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Dykiert I, Florek K, Kraik K, Gać P, Poręba R, Poręba M. Tpeak-Tend ECG Marker in Obesity and Cardiovascular Diseases: A Comprehensive Review. SCIENTIFICA 2024; 2024:4904508. [PMID: 38962529 PMCID: PMC11221957 DOI: 10.1155/2024/4904508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/13/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
Globally, cardiovascular diseases are still the leading cause of death. Numerous methods are used to diagnose cardiovascular pathologies; there is still a place for straightforward and noninvasive techniques, such as electrocardiogram (ECG). Depolarization and repolarization parameters, including QT interval and its derivatives, are well studied. However, the Tpeak-Tend interval is a novel and promising ECG marker with growing evidence for its potential role in predicting malignant arrhythmias. In this review, we discuss the association between the Tpeak-Tend interval and several cardiovascular diseases, including long QT syndrome, cardiomyopathies, heart failure, myocardial infarction, and obesity, which constitutes one of the risk factors for cardiovascular diseases.
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Affiliation(s)
- Irena Dykiert
- Division of PathophysiologyDepartment of Physiology and PathophysiologyWroclaw Medical University, Wrocław, Poland
| | - Kamila Florek
- Students' Scientific Association of Cardiovascular Diseases PreventionDepartment of Internal and Occupational DiseasesHypertension and Clinical OncologyWroclaw Medical University, Wrocław, Poland
| | - Krzysztof Kraik
- Students' Scientific Association of Cardiovascular Diseases PreventionDepartment of Internal and Occupational DiseasesHypertension and Clinical OncologyWroclaw Medical University, Wrocław, Poland
| | - Paweł Gać
- Division of Environmental Health and Occupational MedicineDepartment of Population HealthWroclaw Medical University, Wrocław, Poland
| | - Rafał Poręba
- Department of Internal and Occupational DiseasesHypertension and Clinical OncologyWroclaw Medical University, Wrocław, Poland
| | - Małgorzata Poręba
- Department of Paralympic SportWroclaw University of Health and Sport Sciences, Wrocław, Poland
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Gajda R, Gajda J, Czuba M, Knechtle B, Drygas W. Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement. Sports Med 2024; 54:1-21. [PMID: 37906426 PMCID: PMC10799155 DOI: 10.1007/s40279-023-01948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
There are countless types of portable heart rate monitoring medical devices used variously by leisure-time exercisers, professional athletes, and chronically ill patients. Almost all the currently used heart rate monitors are capable of detecting arrhythmias, but this feature is not widely known or used among their millions of consumers. The aims of this paper were as follows: (1) to analyze the currently available sports heart rate monitors and assess their advantages and disadvantage in terms of heart rate and rhythm monitoring in endurance athletes; (2) to discuss what types of currently available commercial heart rate monitors are most convenient/adjustable to the needs of different consumers (including occasionally physically active adults and cardiac patients), bearing in mind the potential health risks, especially heart rhythm disturbances connected with endurance training; (3) to suggest a set of "optimal" design features for next-generation smart wearable devices based on the consensus opinion of an expert panel of athletes, coaches, and sports medicine doctors. Ninety-two experts aged 20 years and over, involved in endurance sports on a daily basis, were invited to participate in consensus-building discussions, including 56 long-distance runners, 18 cyclists, nine coaches, and nine physicians (sports medicine specialists, cardiologists, and family medicine doctors). The overall consensus endorsed by these experts indicates that the "optimal" sports heart rate monitor should be a one-piece device of the smartwatch type (with two or more electrodes), with integrated smartphone features, and able to collect and continually transmit data without exhibiting artifacts. It should continuously record at least a single-lead electrocardiography, send an alert after an unexpected fall, be of reasonable weight, come at an affordable price, and be user friendly.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, 06-100, Pułtusk, Poland.
