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Rasoul D, Ajay A, Abdullah A, Mathew J, Lee Wei En B, Mashida K, Sankaranarayanan R. Alcohol and Heart Failure. Eur Cardiol 2023; 18:e65. [PMID: 38213665 PMCID: PMC10782426 DOI: 10.15420/ecr.2023.12] [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: 02/24/2023] [Accepted: 10/10/2023] [Indexed: 01/13/2024] Open
Abstract
Alcohol is the most frequently consumed toxic substance in the world and remains a major global public health issue, with one in three adults consuming it worldwide. Alcohol use is a leading risk factor for disease, contributing to over 60 acute and chronic health conditions, with a particularly complex association with cardiovascular disease. Chronic excessive alcohol consumption is associated with a range of cardiac complications, including decreased myocardial contractility, hypertension, arrhythmias, MI and heart failure. However, low-level alcohol consumption is believed to have a protective effect against ischaemic heart disease and diabetes. In most cohort studies, small to moderate amounts of alcohol consumption have not been linked to heart failure, indicating a threshold effect of alcohol with individual (possibly genetic) predisposition rather than a continuous effect of exposure. This review article explores the potential benefits of alcohol on the heart, the association between alcohol use and alcoholic cardiomyopathy and the epidemiology, clinical correlates and management of alcoholic cardiomyopathy.
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Affiliation(s)
- Debar Rasoul
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
| | - Ashwin Ajay
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | - Alend Abdullah
- Cardiology Department, The Dudley Group NHS Foundation TrustDudley, UK
| | - Jean Mathew
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | - Benjamin Lee Wei En
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | | | - Rajiv Sankaranarayanan
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
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Ihekire NL, Okobi OE, Adedoye EA, Akahara PF, Onyekwere AO, Afrifa-Yamoah J, Akinyemi FB. Heartache in a Bottle: Understanding Alcoholic Cardiomyopathy. Cureus 2023; 15:e42886. [PMID: 37664402 PMCID: PMC10474910 DOI: 10.7759/cureus.42886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Alcoholic cardiomyopathy (ACM) is a cardiac ailment marked by impaired contraction and dilation of one or both ventricles of the heart. The extent of daily alcohol intake and duration of alcohol abuse are linked to the development of ACM, although the exact thresholds and timeline for alcohol misuse to induce heart dysfunction remain uncertain. Thus, the objective of this systematic review is to comprehensively evaluate the existing knowledge on the specific disease entity, particularly in light of the ongoing issue of alcohol misuse, with the intention of determining if recent advancements and discoveries have significantly altered the understanding of this condition compared to the past century. This systematic review involved a literature search that was conducted on PubMed to identify suitable and appropriate literature for the study. The inclusion criteria encompassed articles that focused on ACM or the relationship between alcohol abuse and cardiac dysfunction, involved human subjects or relevant animal models, were written in the English language, and were published within the last 10 years. The exclusion criteria included duplicates, case reports, letters, editorials, and reviews not specifically addressing ACM. As a result, a total of 18 articles were included in this systematic review. The risk of bias was assessed through the use of the Cochrane risk-of-bias tool for clinical trials. The findings of this systematic review indicated that the likelihood of ACM occurrence significantly rose when the consumption of over 80 g of alcohol per day occurred for at least five years. The systematic review further revealed that ACM is associated with various detrimental changes in the cellular, structural, and histological aspects of the heart muscles, even though the specific clinical and histological characteristics of ACM have yet to be established. In individuals with an extensive history of excessive alcohol abuse, the diagnosis of ACM was reached through the exclusion of other potential causes of the condition. The fundamental approach to treatment lies in abstaining from alcohol. It is crucial to manage symptoms in individuals with secondary heart failure and address any related complications.
