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Tonelli L, Balla C, Farnè M, Margutti A, Maniscalchi ET, De Feo G, Di Domenico A, De Raffele M, Percesepe A, Uliana V, Barili V, Serra W, Sassone B, Virzì S, De Maria E, Parmeggiani G, Assenza GE, Biagini E, Parisi V, Biffi M, Carinci V, Perugini E, Imbrici P, Ferlini A, Bertini M, Selvatici R, Gualandi F. SCN5A mutation is associated with a higher Shanghai Score in patients with type 1 Brugada ECG pattern. J Cardiovasc Med (Hagerstown) 2023; 24:864-870. [PMID: 37942788 DOI: 10.2459/jcm.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
AIMS Brugada syndrome (BrS) is an inherited arrhythmic disease characterized by a coved ST-segment elevation in the right precordial electrocardiogram leads (type 1 ECG pattern) and is associated with a risk of malignant ventricular arrhythmias and sudden cardiac death. In order to assess the predictive value of the Shanghai Score System for the presence of a SCN5A mutation in clinical practice, we studied a cohort of 125 patients with spontaneous or fever/drug-induced BrS type 1 ECG pattern, variably associated with symptoms and a positive family history. METHODS The Shanghai Score System items were collected for each patient and PR and QRS complex intervals were measured. Patients were genotyped through a next-generation sequencing (NGS) custom panel for the presence of SCN5A mutations and the common SCN5A polymorphism (H558R). RESULTS The total Shanghai Score was higher in SCN5A+ patients than in SCN5A- patients. The 81% of SCN5A+ patients and the 100% of patients with a SCN5A truncating variant exhibit a spontaneous type 1 ECG pattern. A significant increase in PR (P = 0.006) and QRS (P = 0.02) was detected in the SCN5A+ group. The presence of the common H558R polymorphism did not significantly correlate with any of the items of the Shanghai Score, nor with the total score of the system. CONCLUSION Data from our study suggest the usefulness of Shanghai Score collection in clinical practice in order to maximize genetic test appropriateness. Our data further highlight SCN5A mutations as a cause of conduction impairment in BrS patients.
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Affiliation(s)
- Laura Tonelli
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | - Cristina Balla
- Cardiology Department, University Hospital S. Anna Ferrara, Ferrara
| | - Marianna Farnè
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | - Alice Margutti
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | - Eugenia Tiziana Maniscalchi
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | - Gaetano De Feo
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | | | | | - Antonio Percesepe
- Unit of Medical Genetics, University Hospital of Parma, Parma
- Department of Medicine and Surgery, University of Parma, Parma
| | - Vera Uliana
- Unit of Medical Genetics, University Hospital of Parma, Parma
| | - Valeria Barili
- Unit of Medical Genetics, University Hospital of Parma, Parma
| | - Walter Serra
- Unit of Cardiology, University Hospital of Parma, Parma
| | - Biagio Sassone
- Cardiology Division, SS.ma Annunziata Hospital, Department of Emergency, AUSL Ferrara, Cento (Ferrara)
| | - Santo Virzì
- Cardiology Division, SS.ma Annunziata Hospital, Department of Emergency, AUSL Ferrara, Cento (Ferrara)
| | | | - Giulia Parmeggiani
- Medical Genetics Unit, Department of Clinical Pathology, AUSL Romagna, Cesena
| | | | - Elena Biagini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Vanda Parisi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | | | | | - Paola Imbrici
- Department of Pharmacy-Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - Alessandra Ferlini
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | - Matteo Bertini
- Cardiology Department, University Hospital S. Anna Ferrara, Ferrara
| | - Rita Selvatici
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
| | - Francesca Gualandi
- Unit of Medical Genetics, Department of Medical Sciences and Department of Mother and Child, University Hospital S. Anna Ferrara, Ferrara
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Kouranos V, Khattar RS, Okafor J, Ahmed R, Azzu A, Baksi JA, Wechalekar K, Cowie MR, Wells AU, Lüscher TF, Sharma R. Predictors of outcome in a contemporary cardiac sarcoidosis population: Role of brain natriuretic peptide, left ventricular function and myocardial inflammation. Eur J Heart Fail 2023; 25:2287-2298. [PMID: 37877328 DOI: 10.1002/ejhf.3057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
AIMS Cardiac sarcoidosis (CS) is a potentially fatal condition that varies in its clinical presentation. Here, we describe baseline characteristics at presentation along with prognosis and predictors of outcome in a sizable and deeply phenotyped contemporary cohort of CS patients. METHODS AND RESULTS Consecutive CS patients seen at one institution were retrospectively enrolled after undergoing laboratory testing, electrocardiogram, echocardiography, cardiac magnetic resonance (CMR) imaging and 18 F-flourodeoxyglucose positron emission tomography (FDG-PET) at baseline. The composite endpoint consisted of all-cause mortality, aborted sudden cardiac death, major ventricular arrhythmic events, heart failure hospitalization and heart transplantation. A total of 319 CS patients were studied (67% male, 55.4 ± 12 years). During a median follow-up of 2.2 years (range: 1 month-11 years), 8% of patients died, while 33% reached the composite endpoint. The annualized mortality rate was 2.7% and the 5- and 10-year mortality rates were 6.2% and 7.5%, respectively. Multivariate analysis showed serum brain natriuretic peptide (BNP) levels (hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.34-4.31, p = 0.003), CMR left ventricular ejection fraction (LVEF) (HR 0.96, 95% CI 0.94-0.98, p < 0.0001) and maximum standardized uptake value of FDG-PET (HR 1.11, 95% CI 1.04-1.19, p = 0.001) to be independent predictors of outcome. These findings remained robust for different patient subgroups. CONCLUSION Cardiac sarcoidosis is associated with significant morbidity and mortality, particularly in those with cardiac involvement as the first manifestation. Higher BNP levels, lower LVEF and more active myocardial inflammation were independent predictors of outcomes.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Rajdeep S Khattar
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Joseph Okafor
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Raheel Ahmed
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Alessia Azzu
- National Heart & Lung Institute, Imperial College London, London, UK
- Cardiac Magnetic Resonance Imaging Department, Royal Brompton Hospital, London, UK
| | - John Arun Baksi
- National Heart & Lung Institute, Imperial College London, London, UK
- Cardiac Magnetic Resonance Imaging Department, Royal Brompton Hospital, London, UK
| | - Kshama Wechalekar
- National Heart & Lung Institute, Imperial College London, London, UK
- Nuclear Medicine Department, Royal Brompton Hospital, London, UK
| | | | - Athol Umfrey Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Thomas F Lüscher
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
- King's College London, London, UK
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zürich, Switzerland
| | - Rakesh Sharma
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
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Ghafouri P, Taaghi S, Keykhavani A, Bozorgi A, diz AA. Cascade screening can be life-saving: a family with multiple cases of brugada syndrome and sudden cardiac death. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2023. [DOI: 10.1186/s42444-023-00089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
AbstractBrugada syndrome (BrS) may cause a spectrum of symptoms from asymptomatic patients to those who experience cardiac arrest and sudden cardiac death. The diagnosis is confirmed after observation of type I Brugada pattern on the electrocardiogram. Following the diagnosis, risk stratification can help select therapeutic options. Cascade screening should be started to find other family members with BrS. We present a 41-year-old woman diagnosed with BrS, and cascade screening of her relatives unveiled a pedigree of BrS among their family.