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, Czestochowa, Poland.
| | - Jacek Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, 06-100, Pułtusk, Poland
| | - Miłosz Czuba
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen am Vadianplatz, St. Gallen, Switzerland
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention, and Health Promotion, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
- Lazarski University, Warsaw, Poland
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Pupaza A, Cinteza E, Vasile CM, Nicolescu A, Vatasescu R. Assessment of Sudden Cardiac Death Risk in Pediatric Primary Electrical Disorders: A Comprehensive Overview. Diagnostics (Basel) 2023; 13:3551. [PMID: 38066791 PMCID: PMC10706572 DOI: 10.3390/diagnostics13233551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 06/30/2024] Open
Abstract
Sudden cardiac death (SCD) in children is a devastating event, often linked to primary electrical diseases (PED) of the heart. PEDs, often referred to as channelopathies, are a group of genetic disorders that disrupt the normal ion channel function in cardiac cells, leading to arrhythmias and sudden cardiac death. This paper investigates the unique challenges of risk assessment and stratification for channelopathy-related SCD in pediatric patients-Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, long QT syndrome, Anderson-Tawil syndrome, short QT syndrome, and early repolarization syndrome. We explore the intricate interplay of genetic, clinical, and electrophysiological factors that contribute to the complex nature of these conditions. Recognizing the significance of early identification and tailored management, this paper underscores the need for a comprehensive risk stratification approach specifically designed for pediatric populations. By integrating genetic testing, family history, and advanced electrophysiological evaluation, clinicians can enhance their ability to identify children at the highest risk for SCD, ultimately paving the way for more effective preventive strategies and improved outcomes in this vulnerable patient group.
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Affiliation(s)
- Adelina Pupaza
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Eliza Cinteza
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, 33600 Bordeaux, France;
| | - Alin Nicolescu
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Radu Vatasescu
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 804] [Impact Index Per Article: 402.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Gajda R, Knechtle B, Gębska-Kuczerowska A, Gajda J, Stec S, Krych M, Kwaśniewska M, Drygas W. Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation-The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610367. [PMID: 36012002 PMCID: PMC9408438 DOI: 10.3390/ijerph191610367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 05/14/2023]
Abstract
Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200 Czestochowa, Poland
- Correspondence: ; Tel.: +48-604286030
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
| | - Anita Gębska-Kuczerowska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland
| | - Jacek Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, 38-500 Sanok, Poland
| | - Michalina Krych
- Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | - Magdalena Kwaśniewska
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Wojciech Drygas
- Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
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Zaklyazminskaya E, Polyak M, Shestak A, Sadekova M, Komoliatova V, Kiseleva I, Makarov L, Podolyak D, Glukhov G, Zhang H, Abramochkin D, Sokolova OS. Variable Clinical Appearance of the Kir2.1 Rare Variants in Russian Patients with Long QT Syndrome. Genes (Basel) 2022; 13:genes13040559. [PMID: 35456365 PMCID: PMC9025978 DOI: 10.3390/genes13040559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The KCNJ2 gene encodes inward rectifier Kir2.1 channels, maintaining resting potential and cell excitability. Presumably, clinical phenotypes of mutation carriers correlate with ion permeability defects. Loss-of-function mutations lead to QTc prolongation with variable dysmorphic features, whereas gain-of-function mutations cause short QT syndrome and/or atrial fibrillation. Methods: We screened 210 probands with Long QT syndrome for mutations in the KCNJ2 gene. The electrophysiological study was performed for the p.Val93Ile variant in the transfected CHO-K1 cells. Results: We found three rare genetic variants, p.Arg67Trp, p.Val93Ile, and p.R218Q, in three unrelated LQTS probands. Probands with p.Arg67Trp and p.R218Q had a phenotype typical for Andersen-Tawil (ATS), and the p.Val93Ile carrier had lone QTc prolongation. Variant p.Val93Ile was initially described as a gain-of-function pathogenic mutation causing familial atrial fibrillation. We validated electrophysiological features of this variant in CHO-K1 cells, but no family members of these patients had atrial fibrillation. Using ACMG (2015) criteria, we re-assessed this variant as a variant of unknown significance (class III). Conclusions: LQT7 is a rare form of LQTS in Russia, and accounts for 1% of the LQTS cohort. Variant p.Val93Ile leads to a gain-of-function effect in the different cell lines, but its clinical appearance is not so consistent. The clinical significance of this variant might be overestimated.
