudden cardiac death. The exact underlying mechanisms are unclear. Methods: This study investigated the possible roles of nucleoside diphosphate kinase B (NDPK-B) and SK4 channels in the arrhythmogenesis of ARVC by using human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). Results: In hiPSC-CMs from a patient with ARVC, the expression levels of NDPK-B and SK4 channels were upregulated, the cell automaticity was increased and the occurrence rate of arrhythmic events was enhanced. Recombinant NDPK-B applied into hiPSC-CMs from either healthy donors or the patient enhanced SK4 channel current (ISK4), cell automaticity and the occurrence of arrhythmic events, whereas protein histidine phosphatase 1 (PHP-1), a counter actor of NDPK-B, prevented the NDPK-B effect. Application of PHP-1 alone or a SK4 channel blocker also reduced cell automaticity and arrhythmic events. Conclusion: This study demonstrated that the elevated NDPK-B expression, via activating SK4 channels, contributes to arrhythmogenesis in ARVC, and hence, NDPK-B may be a potential therapeutic target for treating arrhythmias in patients with ARVC.
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Haggerty CM, Murray B, Tichnell C, Judge DP, Tandri H, Schwartz M, Sturm AC, Matsumura ME, Murray MF, Calkins H, Fornwalt BK, James CA. Managing Secondary Genomic Findings Associated With Arrhythmogenic Right Ventricular Cardiomyopathy: Case Studies and Proposal for Clinical Surveillance. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002237. [PMID: 29997227 DOI: 10.1161/circgen.118.002237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Brittney Murray
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.).,Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Crystal Tichnell
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Daniel P Judge
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.).,Medical University of South Carolina, Charleston, SC (D.P.J.)
| | - Harikrishna Tandri
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Marci Schwartz
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.)
| | - Amy C Sturm
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.)
| | | | - Michael F Murray
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.).,Yale School of Medicine, New Haven, CT (M.F.M.)
| | - Hugh Calkins
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | | | - Cynthia A James
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
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38
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Li CJ, Chen CS, Yiang GT, Tsai APY, Liao WT, Wu MY. Advanced Evolution of Pathogenesis Concepts in Cardiomyopathies. J Clin Med 2019; 8:jcm8040520. [PMID: 30995779 PMCID: PMC6518034 DOI: 10.3390/jcm8040520] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 12/15/2022] Open
Abstract
Cardiomyopathy is a group of heterogeneous cardiac diseases that impair systolic and diastolic function, and can induce chronic heart failure and sudden cardiac death. Cardiomyopathy is prevalent in the general population, with high morbidity and mortality rates, and contributes to nearly 20% of sudden cardiac deaths in younger individuals. Genetic mutations associated with cardiomyopathy play a key role in disease formation, especially the mutation of sarcomere encoding genes and ATP kinase genes, such as titin, lamin A/C, myosin heavy chain 7, and troponin T1. Pathogenesis of cardiomyopathy occurs by multiple complex steps involving several pathways, including the Ras-Raf-mitogen-activated protein kinase-extracellular signal-activated kinase pathway, G-protein signaling, mechanotransduction pathway, and protein kinase B/phosphoinositide 3-kinase signaling. Excess biomechanical stress induces apoptosis signaling in cardiomyocytes, leading to cell loss, which can induce myocardial fibrosis and remodeling. The clinical features and pathophysiology of cardiomyopathy are discussed. Although several basic and clinical studies have investigated the mechanism of cardiomyopathy, the detailed pathophysiology remains unclear. This review summarizes current concepts and focuses on the molecular mechanisms of cardiomyopathy, especially in the signaling from mutation to clinical phenotype, with the aim of informing the development of therapeutic interventions.