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Zhou N, Gong J, Liang X, Liu W, Li H, Li W. Preoperative Risk Prediction Score for and In-Hospital Clinical Outcomes of Reperfusion Ventricular Fibrillation After Release of Aortic Cross-Clamps: A Retrospective Study. J Cardiothorac Vasc Anesth 2023; 37:127-134. [PMID: 36331419 DOI: 10.1053/j.jvca.2022.09.091] [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: 06/09/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022]
Abstract
Reperfusion ventricular fibrillation (VF) is a common arrhythmia after cardiac surgery. Predictors of reperfusion VF and its relationships with the adverse prognosis are still unclear. This study aimed to identify a risk score model to predict reperfusion VF and its effect on in-hospital outcomes. The authors enrolled 1,024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. A novel risk score model was developed following logistic regression analysis of the predictors of reperfusion VF. The receiver operating characteristic curve was used to validate this model, and the effect of VF on prognosis was later identified in multivariate or Kaplan-Meier analyses. Risk factors for reperfusion VF occurrence included weight >55 kg, preoperative left ventricular ejection fraction <50%, prior stroke, hypertension, aortic valve replacement, HTK solution, and the use of ≥3 grafts in coronary artery bypass grafting. A novel risk score model was developed using the abovementioned variables, and points were assigned to each risk factor according to its odds ratio. A high score (>6) predicted greater than 65% of patients with VF occurrence. Reperfusion VF increased the risk of in-hospital cardiovascular death (p = 0.03) and renal replacement therapy postoperatively (p = 0.022). More attention should be given to reperfusion VF due to an adverse postoperative prognosis, and the developed risk score model may predict this risk.
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Affiliation(s)
- Ning Zhou
- The Sixth Affiliated Hospital of Guangzhou Medical University: Department of Anesthesiology, Qingyuan people's Hospital, Qingyuan City, Guangdong Province, People's Republic of China
| | - Jianping Gong
- The Sixth Affiliated Hospital of Guangzhou Medical University: Department of Anesthesiology, Qingyuan people's Hospital, Qingyuan City, Guangdong Province, People's Republic of China
| | - XiuSheng Liang
- The Sixth Affiliated Hospital of Guangzhou Medical University: Department of Anesthesiology, Qingyuan people's Hospital, Qingyuan City, Guangdong Province, People's Republic of China
| | - Weihua Liu
- The Sixth Affiliated Hospital of Guangzhou Medical University: Department of Anesthesiology, Qingyuan people's Hospital, Qingyuan City, Guangdong Province, People's Republic of China
| | - Heng Li
- The Sixth Affiliated Hospital of Guangzhou Medical University: Department of Anesthesiology, Qingyuan people's Hospital, Qingyuan City, Guangdong Province, People's Republic of China
| | - Weichao Li
- The Sixth Affiliated Hospital of Guangzhou Medical University: Department of Anesthesiology, Qingyuan people's Hospital, Qingyuan City, Guangdong Province, People's Republic of China.
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5
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Mazzanti A, Trancuccio A, Priori SG. Programmed electrophysiological stimulation for risk prediction in patients with Brugada syndrome: closing time? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:545-547. [PMID: 34972648 DOI: 10.1016/j.rec.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Andrea Mazzanti
- Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN Guard-Heart); Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Alessandro Trancuccio
- Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy; Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Silvia G Priori
- Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN Guard-Heart); Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Mene-Afejuku TO, Bamgboje AO, Ogunniyi MO, Akinboboye O, Ibebuogu UN. Ventricular Arrhythmias in Seniors with Heart Failure: Present Dilemmas and Therapeutic Considerations: A Systematic Review. Curr Cardiol Rev 2022; 18:e181021197279. [PMID: 34666644 PMCID: PMC9413729 DOI: 10.2174/1573403x17666211018095324] [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: 01/05/2021] [Revised: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart Failure (HF) is a global public health problem, which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular Arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate the factors associated with VAs among seniors with HF, as well as therapies that may improve the outcomes. METHODS PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific keywords. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes. RESULTS The prevalence of VAs increases with worsening HF. A 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable Cardiac Defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline-Directed Medical Therapy (GDMT) together with device therapy may be required to reduce symptoms. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in selected patients. CONCLUSION Seniors with HF and VAs have high mortality even with the use of device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options are, therefore, required.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, Mayo Clinic Health System, Mankato, 1025 Marsh St, Mankato, MN 56001, USA.,Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Abayomi O Bamgboje
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, NY, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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7
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Mazzanti A, Trancuccio A, Priori SG. La estimulación eléctrica programada para la predicción del riesgo en pacientes con síndrome de Brugada: ¿tiempo de cierre? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Bartolucci C, Fabbri C, Tomasi C, Sabbatani P, Severi S, Corsi C. Computational Analysis of Mapping Catheter Geometry and Contact Quality Effects on Rotor Detection in Atrial Fibrillation. Front Physiol 2021; 12:732161. [PMID: 34955872 PMCID: PMC8696082 DOI: 10.3389/fphys.2021.732161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and catheter mapping has been proved to be an effective approach for detecting AF drivers to be targeted by ablation. Among drivers, the so-called rotors have gained the most attention: their identification and spatial location could help to understand which patient-specific mechanisms are acting, and thus to guide the ablation execution. Since rotor detection by multi-electrode catheters may be influenced by several structural parameters including inter-electrode spacing, catheter coverage, and endocardium-catheter distance, in this study we proposed a tool for testing the ability of different catheter shapes to detect rotors in different conditions. An approach based on the solution of the monodomain equations coupled with a modified Courtemanche ionic atrial model, that considers an electrical remodeling, was applied to simulate spiral wave dynamics on a 2D model for 7.75 s. The developed framework allowed the acquisition of unipolar signals at 2 KHz. Two high-density multipolar catheters were simulated (Advisor™ HD Grid and PentaRay®) and placed in a 2D region in which the simulated spiral wave persists longer. The configuration of the catheters was then modified by changing the number of electrodes, inter-electrodes distance, position, and atrial-wall distance for assessing how they would affect the rotor detection. In contact with the wall and at 1 mm distance from it, all the configurations detected the rotor correctly, irrespective of geometry, coverage, and inter-electrode distance. In the HDGrid-like geometry, the increase of the inter-electrode distance from 3 to 6 mm caused rotor detection failure at 2 mm distance from the LA wall. In the PentaRay-like configuration, regardless of inter-electrode distance, rotor detection failed at 3 mm endocardium-catheter distance. The asymmetry of this catheter resulted in rotation-dependent rotor detection. To conclude, the computational framework we developed is based on realistic catheter shapes designed with parameter configurations which resemble clinical settings. Results showed it is well suited to investigate how mapping catheter geometry and location affect AF driver detection, therefore it is a reliable tool to design and test new mapping catheters.