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Affiliation(s)
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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3
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Urban S, Błaziak M, Jura M, Iwanek G, Zdanowicz A, Guzik M, Borkowski A, Gajewski P, Biegus J, Siennicka A, Pondel M, Berka P, Ponikowski P, Zymliński R. Novel Phenotyping for Acute Heart Failure—Unsupervised Machine Learning-Based Approach. Biomedicines 2022; 10:biomedicines10071514. [PMID: 35884819 PMCID: PMC9313459 DOI: 10.3390/biomedicines10071514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023] Open
Abstract
Acute heart failure (AHF) is a life-threatening, heterogeneous disease requiring urgent diagnosis and treatment. The clinical severity and medical procedures differ according to a complex interplay between the deterioration cause, underlying cardiac substrate, and comorbidities. This study aimed to analyze the natural phenotypic heterogeneity of the AHF population and evaluate the possibilities offered by clustering (unsupervised machine-learning technique) in a medical data assessment. We evaluated data from 381 AHF patients. Sixty-three clinical and biochemical features were assessed at the admission of the patients and were included in the analysis after the preprocessing. The K-medoids algorithm was implemented to create the clusters, and optimization, based on the Davies-Bouldin index, was used. The clustering was performed while blinded to the outcome. The outcome associations were evaluated using the Kaplan-Meier curves and Cox proportional-hazards regressions. The algorithm distinguished six clusters that differed significantly in 58 variables concerning i.e., etiology, clinical status, comorbidities, laboratory parameters and lifestyle factors. The clusters differed in terms of the one-year mortality (p = 0.002). Using the clustering techniques, we extracted six phenotypes from AHF patients with distinct clinical characteristics and outcomes. Our results can be valuable for future trial constructions and customized treatment.
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Affiliation(s)
- Szymon Urban
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
- Correspondence:
| | - Mikołaj Błaziak
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Maksym Jura
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Gracjan Iwanek
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Agata Zdanowicz
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Mateusz Guzik
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Artur Borkowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Piotr Gajewski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Agnieszka Siennicka
- Department of Physiology and Patophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Maciej Pondel
- Institute of Information Systems in Economics, Wroclaw University of Economics and Business, 53-345 Wroclaw, Poland;
| | - Petr Berka
- Department of Information and Knowledge Engineering, Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67 Prague, Czech Republic;
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
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4
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Sabater-Molina M, Navarro-Peñalver M, Muñoz-Esparza C, Esteban-Gil Á, Santos-Mateo JJ, Gimeno JR. Genetic Factors Involved in Cardiomyopathies and in Cancer. J Clin Med 2020; 9:E1702. [PMID: 32498335 PMCID: PMC7356401 DOI: 10.3390/jcm9061702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/05/2023] Open
Abstract
Cancer therapy-induced cardiomyopathy (CCM) manifests as left ventricular (LV) dysfunction and heart failure (HF). It is associated withparticular pharmacological agents and it is typically dose dependent, but significant individual variability has been observed. History of prior cardiac disease, abuse of toxics, cardiac overload conditions, age, and genetic predisposing factors modulate the degree of the cardiac reserve and the response to the injury. Genetic/familial cardiomyopathies (CMY) are increasingly recognized in general populations with an estimated prevalence of 1:250. Association between cardiac and oncologic diseases regarding genetics involves not only the toxicity process, but pathogenicity. Genetic variants in germinal cells that cause CMY (LMNA, RAS/MAPK) can increase susceptibility for certain types of cancer. The study of mutations found in cancer cells (somatic) has revealed the implication of genes commonly associated with the development of CMY. In particular, desmosomal mutations have been related to increased undifferentiation and invasiveness of cancer. In this article, the authors review the knowledge on the relevance of environmental and genetic background in CCM and give insights into the shared genetic role in the pathogenicity of the cancer process and development of CMY.
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Affiliation(s)
- María Sabater-Molina
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Universitario Virgen dela Arrixaca, El Palmar, 30120 Murcia, Spain; (M.S.-M.); (M.N.-P.); (C.M.-E.); (J.R.G.)
- Universidad de Murcia, El Palmar, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, 30120 Murcia, Spain
- European Reference Networks (Guard-Heart), European Commission, 30120 Murcia, Spain
- Red de investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marina Navarro-Peñalver
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Universitario Virgen dela Arrixaca, El Palmar, 30120 Murcia, Spain; (M.S.-M.); (M.N.-P.); (C.M.-E.); (J.R.G.)