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Affiliation(s)
- Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
| | - Chien-Sheng Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
| | - Andy Po-Yi Tsai
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan.
| | - Wan-Ting Liao
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Chinese Medicine Department, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
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Headrick AT, Rosenfeld JA, Yang Y, Tunuguntla H, Allen HD, Penny DJ, Kim JJ, Landstrom AP. Incidentally identified genetic variants in arrhythmogenic right ventricular cardiomyopathy-associated genes among children undergoing exome sequencing reflect healthy population variation. Mol Genet Genomic Med 2019; 7:e593. [PMID: 30985088 PMCID: PMC6565596 DOI: 10.1002/mgg3.593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND With expanding use of clinical whole exome sequencing (WES), genetic variants of uncertain significance are increasingly identified. As pathologic mutations in genes associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) carry a risk of sudden death, determining the diagnostic relevance of incidentally identified variants associated with these genes is critical. METHODS WES variants from a large, predominantly pediatric cohort (N = 7,066 probands) were obtained for nine ARVC-associated genes (Baylor Miraca). For comparison, a control cohort was derived from the gnomAD database and an ARVC case cohort (N = 1,379 probands) was established from ARVC cases in the literature. Topologic mapping was performed and signal-to-noise analysis was conducted normalizing WES, or case variants, against control variant frequencies. Retrospective chart review was performed of WES cases evaluated clinically (Texas Children's Hospital). RESULTS Incidentally identified variants occurred in 14% of WES referrals and localized to genes which were rare among ARVC cases yet similar to controls. Amino acid-level signal-to-noise analysis of cases demonstrated "pathologic hotspots" localizing to critical domains of PKP2 and DSG2 while WES variants did not. PKP2 ARM7 and ARM8 domains and DSG2 N-terminal cadherin-repeat domains demonstrated high pathogenicity while normalized WES variant frequency was low. Review of clinical data available on WES referrals demonstrated none with evidence of ARVC among variant-positive individuals. CONCLUSIONS Incidentally identified variants are common among pediatric WES testing with gene frequencies similar to "background" variants. Incidentally identified variants are unlikely to be pathologic.
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Affiliation(s)
- Andrew T. Headrick
- Department of Pediatrics, Section of Pediatric CardiologyBaylor College of MedicineHoustonTexas
| | - Jill A. Rosenfeld
- Department of Molecular and Human Genetics and Baylor Genetics LaboratoriesBaylor College of MedicineHoustonTexas
| | - Yaping Yang
- Department of Molecular and Human Genetics and Baylor Genetics LaboratoriesBaylor College of MedicineHoustonTexas
| | - Hari Tunuguntla
- Department of Pediatrics, Section of Pediatric CardiologyBaylor College of MedicineHoustonTexas
| | - Hugh D. Allen
- Department of Pediatrics, Section of Pediatric CardiologyBaylor College of MedicineHoustonTexas
| | - Daniel J. Penny
- Department of Pediatrics, Section of Pediatric CardiologyBaylor College of MedicineHoustonTexas
| | - Jeffrey J. Kim
- Department of Pediatrics, Section of Pediatric CardiologyBaylor College of MedicineHoustonTexas
| | - Andrew P. Landstrom
- Department of Pediatrics, Section of Pediatric CardiologyBaylor College of MedicineHoustonTexas
- Department of Pediatrics, Division of Pediatric CardiologyDuke University School of MedicineDurhamNorth Carolina
- Present address:
Department of Pediatrics, Division of Pediatric CardiologyDuke University School of MedicineDuke University Medical CenterDurhamNorth Carolina
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Elias Neto J, Tonet J, Frank R, Fontaine G. Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) - What We Have Learned after 40 Years of the Diagnosis of This Clinical Entity. Arq Bras Cardiol 2019; 112:91-103. [PMID: 30673021 PMCID: PMC6317628 DOI: 10.5935/abc.20180266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/12/2018] [Indexed: 11/22/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) was initially
recognized as a clinical entity by Fontaine and Marcus, who evaluated a group of
patients with ventricular tachyarrhythmia from a structurally impaired right
ventricle (RV). Since then, there have been significant advances in the
understanding of the pathophysiology, manifestation and clinical progression,
and prognosis of the pathology. The identification of genetic mutations
impairing cardiac desmosomes led to the inclusion of this entity in the
classification of cardiomyopathies. Classically, ARVC/D is an inherited disease
characterized by ventricular arrhythmias, right and / or left ventricular
dysfunction; and fibro-fatty substitution of cardiomyocytes; its identification
can often be challenging, due to heterogeneous clinical presentation, highly
variable intra- and inter-family expressiveness, and incomplete penetrance. In the absence of a gold standard that allows the diagnosis of ARVC/D, several
diagnostic categories were combined and recently reviewed for a higher
diagnostic sensitivity, without compromising the specificity. The finding that
electrical abnormalities, particularly ventricular arrhythmias, usually precede
structural abnormalities is extremely important for risk stratification in
positive genetic members. Among the complementary exams, cardiac magnetic
resonance imaging (CMR) allows the early diagnosis of left ventricular
impairment, even before morpho-functional abnormalities. Risk stratification
remains a major clinical challenge, and antiarrhythmic drugs, catheter ablation
and implantable cardioverter defibrillator are the currently available
therapeutic tools. The disqualification of the sport prevents cases of sudden
death because the effort can trigger not only the electrical instability, but
also the onset and progression of the disease.