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Affiliation(s)
- Elena Zaklyazminskaya
- Medical Genetics Laboratory, B.V. Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (E.Z.); (M.P.); (A.S.); (M.S.); (D.P.)
| | - Margarita Polyak
- Medical Genetics Laboratory, B.V. Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (E.Z.); (M.P.); (A.S.); (M.S.); (D.P.)
| | - Anna Shestak
- Medical Genetics Laboratory, B.V. Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (E.Z.); (M.P.); (A.S.); (M.S.); (D.P.)
| | - Mariam Sadekova
- Medical Genetics Laboratory, B.V. Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (E.Z.); (M.P.); (A.S.); (M.S.); (D.P.)
| | - Vera Komoliatova
- Center for Syncope and Cardiac Arrhythmias in Children and Adolescents, Federal Medical Biological Agency, 115481 Moscow, Russia; (V.K.); (I.K.); (L.M.)
| | - Irina Kiseleva
- Center for Syncope and Cardiac Arrhythmias in Children and Adolescents, Federal Medical Biological Agency, 115481 Moscow, Russia; (V.K.); (I.K.); (L.M.)
| | - Leonid Makarov
- Center for Syncope and Cardiac Arrhythmias in Children and Adolescents, Federal Medical Biological Agency, 115481 Moscow, Russia; (V.K.); (I.K.); (L.M.)
| | - Dmitriy Podolyak
- Medical Genetics Laboratory, B.V. Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (E.Z.); (M.P.); (A.S.); (M.S.); (D.P.)
| | - Grigory Glukhov
- Faculty of Biology, Shenzhen MSU-BIT University, Shenzhen 517182, China; (G.G.); (H.Z.)
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia;
| | - Han Zhang
- Faculty of Biology, Shenzhen MSU-BIT University, Shenzhen 517182, China; (G.G.); (H.Z.)
| | - Denis Abramochkin
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia;
- Laboratory of Cardiac Electrophysiology, National Medical Research Center for Cardiology, 121500 Moscow, Russia
| | - Olga S. Sokolova
- Faculty of Biology, Shenzhen MSU-BIT University, Shenzhen 517182, China; (G.G.); (H.Z.)
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia;
- Correspondence:
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Jin JY, Guo BB, Dong Y, Sheng Y, Fan LL, Zhang LB. Case Report: A Novel CACNA1S Mutation Associated With Hypokalemic Periodic Paralysis in a Chinese Family. Front Genet 2021; 12:743184. [PMID: 34777470 PMCID: PMC8586648 DOI: 10.3389/fgene.2021.743184] [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: 07/17/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Hypokalemic periodic paralysis (HypoPP) is a rare autosomal dominant disorder characterized by episodic flaccid paralysis with concomitant hypokalemia. More than half of patients were associated with mutations in CACNA1S that encodes the alpha-1-subunit of the skeletal muscle L-type voltage-dependent calcium channel. Mutations in CACNA1S may alter the structure of CACNA1S and affect the functions of calcium channels, which damages Ca2+-mediated excitation-contraction coupling. In this research, we identified and described a Chinese HypoPP patient with a novel frameshift mutation in CACNA1S [NM_000069.2: c.1364delA (p.Asn455fs)] by targeted sequencing. This study would expand the spectrum of CACNA1S mutations, further our understanding of HypoPP, and provided a new perspective for selecting effective treatments.
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Affiliation(s)
- Jie-Yuan Jin
- School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China
| | - Bing-Bing Guo
- School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China.,CAS Key Laboratory of Infection and Immunity, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Yi Dong
- School of Life Sciences, Central South University, Changsha, China
| | - Yue Sheng
- School of Life Sciences, Central South University, Changsha, China
| | - Liang-Liang Fan
- School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Li-Bing Zhang
- Department of Pediatrics, Affiliated Hospital of Yangzhou University, Yangzhou, China
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Catheter ablation of frequent monomorphic ventricular arrhythmias in Andersen-Tawil syndrome: case report and focused literature review. J Interv Card Electrophysiol 2021; 66:729-736. [PMID: 34665385 DOI: 10.1007/s10840-021-01077-w] [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: 08/09/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Andersen-Tawil syndrome type 1 is a rare autosomal dominant disease caused by a KCNJ2 gene mutation and clinically characterized by dysmorphic features, periodic muscular paralysis, and frequent ventricular arrhythmias (VAs). Although polymorphic and bidirectional ventricular tachycardias are prevalent, PVCs are the most frequent VAs. In addition, a "dominant" morphology with RBBB pattern associated with either superior or inferior axis is seen in most of the patients. Due to the limited efficacy of most antiarrhythmic drugs, catheter ablation (CA) is an alternative in patients with monomorphic VAs. Based on our experience, we aimed to review the arrhythmogenic mechanisms and substrates for VAs, and we analyzed the potential reasons for CA failure in this group of patients. METHODS Case report and focused literature review. RESULTS Catheter ablation has been reported to be unsuccessful in all of the few cases published so far. Most of the information suggests that VAs are mainly originated from the left ventricle and probably in the Purkinje network. Although identifying well-established and accepted mapping criteria for successful ablation of a monomorphic ventricular arrhythmia, papillary muscles seem not to be the right target. CONCLUSIONS More research is needed to understand better the precise mechanism and site of origin of VAs in Andersen-Tawil syndrome patients with this particular "dominant" monomorphic ventricular pattern to establish the potential role of CA.