- Universidad de Murcia, El Palmar, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, 30120 Murcia, Spain
- European Reference Networks (Guard-Heart), European Commission, 30120 Murcia, Spain
| | - Carmen Muñoz-Esparza
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Universitario Virgen dela Arrixaca, El Palmar, 30120 Murcia, Spain; (M.S.-M.); (M.N.-P.); (C.M.-E.); (J.R.G.)
- Universidad de Murcia, El Palmar, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, 30120 Murcia, Spain
- European Reference Networks (Guard-Heart), European Commission, 30120 Murcia, Spain
- Red de investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ángel Esteban-Gil
- Biomedical Informatics & Bioinformatics Platform, Institute for Biomedical Research of Murcia (IMIB)/Foundation for Healthcare Training & Research of the Region of Murcia (FFIS), 30003 Murcia, Spain;
| | - Juan Jose Santos-Mateo
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Universitario Virgen dela Arrixaca, El Palmar, 30120 Murcia, Spain; (M.S.-M.); (M.N.-P.); (C.M.-E.); (J.R.G.)
- Universidad de Murcia, El Palmar, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, 30120 Murcia, Spain
- European Reference Networks (Guard-Heart), European Commission, 30120 Murcia, Spain
| | - Juan R. Gimeno
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Universitario Virgen dela Arrixaca, El Palmar, 30120 Murcia, Spain; (M.S.-M.); (M.N.-P.); (C.M.-E.); (J.R.G.)
- Universidad de Murcia, El Palmar, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, 30120 Murcia, Spain
- European Reference Networks (Guard-Heart), European Commission, 30120 Murcia, Spain
- Red de investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Propranolol Is Associated with Lower Risk of Incidence of Hepatocellular Carcinoma in Patients with Alcoholic Cirrhosis: A Tertiary-Center Study and Indirect Comparison with Meta-Analysis. Gastroenterol Res Pract 2020; 2020:1892584. [PMID: 32454812 PMCID: PMC7238337 DOI: 10.1155/2020/1892584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
Alcoholic cirrhosis (AC) leads to enormous disease burden and occupies a substantial proportion in the etiology of hepatocellular carcinoma (HCC), but scarce attention has been paid to this topic. Besides, propranolol has been reported to decrease the rate of HCC in viral hepatitis. We conducted a retrospective tertiary-center cohort study to identify the HCC incidence in AC patients with or without propranolol. A total of 1,046 AC patients with hospitalization had been screened, and those with regular follow-up for three years or otherwise until the date of malignancy diagnosis without meeting exclusion criteria were enrolled; finally, 23 AC patients with propranolol and 46 AC patients without propranolol were analyzed after twofold propensity-score matching. The cumulative incidence of HCC was lower in the propranolol group (log-rank test, P = 0.046). Furthermore, we undertook the meta-analysis of annual incidence of HCC in AC patients, and 1,949 publications were screened, within which eight studies were analyzed; the pooled annual incidence was 2.41%, which was higher than the calculated annual incidence of HCC in our AC cohort with propranolol (1.45%). In conclusion, propranolol is associated with decreased risk of HCC incidence in patients with AC.
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Díez-Villanueva P, Vicent L, de la Cuerda F, Esteban-Fernández A, Gómez-Bueno M, de Juan-Bagudá J, Iniesta ÁM, Ayesta A, Rojas-González A, Bover-Freire R, Iglesias D, García-Aguado M, Perea-Egido JÁ, Salamanca J, Martínez-Sellés M. Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan. Cardiology 2020; 145:275-282. [PMID: 31940620 DOI: 10.1159/000505148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. METHODS We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). RESULTS After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). CONCLUSIONS In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.