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Affiliation(s)
- Jorge Elias Neto
- Vitória Apart Hospital - Serviço de Eletrofisiologia, Serra, ES - Brazil
| | - Joelci Tonet
- 'Unité de Rythmologie de l'Institut de Cardiologie de l'Hôpital Pitié-Salpêtrière, Paris - France
| | - Robert Frank
- 'Unité de Rythmologie de l'Institut de Cardiologie de l'Hôpital Pitié-Salpêtrière, Paris - France
| | - Guy Fontaine
- 'Unité de Rythmologie de l'Institut de Cardiologie de l'Hôpital Pitié-Salpêtrière, Paris - France
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Wang W, James CA, Calkins H. Diagnostic and therapeutic strategies for arrhythmogenic right ventricular dysplasia/cardiomyopathy patient. Europace 2019; 21:9-21. [PMID: 29688316 PMCID: PMC6321962 DOI: 10.1093/europace/euy063] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a rare inherited heart muscle disease characterized by ventricular tachyarrhythmia, predominant right ventricular dysfunction, and sudden cardiac death. Its pathophysiology involves close interaction between genetic mutations and exposure to physical activity. Mutations in genes encoding desmosomal protein are the most common genetic basis. Genetic testing plays important roles in diagnosis and screening of family members. Syncope, palpitation, and lightheadedness are the most common symptoms. The 2010 Task Force Criteria is the standard for diagnosis today. Implantation of a defibrillator in high-risk patients is the only therapy that provides adequate protection against sudden death. Selection of patients who are best candidates for defibrillator implantation is challenging. Exercise restriction is critical in affected individuals and at-risk family members. Antiarrhythmic drugs and ventricular tachycardia ablation are valuable but palliative components of the management. This review focuses on the current diagnostic and therapeutic strategies in ARVD/C and outlines the future area of development in this field.
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Affiliation(s)
- Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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Clinical utility of endomyocardial biopsies in the diagnosis of arrhythmogenic right ventricular cardiomyopathy in children. Pediatr Res 2018; 84:552-557. [PMID: 29976970 DOI: 10.1038/s41390-018-0093-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/30/2018] [Accepted: 06/06/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Histomorphometry of endomyocardial biopsies is one component of arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis, although there is a need for stricter diagnostic criteria for this disease in pediatrics. The clinical utility of biopsy analysis as a component of ARVC diagnosis was evaluated in pediatric patients. METHODS Histomorphometric analysis of fibrofatty infiltrate was completed on pediatric right ventricular endomyocardial biopsy samples. Myocardial replacement by fat and fibrosis was quantified. ARVC diagnosis was established using the 2010 ARVC Task Force criteria, with the biopsy measures compared across various ARVC diagnoses (definite, borderline, possible, or no ARVC). Receiver-operating characteristic (ROC) curve analysis was also completed using biopsy measures. RESULTS The greatest proportion of fat, fibrosis, and myocardial replacement was in the definite ARVC cohort, and was significantly larger than for the other diagnosis cohorts. ROC curve analysis (with the biopsy analysis removed from the diagnostic classification) produced cutoff values of 15 and 25% myocardial replacement, which is lower than current adult diagnosis criteria. CONCLUSION We propose modifications in pediatric major and minor biopsy diagnosis criteria to allow for improved sensitivity. This study suggests that biopsy analysis in children is most significant for subjects with a more severe disease presentation.