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Yilmaz S, Kanat S. Failure of radiofrequency catheter ablation and success of flecainide to suppress premature ventricular contractions in Andersen-Tawil syndrome: A case report. J Electrocardiol 2021; 68:37-40. [PMID: 34311212 DOI: 10.1016/j.jelectrocard.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
This case report presents a 33-year-old woman with premature ventricular contractions (PVCs). Her genetic testing was positive for KCNJ2 missense mutation at chr17:68171832;NM_000891.2. This mutation was compatible with Andersen-Tawil syndrome. We made an electrophysiological study to determine origin of PVCs however at endocardial mapping there was not any focus of PVC and at epicardial mapping we ablated low voltage areas in the inferior segments of both ventricles. She was discharged with flecainide and metoprolol therapy. After 3 months, her PVC burden was significantly decreased at Holter monitoring.
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Affiliation(s)
- Samet Yilmaz
- Cardiology Department, Pamukkale University Hospitals, Pamukkale, Denizli, Turkey.
| | - Selcuk Kanat
- Cardiology Clinic, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Abstract
This chapter describes what a channelopathy is and how mutations in the genes result in different types of clinical abnormalities. It provides a description of common types of cardiac channelopathies with examples of how there are some areas of overlap with sensory-neuromuscular channelopathies. We describe the cardiac channelopathies of Jervell and Lange-Nielson syndrome, Andersen-Tawil syndrome, Timothy syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, and sinoatrial node dysfunction and deafness. We also discuss sudden unexpected death in epilepsy and how it could relate to some cardiac channelopathies.
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Dolci C, Sansone VA, Gibelli D, Cappella A, Sforza C. Distinctive facial features in Andersen-Tawil syndrome: A three-dimensional stereophotogrammetric analysis. Am J Med Genet A 2020; 185:781-789. [PMID: 33369085 DOI: 10.1002/ajmg.a.62040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/19/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
Abstract
Andersen-Tawil syndrome (ATS) is a rare potassium channelopathy causing periodic paralysis, cardiac arrhythmias, and dysmorphic features. A detailed analysis of the face could facilitate diagnosis of ATS, as approximately 30% of patients do not show variants in KCNJ2 gene, and diagnosis is established by clinical findings. We aimed to characterize the face in ATS through a quantitative approach, as facial anomalies may be unnoticed on visual inspection. Facial images of 12 subjects with genetically confirmed ATS (six males, six females, age 5-67 years) were acquired through stereophotogrammetry. Using 38 soft-tissue landmarks, linear distances, angles, and ratios were calculated and expressed as z-score values, with reference to 477 healthy subjects matched for sex and age. All patients showed decreased lower facial height with shortening of philtrum (mean z-score ± SD: -1.5 ± 0.9), smaller mid and lower facial depths (-1.9 ± 0.7; -2.3 ± 0.9), short palpebral fissures (right -1.2 ± 0.4; left -1.6 ± 0.6), smaller mandibular ramus length (-2.1 ± 0.4), and increased nasal width/length ratio (1.4 ± 0.5) with smaller nostril axis length (right -1.8 ± 0.8, left -1.6 ± 0.7). Hypertelorism and low-set ears were detected in two-thirds of patients. The study quantified facial dysmorphysm in ATS, extending information about known features, and detecting unrecorded philtrum and nostril characteristics, which may be distinctive traits of the disorder.