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Affiliation(s)
- Chiara Bartolucci
- Computational Physiopathology Unit, Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Claudio Fabbri
- Computational Physiopathology Unit, Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Corrado Tomasi
- Electrophysiology Laboratory, Cardiology Unit, Ravenna and Cesena Hospitals, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Paolo Sabbatani
- Electrophysiology Laboratory, Cardiology Unit, Ravenna and Cesena Hospitals, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Stefano Severi
- Computational Physiopathology Unit, Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Cristiana Corsi
- Computational Physiopathology Unit, Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
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Tong L, Zhao C, Fu Z, Dong R, Wu Z, Wang Z, Zhang N, Wang X, Cao B, Sun Y, Zheng D, Xia L, Deng D. Preliminary Study: Learning the Impact of Simulation Time on Reentry Location and Morphology Induced by Personalized Cardiac Modeling. Front Physiol 2021; 12:733500. [PMID: 35002750 PMCID: PMC8739986 DOI: 10.3389/fphys.2021.733500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Personalized cardiac modeling is widely used for studying the mechanisms of cardiac arrythmias. Due to the high demanding of computational resource of modeling, the arrhythmias induced in the models are usually simulated for just a few seconds. In clinic, it is common that arrhythmias last for more than several minutes and the morphologies of reentries are not always stable, so it is not clear that whether the simulation of arrythmias for just a few seconds is long enough to match the arrhythmias detected in patients. This study aimed to observe how long simulation of the induced arrhythmias in the personalized cardiac models is sufficient to match the arrhythmias detected in patients. A total of 5 contrast enhanced MRI datasets of patient hearts with myocardial infarction were used in this study. Then, a classification method based on Gaussian mixture model was used to detect the infarct tissue. For each reentry, 3 s and 10 s were simulated. The characteristics of each reentry simulated for different duration were studied. Reentries were induced in all 5 ventricular models and sustained reentries were induced at 39 stimulation sites in the model. By analyzing the simulation results, we found that 41% of the sustained reentries in the 3 s simulation group terminated in the longer simulation groups (10 s). The second finding in our simulation was that only 23.1% of the sustained reentries in the 3 s simulation did not change location and morphology in the extended 10 s simulation. The third finding was that 35.9% reentries were stable in the 3 s simulation and should be extended for the simulation time. The fourth finding was that the simulation results in 10 s simulation matched better with the clinical measurements than the 3 s simulation. It was shown that 10 s simulation was sufficient to make simulation results stable. The findings of this study not only improve the simulation accuracy, but also reduce the unnecessary simulation time to achieve the optimal use of computer resources to improve the simulation efficiency and shorten the simulation time to meet the time node requirements of clinical operation on patients.
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Affiliation(s)
- Lv Tong
- School of Biomedical Engineering, Dalian University of Technology, Dalian, China
| | - Caiming Zhao
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenyin Fu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ruiqing Dong
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhenghong Wu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xinlu Wang
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Boyang Cao
- School of Biomedical Engineering, Dalian University of Technology, Dalian, China
| | - Yutong Sun
- School of Biomedical Engineering, Dalian University of Technology, Dalian, China
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, Coventry, United Kingdom
| | - Ling Xia
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Dongdong Deng
- School of Biomedical Engineering, Dalian University of Technology, Dalian, China
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10
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Dunn AJ, ElRefai MH, Roberts PR, Coniglio S, Wiles BM, Zemkoho AB. Deep learning methods for screening patients' S-ICD implantation eligibility. Artif Intell Med 2021; 119:102139. [PMID: 34531008 DOI: 10.1016/j.artmed.2021.102139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
Subcutaneous Implantable Cardioverter-Defibrillators (S-ICDs) are used for prevention of sudden cardiac death triggered by ventricular arrhythmias. T Wave Over Sensing (TWOS) is an inherent risk with S-ICDs which can lead to inappropriate shocks. A major predictor of TWOS is a high T:R ratio (the ratio between the amplitudes of the T and R waves). Currently, patients' Electrocardiograms (ECGs) are screened over 10 s to measure the T:R ratio to determine the patients' eligibility for S-ICD implantation. Due to temporal variations in the T:R ratio, 10 s is not a long enough window to reliably determine the normal values of a patient's T:R ratio. In this paper, we develop a convolutional neural network (CNN) based model utilising phase space reconstruction matrices to predict T:R ratios from 10-second ECG segments without explicitly locating the R or T waves, thus avoiding the issue of TWOS. This tool can be used to automatically screen patients over a much longer period and provide an in-depth description of the behavior of the T:R ratio over that period. The tool can also enable much more reliable and descriptive screenings to better assess patients' eligibility for S-ICD implantation.