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Affiliation(s)
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Manuel Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | - Ana Ayesta
- Servicio de Cardiología, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | | | - Ramón Bover-Freire
- Servicio de Cardiología, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Diego Iglesias
- Servicio de Cardiología, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense, Universidad Europea, Madrid, Spain
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7
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Ware JS, Amor-Salamanca A, Tayal U, Govind R, Serrano I, Salazar-Mendiguchía J, García-Pinilla JM, Pascual-Figal DA, Nuñez J, Guzzo-Merello G, Gonzalez-Vioque E, Bardaji A, Manito N, López-Garrido MA, Padron-Barthe L, Edwards E, Whiffin N, Walsh R, Buchan RJ, Midwinter W, Wilk A, Prasad S, Pantazis A, Baski J, O'Regan DP, Alonso-Pulpon L, Cook SA, Lara-Pezzi E, Barton PJ, Garcia-Pavia P. Genetic Etiology for Alcohol-Induced Cardiac Toxicity. J Am Coll Cardiol 2019; 71:2293-2302. [PMID: 29773157 PMCID: PMC5957753 DOI: 10.1016/j.jacc.2018.03.462] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Alcoholic cardiomyopathy (ACM) is defined by a dilated and impaired left ventricle due to chronic excess alcohol consumption. It is largely unknown which factors determine cardiac toxicity on exposure to alcohol. OBJECTIVES This study sought to evaluate the role of variation in cardiomyopathy-associated genes in the pathophysiology of ACM, and to examine the effects of alcohol intake and genotype on dilated cardiomyopathy (DCM) severity. METHODS The authors characterized 141 ACM cases, 716 DCM cases, and 445 healthy volunteers. The authors compared the prevalence of rare, protein-altering variants in 9 genes associated with inherited DCM. They evaluated the effect of genotype and alcohol consumption on phenotype in DCM. RESULTS Variants in well-characterized DCM-causing genes were more prevalent in patients with ACM than control subjects (13.5% vs. 2.9%; p = 1.2 ×10-5), but similar between patients with ACM and DCM (19.4%; p = 0.12) and with a predominant burden of titin truncating variants (TTNtv) (9.9%). Separately, we identified an interaction between TTN genotype and excess alcohol consumption in a cohort of DCM patients not meeting ACM criteria. On multivariate analysis, DCM patients with a TTNtv who consumed excess alcohol had an 8.7% absolute reduction in ejection fraction (95% confidence interval: -2.3% to -15.1%; p < 0.007) compared with those without TTNtv and excess alcohol consumption. The presence of TTNtv did not predict phenotype, outcome, or functional recovery on treatment in ACM patients. CONCLUSIONS TTNtv represent a prevalent genetic predisposition for ACM, and are also associated with a worse left ventricular ejection fraction in DCM patients who consume alcohol above recommended levels. Familial evaluation and genetic testing should be considered in patients presenting with ACM.
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Affiliation(s)
- James S Ware
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom; MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Almudena Amor-Salamanca
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Risha Govind
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Isabel Serrano
- Department of Cardiology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Rovira Virgili University, Tarragona, Spain
| | - Joel Salazar-Mendiguchía
- Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Bellvitge, Barcelona, Spain; Genetics Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Manuel García-Pinilla
- CIBER in Cardiovascular Diseases, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Domingo A Pascual-Figal
- CIBER in Cardiovascular Diseases, Madrid, Spain; Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - Julio Nuñez
- CIBER in Cardiovascular Diseases, Madrid, Spain; Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia, Valencia, Spain
| | - Gonzalo Guzzo-Merello
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Alfredo Bardaji
- Department of Cardiology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Rovira Virgili University, Tarragona, Spain
| | - Nicolas Manito
- Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Bellvitge, Barcelona, Spain
| | - Miguel A López-Garrido
- CIBER in Cardiovascular Diseases, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Laura Padron-Barthe
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Elizabeth Edwards
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom; MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Roddy Walsh
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Rachel J Buchan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - William Midwinter
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Alicja Wilk
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Antonis Pantazis
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - John Baski
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Luis Alonso-Pulpon
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Stuart A Cook
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Division of Cardiovascular & Metabolic Disorders, Duke-National University of Singapore, Singapore
| | - Enrique Lara-Pezzi
- CIBER in Cardiovascular Diseases, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Paul J Barton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom.
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain; University Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain.
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