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Affiliation(s)
- Claudia Dolci
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Valeria A Sansone
- NEuroMuscularOmnicenter, NEMO Clinical Center, Neurorehabilitation Unit, Università degli Studi di Milano, Milan, Italy
| | - Daniele Gibelli
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Annalisa Cappella
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Chiarella Sforza
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Gajda R. Is Continuous ECG Recording on Heart Rate Monitors the Most Expected Function by Endurance Athletes, Coaches, and Doctors? Diagnostics (Basel) 2020; 10:diagnostics10110867. [PMID: 33114156 PMCID: PMC7690815 DOI: 10.3390/diagnostics10110867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Heart rate monitors (HRMs) are important for measuring heart rate, which can be used as a training parameter for healthy athletes. They indicate stress-related heart rhythm disturbances—recognized as an unexpected increase in heart rate (HR)—which can be life-threatening. Most HRMs confuse arrhythmias with artifacts. This study aimed to assess the usefulness of electrocardiogram (ECG) recordings from sport HRMs for endurance athletes, coaches, and physicians, compared with other basic and hypothetical functions. We conducted three surveys among endurance athletes (76 runners, 14 cyclists, and 10 triathletes), 10 coaches, and 10 sports doctors to obtain information on how important ECG recordings are and what HRM functions should be improved to meet their expectations in the future. The respondents were asked questions regarding use and hypothetical functions, as well as their preference for HRM type (optical/strap). Athletes reported distance, pace, instant HR, and oxygen threshold as being the four most important functions. ECG recording ranked eighth and ninth for momentary and continuous recording, respectively. Coaches placed more importance on ECG recording. Doctors ranked ECG recording the highest. All participants preferred optical HRMs to strap HRMs. Research on the improvement and implementation of HRM functions showed slightly different preferences for athletes compared with coaches and doctors. In cases where arrhythmia was suspected, the value of the HRM’s ability to record ECGs during training by athletes and coaches increased. For doctors, this is the most desirable feature in any situation. Considering the expectations of all groups, continuous ECG recording during training will significantly improve the safety of athletes.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
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Abstract
Andersen-Tawil syndrome (ATS) is a very rare orphan genetic multisystem channelopathy without structural heart disease (with rare exceptions). ATS type 1 is inherited in an autosomal dominant fashion and is caused by mutations in the KCNJ2 gene, which encodes the α subunit of the K+ channel protein Kir2.1 (in ≈ 50-60% of cases). ATS type 2 is in turn linked to a rare mutation in the KCNJ5-GIRK4 gene that encodes the G protein-sensitive-activated inwardly rectifying K+ channel Kir3.4 (15%), which carries the acetylcholine-induced potassium current. About 30% of cases are de novo/sporadic, suggesting that additional as-yet unidentified genes also cause the disorder. A triad of periodic muscle paralysis, repolarization changes in the electrocardiogram, and structural body changes characterize ATS. The typical muscular change is episodic flaccid muscle weakness. Prolongation of the QU/QUc intervals and normal or minimally prolonged QT/QTc intervals with a tendency to ventricular arrhythmias are typical repolarization changes. Bidirectional ventricular tachycardia is the hallmark ventricular arrhythmia, but also premature ventricular contractions, and rarely, polymorphic ventricular tachycardia of torsade de pointes type may be present. Patients with ATS have characteristic physical developmental dysmorphisms that affect the face, skull, limbs, thorax, and stature. Mild learning difficulties and a distinct neurocognitive phenotype (deficits in executive function and abstract reasoning) have been described. About 60% of affected individuals have all features of the major triad. The purpose of this review is to present historical aspects, nomenclature (observations/criticisms), epidemiology, genetics, electrocardiography, arrhythmias, electrophysiological mechanisms, diagnostic criteria/clues of periodic paralysis, prognosis, and management of ATS.