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Affiliation(s)
- Anthony J Dunn
- University of Southampton, School of Mathematical Sciences, United Kingdom
| | | | | | - Stefano Coniglio
- University of Southampton, School of Mathematical Sciences, United Kingdom
| | - Benedict M Wiles
- St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Alain B Zemkoho
- University of Southampton, School of Mathematical Sciences, United Kingdom.
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11
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Frydensberg VS, Johansen JB, Möller S, Riahi S, Wehberg S, Haarbo J, Philbert BT, Jørgensen OD, Larsen ML, Nielsen JC, Pedersen SS. Anxiety and depression symptoms in Danish patients with an implantable cardioverter-defibrillator: prevalence and association with indication and sex up to 2 years of follow-up (data from the national DEFIB-WOMEN study). Europace 2021; 22:1830-1840. [PMID: 33106878 DOI: 10.1093/europace/euaa176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/02/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate (i) the prevalence of anxiety and depression and (ii) the association between indication for implantable cardioverter-defibrillator (ICD) implantation and sex in relation to anxiety and depression up to 24 months' follow-up. METHODS AND RESULTS Patients with a first-time ICD, participating in the national, multi-centre, prospective DEFIB-WOMEN study (n = 1496; 18% women) completed the Hospital Anxiety and Depression Scale at baseline, 3, 6, 12, and 24 months. Data were analysed using linear mixed modelling for longitudinal data. Patients with a secondary prophylactic indication (SPI) had higher mean anxiety scores than patients with a primary prophylactic indication (PPI) at baseline, 3, and 12 months and higher mean depression scores at all-time points, except at 24 months. Women had higher mean anxiety scores as compared to men at all-time points; however, only higher mean depression scores at baseline. Overall, women with SPI had higher anxiety and depression symptom scores than men with SPI. Symptoms decreased over time in both women and men. From baseline to follow-up, the prevalence of anxiety (score ≥8) was highest in patients with SPI (13.3-20.2%) as compared to patients with PPI (range 10.0-14.7%). The prevalence of depression was stable over the follow-up period in both groups (range 8.5-11.1%). CONCLUSION Patients with a SPI reported higher anxiety and depression scores as compared to patients with PPI. Women reported higher anxiety scores than men, but only higher depression scores at baseline. Women with SPI reported the highest anxiety and depression scores overall.
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Affiliation(s)
- Vivi Skibdal Frydensberg
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sonja Wehberg
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Dan Jørgensen
- Department of Heart Lung & Vascular Surgery, Odense University Hospital, Odense, Denmark
| | | | | | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
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12
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Vitali F, Brieda A, Balla C, Pavasini R, Tonet E, Serenelli M, Ferrari R, Delise P, Rapezzi C, Bertini M. Standard ECG in Brugada Syndrome as a Marker of Prognosis: From Risk Stratification to Pathophysiological Insights. J Am Heart Assoc 2021; 10:e020767. [PMID: 33977759 PMCID: PMC8200706 DOI: 10.1161/jaha.121.020767] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The 12‐lead ECG plays a key role in the diagnosis of Brugada syndrome (BrS). Since the spontaneous type 1 ECG pattern was first described, several other ECG signs have been linked to arrhythmic risk, but results are conflicting. Methods and Results We performed a systematic review to clarify the associations of these specific ECG signs with the risk of syncope, sudden death, or equivalents in patients with BrS. The literature search identified 29 eligible articles comprising overall 5731 patients. The ECG findings associated with an incremental risk of syncope, sudden death, or equivalents (hazard ratio ranging from 1.1–39) were the following: localization of type 1 Brugada pattern (in V2 and peripheral leads), first‐degree atrioventricular block, atrial fibrillation, fragmented QRS, QRS duration >120 ms, R wave in lead aVR, S wave in L1 (≥40 ms, amplitude ≥0.1 mV, area ≥1 mm2), early repolarization pattern in inferolateral leads, ST‐segment depression, T‐wave alternans, dispersion of repolarization, and Tzou criteria. Conclusions At least 12 features of standard ECG are associated with a higher risk of sudden death in BrS. A multiparametric risk assessment approach based on ECG parameters associated with clinical and genetic findings could help improve current risk stratification scores of patients with BrS and warrants further investigation. Registration URL: https://www.crd.york.ac.uk/prospero/. Unique identifier: CRD42019123794.
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Affiliation(s)
| | | | | | | | | | | | - Roberto Ferrari
- Cardiological Center University of Ferrara Italy.,Cardiology Unit Maria Cecilia HospitalGruppo Villa Maria Care & Research Ravenna Italy
| | | | - Claudio Rapezzi
- Cardiological Center University of Ferrara Italy.,Cardiology Unit Maria Cecilia HospitalGruppo Villa Maria Care & Research Ravenna Italy
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13
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Paliakaitė B, Petrėnas A, Sološenko A, Marozas V. Modeling of artifacts in the wrist photoplethysmogram: Application to the detection of life-threatening arrhythmias. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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Brazile T, Mulukutla S, Thoma F, Estes NAM, Jain S, Saba S. Inverse association of mortality and body mass index in patients with left ventricular systolic dysfunction of both ischemic and non-ischemic etiologies. Clin Cardiol 2021; 44:495-500. [PMID: 33675050 PMCID: PMC8027570 DOI: 10.1002/clc.23556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and outcomes, the 'obesity paradox', in several diseases. HYPOTHESIS We sought to evaluate whether the obesity paradox is present in patients with left ventricular systolic dysfunction (LVSD) of all etiologies, using all-cause mortality as the primary endpoint and hospitalization as the secondary endpoint. METHODS We conducted a retrospective cohort study of LVSD patients (n = 18 003) seen within the University of Pittsburgh Medical Center network between January 2011 and December 2017. Patients were divided into four BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): <20%, 20-35%, and 35-50%. RESULTS Over a median follow-up of 2.28 years, higher BMI (mean 28.9 ± 6.8) was associated with better survival for the overall cohort and within LVEF strata (p < .0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and prior myocardial infarction are independent predictors of death. CONCLUSIONS Our results support the existence of an obesity paradox impacting all-cause mortality in patients with LVSD of ischemic and non-ischemic etiologies even after adjusting for LVEF and comorbidities. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of LVSD is established.