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Abstract
Blood, serum and plasma represent accessible sources of data about physiological and pathologic status. In arrhythmogenic cardiomyopathy (ACM), circulating nucleated cells are routinely used for detection of germinal genetic mutations. In addition, different biomarkers have been proposed for diagnostic purposes and for monitoring disease progression, including inflammatory cytokines, markers of myocardial dysfunction and damage, and microRNAs. This review summarizes the current information that can be retrieved from the blood of ACM patients and considers the future prospects. Improvements in current knowledge of circulating factors may provide noninvasive means to simplify and improve the diagnosis, prognosis prediction, and management of ACM patients.
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e210-e271. [PMID: 29084733 DOI: 10.1161/cir.0000000000000548] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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No major role for rare plectin variants in arrhythmogenic right ventricular cardiomyopathy. PLoS One 2018; 13:e0203078. [PMID: 30161220 PMCID: PMC6117038 DOI: 10.1371/journal.pone.0203078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
Aims Likely pathogenic/pathogenic variants in genes encoding desmosomal proteins play an important role in the pathophysiology of arrhythmogenic right ventricular cardiomyopathy (ARVC). However, for a substantial proportion of ARVC patients, the genetic substrate remains unknown. We hypothesized that plectin, a cytolinker protein encoded by the PLEC gene, could play a role in ARVC because it has been proposed to link the desmosomal protein desmoplakin to the cytoskeleton and therefore has a potential function in the desmosomal structure. Methods We screened PLEC in 359 ARVC patients and compared the frequency of rare coding PLEC variants (minor allele frequency [MAF] <0.001) between patients and controls. To assess the frequency of rare variants in the control population, we evaluated the rare coding variants (MAF <0.001) found in the European cohort of the Exome Aggregation Database. We further evaluated plectin localization by immunofluorescence in a subset of patients with and without a PLEC variant. Results Forty ARVC patients carried one or more rare PLEC variants (11%, 40/359). However, rare variants also seem to occur frequently in the control population (18%, 4754/26197 individuals). Nor did we find a difference in the prevalence of rare PLEC variants in ARVC patients with or without a desmosomal likely pathogenic/pathogenic variant (14% versus 8%, respectively). However, immunofluorescence analysis did show decreased plectin junctional localization in myocardial tissue from 5 ARVC patients with PLEC variants. Conclusions Although PLEC has been hypothesized as a promising candidate gene for ARVC, our current study did not show an enrichment of rare PLEC variants in ARVC patients compared to controls and therefore does not support a major role for PLEC in this disorder. Although rare PLEC variants were associated with abnormal localization in cardiac tissue, the confluence of data does not support a role for plectin abnormalities in ARVC development.
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Translating emerging molecular genetic insights into clinical practice in inherited cardiomyopathies. J Mol Med (Berl) 2018; 96:993-1024. [PMID: 30128729 DOI: 10.1007/s00109-018-1685-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/22/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
Abstract
Cardiomyopathies are primarily genetic disorders of the myocardium associated with higher risk of life-threatening cardiac arrhythmias, heart failure, and sudden cardiac death. The evolving knowledge in genomic medicine during the last decade has reshaped our understanding of cardiomyopathies as diseases of multifactorial nature and complex pathophysiology. Genetic testing in cardiomyopathies has subsequently grown from primarily a research tool into an essential clinical evaluation piece with important clinical implications for patients and their families. The purpose of this review is to provide with a contemporary insight into the implications of genetic testing in diagnosis, therapy, and prognosis of patients with inherited cardiomyopathies. Here, we summarize the contemporary knowledge on genotype-phenotype correlations in inherited cardiomyopathies and highlight the recent significant achievements in the field of translational cardiovascular genetics.
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 676] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Sramko M, Hoogendoorn JC, Glashan CA, Zeppenfeld K. Advancement in cardiac imaging for treatment of ventricular arrhythmias in structural heart disease. Europace 2018; 21:383-403. [DOI: 10.1093/europace/euy150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/23/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marek Sramko
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Jarieke C Hoogendoorn
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Claire A Glashan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
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