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Vivekanandam V, Männikkö R, Matthews E, Hanna MG. Improving genetic diagnostics of skeletal muscle channelopathies. Expert Rev Mol Diagn 2020; 20:725-736. [PMID: 32657178 DOI: 10.1080/14737159.2020.1782195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Skeletal muscle channelopathies are rare inherited conditions that cause significant morbidity and impact on quality of life. Some subsets have a mortality risk. Improved genetic methodology and understanding of phenotypes have improved diagnostic accuracy and yield. AREAS COVERED We discuss diagnostic advances since the advent of next-generation sequencing and the role of whole exome and genome sequencing. Advances in genotype-phenotype-functional correlations have improved understanding of inheritance and phenotypes. We outline new phenotypes, particularly in the pediatric setting and consider co-existing mutations that may act as genetic modifiers. We also discuss four newly identified genes associated with skeletal muscle channelopathies. EXPERT OPINION Next-generation sequencing using gene panels has improved diagnostic rates, identified new mutations, and discovered patients with co-existing pathogenic mutations ('double trouble'). This field has previously focussed on single genes, but we are now beginning to understand interactions between co-existing mutations, genetic modifiers, and their role in pathomechanisms. New genetic observations in pediatric presentations of channelopathies broadens our understanding of the conditions. Genetic and mechanistic advances have increased the potential to develop treatments.
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Affiliation(s)
- Vinojini Vivekanandam
- Queen Square Centre for Neuromuscular Diseases and Department of Neuromuscular Diseases, Queen Square Institute of Neurology, UCL and National Hospital for Neurology and Neurosurgery , London, UK
| | - Roope Männikkö
- Queen Square Centre for Neuromuscular Diseases and Department of Neuromuscular Diseases, Queen Square Institute of Neurology, UCL and National Hospital for Neurology and Neurosurgery , London, UK
| | - Emma Matthews
- Queen Square Centre for Neuromuscular Diseases and Department of Neuromuscular Diseases, Queen Square Institute of Neurology, UCL and National Hospital for Neurology and Neurosurgery , London, UK
| | - Michael G Hanna
- Queen Square Centre for Neuromuscular Diseases and Department of Neuromuscular Diseases, Queen Square Institute of Neurology, UCL and National Hospital for Neurology and Neurosurgery , London, UK
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Meta-analysis of T peak-T end and T peak-T end/QT ratio for risk stratification in congenital long QT syndrome. J Electrocardiol 2018; 51:396-401. [PMID: 29550106 DOI: 10.1016/j.jelectrocard.2018.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/13/2018] [Accepted: 03/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Congenital long QT syndrome (LQTS) predisposes affected individuals to ventricular tachycardia/fibrillation (VF/VF), potentially resulting in sudden cardiac death. The Tpeak-Tend interval and the Tpeak-Tend/QT ratio, electrocardiographic markers of dispersion of ventricular repolarization, were proposed for risk stratification but their predictive values in LQTS have been controversial. A systematic review and meta-analysis was conducted to examine the value of Tpeak-Tend intervals and Tpeak-Tend/QT ratios in predicting arrhythmic and mortality outcomes in congenital LQTS. METHOD PubMed and Embase databases were searched until 9th May 2017, identifying 199 studies. RESULTS Five studies on long QT syndrome were included in the final meta-analysis. Tpeak-Tend intervals were longer (mean difference [MD]: 13ms, standard error [SE]: 4ms, P=0.002; I2=34%) in congenital LQTS patients with adverse events [syncope, ventricular arrhythmias or sudden cardiac death] compared to LQTS patients without such events. By contrast, Tpeak-Tend/QT ratios were not significantly different between the two groups (MD: 0.02, SE: 0.02, P=0.26; I2=0%). CONCLUSION This meta-analysis showed that Tpeak-Tend interval is significant higher in individuals who are at elevated risk of adverse events in congenital LQTS, offering incremental value for risk stratification.
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Boldt LH, Parwani AS, Heinzel FR. Commercially Available Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes: Another Piece in Our Tool Box, but Not a Swiss Army Knife Yet. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.117.001913. [PMID: 29021307 DOI: 10.1161/circgenetics.117.001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Leif-Hendrik Boldt
- From the Department of Cardiology, Charité - Universitätsmedizin Berlin, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (L.H.B., F.R.H.).
| | - Abdul S Parwani
- From the Department of Cardiology, Charité - Universitätsmedizin Berlin, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (L.H.B., F.R.H.)
| | - Frank R Heinzel
- From the Department of Cardiology, Charité - Universitätsmedizin Berlin, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (L.H.B., F.R.H.)
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