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Affiliation(s)
- Tiffany Brazile
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Suresh Mulukutla
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Floyd Thoma
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - N. A. Mark Estes
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Sandeep Jain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Samir Saba
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
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15
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Steijns F, Tóth MI, Demolder A, Larsen LE, Desloovere J, Renard M, Raedt R, Segers P, De Backer J, Sips P. Ambulatory Electrocardiographic Monitoring and Ectopic Beat Detection in Conscious Mice. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3867. [PMID: 32664419 PMCID: PMC7412233 DOI: 10.3390/s20143867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 12/26/2022]
Abstract
Ambulatory electrocardiography (AECG) is a primary diagnostic tool in patients with potential arrhythmic disorders. To study the pathophysiological mechanisms of arrhythmic disorders, mouse models are widely implemented. The use of a technique similar to AECG for mice is thus of great relevance. We have optimized a protocol which allows qualitative, long-term ECG data recording in conscious, freely moving mice. Automated algorithms were developed to efficiently process the large amount of data and calculate the average heart rate (HR), the mean peak-to-peak interval and heart rate variability (HRV) based on peak detection. Ectopic beats are automatically detected based on aberrant peak intervals. As we have incorporated a multiple lead configuration in our ECG set-up, the nature and origin of the suggested ectopic beats can be analyzed in detail. The protocol and analysis tools presented here are promising tools for studies which require detailed, long-term ECG characterization in mouse models with potential arrhythmic disorders.
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Affiliation(s)
- Felke Steijns
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.)
| | - Máté I. Tóth
- Institute Biomedical Technology, Ghent University, 9000 Ghent, Belgium; (M.I.T.); (L.E.L.); (P.S.)
| | - Anthony Demolder
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (A.D.); (J.D.B.)
| | - Lars E. Larsen
- Institute Biomedical Technology, Ghent University, 9000 Ghent, Belgium; (M.I.T.); (L.E.L.); (P.S.)
- 4BRAIN, Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (J.D.); (R.R.)
| | - Jana Desloovere
- 4BRAIN, Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (J.D.); (R.R.)
| | - Marjolijn Renard
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.)
| | - Robrecht Raedt
- 4BRAIN, Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (J.D.); (R.R.)
| | - Patrick Segers
- Institute Biomedical Technology, Ghent University, 9000 Ghent, Belgium; (M.I.T.); (L.E.L.); (P.S.)
| | - Julie De Backer
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (A.D.); (J.D.B.)
| | - Patrick Sips
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.)
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16
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Castro Junior RLD, Lima NDA, Vitorino SS. Brugada Pattern Mimicking Myocardial Acute Infarct. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i1.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Brugada syndrome (BrS) has been described as an arrhythmic disorder characterized by ST elevation with successive negative T wave in the right precordial leads. Patients are at risk for sudden cardiac death (SCD) due to ventricular fibrillation (VF). This specific electrocardiogram (ECG) pattern can sometimes be confused with ST elevation myocardial ischemia. This report shows a patient who presented with chest pain and had an ECG compatible with Brugada. An ischemic workup was performed, and acute coronary syndrome was ruled out. He had a final diagnosis of BrS and was discharged home after the placement of an automatic defibrillator.
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17
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Abstract
This article reviews treatment and management of common cardiovascular emergencies in critically ill patients, focusing on acute decompensated heart failure, cardiogenic shock, pulmonary embolism, and hypertensive crisis management with inotropes, vasopressors, diuretics, and antiarrhythmic drugs. Clinicians frequently come across challenging clinical scenarios, and there is a gap between evidence-based medicine and clinical practice. Inotropic and vasopressor agents are useful in the acute setting but must be weaned off or used as a bridge for mechanical circulation support devices. Clinicians should aim to lower complications by choosing medications with respect to comorbidities and close the gap between evidence-based medicine and clinical practice.
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Affiliation(s)
- Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Rakushumimarika Harada
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Michinari Hieda
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, 7232 Greenville Avenue, Dallas, TX 75231, USA.
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18
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Mechanick JI, Farkouh ME, Newman JD, Garvey WT. Cardiometabolic-Based Chronic Disease, Addressing Knowledge and Clinical Practice Gaps: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:539-555. [PMID: 32029137 PMCID: PMC8168371 DOI: 10.1016/j.jacc.2019.11.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
Abstract
In the second part of this JACC State-of-the-Art Review, an early and sustainable preventive care plan is described for cardiometabolic-based chronic disease. This plan can improve cardiometabolic health by targeting early mechanistic events to decrease the risk for certain cardiovascular diseases (e.g., coronary heart disease, heart failure, and atrial fibrillation). Included are various prevention modalities, intensive lifestyle interventions, pharmacotherapy and cardiovascular outcome trial evidence, and bariatric/metabolic procedures. A tactical approach of implementing published clinical practice guidelines/algorithms for early behavioral, adiposity, and dysglycemia targeting is emphasized, as well as relevant educational and research implications.
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Affiliation(s)
- Jeffrey I Mechanick
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D Newman
- Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York
| | - W Timothy Garvey
- Department of Nutrition Sciences and Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama; Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
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19
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Kiuchi MG, Ho JK, Nolde JM, Gavidia LML, Carnagarin R, Matthews VB, Schlaich MP. Sympathetic Activation in Hypertensive Chronic Kidney Disease - A Stimulus for Cardiac Arrhythmias and Sudden Cardiac Death? Front Physiol 2020; 10:1546. [PMID: 32009970 PMCID: PMC6974800 DOI: 10.3389/fphys.2019.01546] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Studies have revealed a robust and independent correlation between chronic kidney disease (CKD) and cardiovascular (CV) events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse CV events, including malignant ventricular arrhythmias and sudden cardiac death (SCD). Moreover, other studies point out that cardiac structural and electrophysiological changes are a common occurrence in this population. These processes are likely contributors to the heightened hazard of arrhythmias in CKD population and may be useful indicators to detect patients who are at a higher SCD risk. Sympathetic overactivity is associated with increased CV risk, specifically in the population with CKD, and it is a central feature of the hypertensive state, occurring early in its clinical course. Sympathetic hyperactivity is already evident at the earliest clinical stage of CKD and is directly related to the progression of renal failure, being most pronounced in those with end-stage renal disease. Sympathetic efferent and afferent neural activity in kidney failure is a crucial facilitator for the perpetuation and evolvement of the disease. Here, we will revisit the role of the feedback loop of the sympathetic neural cycle in the context of CKD and how it may aggravate several of the risk factors responsible for causing SCD. Targeting the overactive sympathetic nervous system therapeutically, either pharmacologically or with newly available device-based approaches, may prove to be a pivotal intervention to curb the substantial burden of cardiac arrhythmias and SCD in the high-risk population of patients with CKD.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Janis Marc Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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20
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Hess PL, Matlock DD, Al-Khatib SM. Decision-making regarding primary prevention implantable cardioverter-defibrillators among older adults. Clin Cardiol 2019; 43:187-195. [PMID: 31867773 PMCID: PMC7021655 DOI: 10.1002/clc.23315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 11/12/2022] Open
Abstract
Most implantable cardioverter defibrillators (ICDs) are implanted for the purpose of primary prevention of sudden cardiac death among older patients with heart failure with reduced ejection fraction. Shared decision‐making prior to device implantation is guideline‐recommended and payer‐mandated. This article summarizes patient and provider attitudes toward device placement, device efficacy and effectiveness, potential periprocedural complications, long‐term events such as shocks, quality of life, costs, and shared decision‐making principles and recommendations. Most patients eligible for an ICD anticipate more than 10 years of survival. Physicians are less likely to offer an ICD to patients ≥80 years of age given a perceived lack of benefit. There is a dearth of data from randomized clinical trials addressing device efficacy among older patients; there is a need for more research in this area. However, currently available data support the use of ICDs irrespective of age provided life expectancy exceeds 1 year. Advanced age is independently associated with complications at the time of device placement but not the risk of device infection. The risk of inappropriate shock may be comparable or lower than that of younger patients. While quality of life is generally not adversely impacted by an ICD, a subset of patients experience post‐traumatic stress disorder. ICDs are cost‐effective from societal and health care sector perspectives; however, out‐of‐pocket costs vary according to insurance type and level. Shared decision‐making encounters may be incremental and iterative in nature. Providers are encouraged to partner with their patients, providing them counsel tailored to their values, preferences, and clinical presentation inclusive of age.
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Affiliation(s)
- Paul L Hess
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Cardiology Section, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel D Matlock
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Cardiology Section, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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21
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Amin M, Kella D, Killu AM, Padmanabhan D, Hodge DO, Golafshar MA, Chamberlain AM, Lee JZ, Shen WK, Friedman PA, Asirvatham SJ, Roger VL, Gersh BJ, Mulpuru SK. Sudden cardiac arrest and ventricular arrhythmias following first type I myocardial infarction in the contemporary era. J Cardiovasc Electrophysiol 2019; 30:2869-2876. [PMID: 31588605 DOI: 10.1111/jce.14218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/18/2019] [Accepted: 10/02/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Myocardial infarction (MI) is associated with an increase in subsequent heart failure (HF), recurrent ischemic events, sudden cardiac arrest, and ventricular arrhythmias (SCA-VA). The primary objective of the study to determine the role of intercurrent HF and ischemic events on the development of SCA-VA following first type I MI. METHODS AND RESULTS A retrospective cohort study of patients experiencing first type 1 MI in Olmsted County, Minnesota (2002-2012) was conducted by identifying patients using the medical records linkage system (Rochester epidemiology project). Patients aged ≥18 years were followed from the time of MI till death or 31 July, 2017. Intercurrent HF and ischemic events were the primary exposures following MI and their association with outcome SCA-VA was assessed. Eight hundred and sixty-seven patients (mean age was 63 ± 14.5 years; 69% male; 49.8% ST-elevation myocardial infarction) who had their first type I MI during the study period were included. Majority of acute MI patients were revascularized using percutaneous coronary intervention and bypass surgery (628 [72.43%] and 87 [10.03%] respectively). During a mean follow-up of 7.69 ± 4.17 years, HF, recurrent ischemic events and SCA-VA occurred in 155 (17.9%), 245 (28.3%), and 40 (4.61%) patients respectively. Low ejection fraction (adjusted hazard ratio [HR] 0.95; 95% confidence interval [CI], 0.93-0.98; P < .001), intercurrent HF (adjusted HR 3.11; 95% CI, 1.39-6.95; P = .006) and recurrent ischemic events (adjusted HR 3.47; 95% CI, 1.68-7.18; P < .001) were associated with subsequent SCA-VA. CONCLUSION SCA-VA occurred in a small proportion of patients after MI and is associated with intercurrent HF and recurrent ischemic events.
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Affiliation(s)
- Mustapha Amin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Danesh Kella
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Deepak Padmanabhan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Department of Statistics, Mayo Clinic, Jacksonville, Florida
| | | | - Alanna M Chamberlain
- Department of Epidemiology, Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Justin Z Lee
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Véronique L Roger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Epidemiology, Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Bernard J Gersh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
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22
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Sandhu A, Levy A, Varosy PD, Matlock D. Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Older Adults With Heart Failure. J Am Geriatr Soc 2019; 67:2193-2199. [PMID: 31403714 DOI: 10.1111/jgs.16099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/04/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are cardiac implantable electronic devices that may improve morbidity and mortality in select patients with heart failure. Although the benefits of these devices have been well defined, competing mortality risks, comorbid conditions, and frailty pose difficulty in determining risk-benefit trade-offs when these options are considered for older adults. CONCLUSION In this review, we focus on the benefit, risk, and use of ICD and CRT in older adults, particularly because the goals of care for many older adults include a shift away from life-prolonging interventions. Additionally, we discuss periprocedural risk, cost, and maintenance in older populations. Finally, we introduce a framework for helping clinicians and older adults make these challenging decisions collectively. J Am Geriatr Soc 67:2193-2199, 2019.
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Affiliation(s)
- Amneet Sandhu
- Section of Electrophysiology, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.,Section of Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrew Levy
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul D Varosy
- Section of Electrophysiology, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.,Section of Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Veterans Affairs (VA) Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado.,Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado
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23
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Abbas H, Roomi S, Ullah W, Ahmad A, Gajanan G. Brugada pattern: a comprehensive review on the demographic and clinical spectrum. BMJ Case Rep 2019; 12:12/7/e229829. [PMID: 31300599 DOI: 10.1136/bcr-2019-229829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A prominent coved or saddle-shaped ST-segment elevation followed by T wave changes in V1-V3 and in the absence of other identifiable cause is termed as Brugada pattern. This pattern in the presence of documented ventricular arrhythmias or its symptoms (syncope, seizure) or significant family for sudden cardiac death or abovementioned ECG changes is called Brugada syndrome. Here we present a comprehensive literature review on the precipitation factors of Brugada syndrome/pattern by various stimuli, its presentation, associations, management and outcomes. We are also presenting a unique case of Brugada pattern where the patient's Brugada pattern was unmasked at an extreme old age by infection.
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Affiliation(s)
- Hassan Abbas
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Asrar Ahmad
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Ganesh Gajanan
- Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
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24
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Levine GN, O’Gara PT, Beckman JA, Al-Khatib SM, Birtcher KK, Cigarroa JE, de las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Hlatky MA, Joglar JA, Piano MR, Wijeysundera DN. Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies. J Am Coll Cardiol 2019; 73:1990-1998. [DOI: 10.1016/j.jacc.2019.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Romero J, Li DL, Avendano R, Diaz JC, Tung R, Di Biase L. Brugada Syndrome: Progress in Genetics, Risk Stratification and Management. Arrhythm Electrophysiol Rev 2019; 8:19-27. [PMID: 30918663 PMCID: PMC6434506 DOI: 10.15420/aer.2018.66.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Brugada syndrome (BrS) is one of the most common causes of sudden cardiac death in normal structural heart individuals. First characterised in 1992, the global prevalence of BrS is unclear, with estimates placing it at around 0.05% and presenting most frequently in southeast Asian countries. This review aims to summarise the development in the understanding of BrS and, importantly, progress in its management, underpinned by knowledge regarding its genetics and molecular mechanisms. It also provides update on risk stratification and promising new therapies for BrS, including epicardial ablation. Future studies are required to increase understanding of the pathogenesis of this disease and to guide clinical practice.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Dan L Li
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center Nashville, TN, US
| | - Ricardo Avendano
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine New Haven, CT, US
| | - Juan Carlos Diaz
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Roderick Tung
- University of Chicago, School of Medicine Chicago, IL, US
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
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26
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Coscarella M, Motte S, Dalati MF, Oliveira-E-Silva T, Entezari K, Roumeguere T. New oral anti-coagulation drugs and prostate biopsy: a call for guidelines. Ther Adv Urol 2018; 10:437-443. [PMID: 30574204 PMCID: PMC6295786 DOI: 10.1177/1756287218811037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/11/2018] [Indexed: 01/14/2023] Open
Abstract
Background: Prostate biopsy is a rather frequent procedure, mostly performed in outpatient settings. Bleeding complications following this procedure require precise and delicate management of pre-, peri- and post-procedure anti-coagulation treatments. New oral anti-coagulation drugs (NOACs) are increasingly used. However, the management of such treatments is feared and not yet well known to urologists. A protocol for prostate biopsy management of NOACs seems mandatory. Materials and methods: A review of the literature, using Pubmed and Cochrane databases, together with analysis of several medical associations’ recommendations in urology, anaesthesiology, cardiology, oncology and drug safety agency, was performed. Results: There are no recommendations about NOAC management for prostate biopsy available from scientific societies. There is also a lack of specific urological studies. However, several panels of expert recommendations could be helpful in establishing standardized protocols adapted from surgery to prostate biopsy. With the growing use of NOACs, recommendations have shifted to continue anti-coagulant treatment without bridging NOACs for low bleeding risk procedures such as prostate biopsy, in carefully selected groups of patients. Conclusion: Extensive indications coupled with the ease of use of NOACs contribute significantly to the widespread replacement of traditional vitamin K antagonist. Knowing that heparin bridging leads to more bleeding, and in the pursuit of more autonomy and safety, urologists should be able to propose dedicated anti-coagulant management using NOACs adapted to carefully selected patients before the prostate biopsy procedure. Further studies and guidelines specific to the concept of non-bridging for anti-coagulant-requiring patients are mandatory for this routine procedure.
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Affiliation(s)
- Mathieu Coscarella
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Route de Lennik 808, 1070 Brussels, Belgium Department of Urology, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Motte
- Department of Vascular Diseases, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Mohamad-Fadi Dalati
- Department of Urology, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Tania Oliveira-E-Silva
- Department of Urology, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Kim Entezari
- Department of Urology, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguere
- Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Li X, Yao Y, Chen Z, Fan S, Hua W, Zhang S, Fan X. Thyroid-stimulating hormone within the normal range and risk of major adverse cardiovascular events in nonischemic dilated cardiomyopathy patients with severe left ventricular dysfunction. Clin Cardiol 2018; 42:120-128. [PMID: 30447088 DOI: 10.1002/clc.23117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The association between thyroid-stimulating-hormone (TSH) and prognosis of nonischemic dilated cardiomyopathy (NIDCM) in patients with normal thyroid function remains unclear. HYPOTHESIS Our aim was to investigate the association between TSH and major adverse cardiovascular events in euthyroid NIDCM patients. METHODS The original cohort consisted of 216 consecutive euthyroid NIDCM patients, with left ventricular ejection fraction (LVEF) ≤35%, who were observed from 2010 to 2013. Patients with persistent ventricular arrhythmia (VA) histories, amiodarone taken for VA prevention, or on heart transplant list within 1 year were excluded. A follow-up evaluation was performed, and VA events, heart failure (HF) exacerbation/heart transplant, cardiac death, or death from any cause were separately evaluated. RESULTS A total of 184 patients were enrolled, and 97.8% (180/184) ultimately received follow-up evaluations. During the median 4.6-year follow-up, 24 VA events, 28 cardiac deaths, 30 all-cause deaths, 40 HF exacerbations, and 11 heart transplant events occurred. Serum TSH levels showed good predictive efficacies for VA events (area under the curve [AUC] = 0.702, 95% confidence interval [CI]: 0.629-0.767), and the risk of VA events increased, according to serum TSH quarters, as determined by Kaplan-Meier analysis (2.2% vs 13.4% vs 21.0% vs 30.0%, Q1-Q4, P = 0.011). Multivariable Cox analysis showed that patients at the Q4 level of serum TSH (>2.67 mIU/L) suffered an increased risk of VA events, compared with those at the Q1 level of TSH (hazard ratio [HR] = 15.88, 95% CI: 2.01-65.15) or those at the other three quarters (HR = 3.17, 95% CI: 1.38-7.26). However, the Q4 TSH level was not associated with other adverse cardiac events. CONCLUSION An association between TSH levels and the risk of VA events may exist in euthyroid NIDCM patients.
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Affiliation(s)
- Xiaofei Li
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoran Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyang Fan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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28
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Suarez K, Mack R, Hardegree EL, Chiles C, Banchs JE, Gonzalez MD. Isoproterenol suppresses recurrent torsades de pointes in a patient with long QT syndrome type 2. HeartRhythm Case Rep 2018; 4:576-579. [PMID: 30581736 PMCID: PMC6301889 DOI: 10.1016/j.hrcr.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Keith Suarez
- Division of Cardiology, Department of Medicine, Baylor Scott & White Health, Scott & White Memorial Hospital, Temple, Texas
| | - Ryan Mack
- Division of Cardiology, Department of Medicine, Baylor Scott & White Health, Scott & White Memorial Hospital, Temple, Texas
| | - Evan L Hardegree
- Division of Cardiology, Department of Medicine, Baylor Scott & White Health, Scott & White Memorial Hospital, Temple, Texas
| | - Christopher Chiles
- Division of Cardiology, Department of Medicine, Baylor Scott & White Health, Scott & White Memorial Hospital, Temple, Texas
| | - Javier E Banchs
- Division of Cardiology, Department of Medicine, Baylor Scott & White Health, Scott & White Memorial Hospital, Temple, Texas
| | - Mario D Gonzalez
- Penn State Heart & Vascular Institute, Penn State Hershey Health, Hershey, Pennsylvania
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29
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Yuan M, Tian C, Li X, Yang X, Wang X, Yang Y, Liu N, Kusano KF, Barajas-Martinez H, Hu D, Shang H, Gao Y, Xing Y. Gender Differences in Prognosis and Risk Stratification of Brugada Syndrome: A Pooled Analysis of 4,140 Patients From 24 Clinical Trials. Front Physiol 2018; 9:1127. [PMID: 30246798 PMCID: PMC6113678 DOI: 10.3389/fphys.2018.01127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Male gender has been consistently shown to be a risk factor for a greater number of arrhythmic events in patients with Brugada Syndrome (BrS). However, there have been no large-scale comprehensive pooled analyses to statistically and systematically verify this association. Therefore, we conducted a pooled analysis on gender differences in prognosis and risk stratification of BrS with a largest sample capacity at present. Methods: We searched PubMed, Embase, Medline, Cochrane Library databases, Chinese National Knowledge Infrastructure, and Wanfang Data for relevant studies published from 2002 to 2017. The prognosis and risk stratification of BrS and risk factors were then investigated and evaluated according to gender. Results: Twenty-four eligible studies involving 4,140 patients were included in the analysis. Male patients (78.1%) had a higher risk of arrhythmic events than female patients (95% confidence interval: 1.46–2.91, P < 0.0001). Among the male population, there were statistical differences between symptomatic patients and asymptomatic patients (95% CI: 2.63–7.86, P < 0.00001), but in the female population, no statistical differences were found. In the female subgroup, electrophysiological study (EPS) positive patients had a tendency toward a higher risk of arrhythmic events than EPS-negative patients (95% CI: 0.93–29.77, P = 0.06). Conclusions: Male patients are at a higher risk of arrhythmic events than female patients. Within the male population, symptomatic patients have a significantly higher risk profile compared to asymptomatic patients, but no such differences are evident within the female population. Consequently, in the female population, the risk of asymptomatic patterns cannot be underestimated.
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Affiliation(s)
- Mengchen Yuan
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Chao Tian
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xinye Li
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyu Yang
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaofeng Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yihan Yang
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing An Zhen Hospital of the Capital University of Medical Sciences, Beijing, China
| | - Kengo F Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Dan Hu
- Masonic Medical Research Laboratory, Utica, NY, United States.,Hubei Key Laboratory of Cardiology, Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yonghong Gao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yanwei Xing
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
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30
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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: 692] [Impact Index Per Article: 115.3] [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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Abstract
Case presentation A 47-year-old Caucasian woman with type 1 diabetes presented with epigastric pain and vomiting. She had not been adherent with her diet and insulin therapy for the past 3 weeks. She never had a personal or family history of arrhythmia-related symptoms, ventricular tachycardia or fibrillation (VT/VF) or premature sudden cardiac death (SCD). Examination revealed dry mucosa, tachycardia and epigastric tenderness to palpation. Her ECG showed ST elevations (V1-V3) with associated T wave inversions (figure 1A). A baseline ECG 1 year ago had no abnormalities. Serial troponin I and T were negative, but Creatinine Kinase MB (CKMB) was elevated. Her biochemistry test showed sodium of 118 mM, potassium of 6.7 mM, bicarbonate of 4 mM, anion gap of 40, glucose of 985 mM and beta hydroxyl-butyrate of >45.0 mg/dL. Cardiac catheterisation revealed normal anatomy with all vessels widely patent; left ventricular end diastolic pressure (LVEDP) was 1 mm Hg. With treatment, diabetic ketoacidosis (DKA) resolved after 8 hours and repeat ECG showed all changes had resolved (figure 1B). She was monitored on telemetry without any VT/VF episodes. Serial ECGs were done with resolution of changes. She had no positive studies for inducible VT. The rest of her admission was uneventful.Figure 1(A) ECG on presentation. (B) ECG 8 hours after admission. Question Which of the following is the best next step in managing this patient?Quinidine therapy.Implantable cardioverter-defibrillator (ICD) placement. SCN5A gene mutation testing.Observation without therapy.
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Affiliation(s)
- Christian Abrahim
- Department of Internal Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Satish Maharaj
- Department of Internal Medicine, University of Florida, Jacksonville, Florida, USA
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32
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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. J Am Coll Cardiol 2017; 72:1677-1749. [PMID: 29097294 DOI: 10.1016/j.jacc.2017.10.053] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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