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Ho CN, Chung WC, Kao CL, Hsu CW, Hung KC, Yu CH, Chen JY, Chen IW. Impact of preoperative QTc interval prolongation on short-term postoperative outcomes: A retrospective study. J Clin Anesth 2024; 98:111574. [PMID: 39121785 DOI: 10.1016/j.jclinane.2024.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/29/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
STUDY OBJECTIVE Although a prolonged heart rate-corrected QT interval (QTcI) is associated with an increased risk of mortality in the general population, its prognostic value in surgical patients remains unclear. We aimed to examine whether preoperative QTcI prolongation predicts short-term postoperative outcomes in elderly patients undergoing noncardiac surgery. DESIGN The study was a retrospective analysis using the TriNetX network database. SETTING Operating room. INTERVENTION Assessment and categorization of preoperative QTcI. PATIENTS Data of patients aged ≥65 years who underwent non-cardiac surgery between 2010 and 2023 were analyzed. MEASUREMENTS Patients were categorized into four groups based on preoperative QTcI: long (500-600 ms), borderline (460-500 ms), high-normal (420-460 ms) and control (370-420 ms) groups. The groups were compared using a propensity score-matched analysis. The primary outcome was the all-cause 90-day mortality risk. The secondary outcomes included 90-day risks of postoperative new-onset atrial fibrillation (Af), ventricular arrhythmias (VAs), emergency visits, hospital readmissions, and pneumonia. RESULTS In total, data on 519,929 patients were collected in this study. Pairwise comparisons showed that all QTcI prolongation groups demonstrated a heightened incidence of postoperative mortality, arrhythmias, and other complications compared to the control group. Patients with a long QTcI had a 3-fold higher risk of mortality (hazard ratio [HR] = 3.124, p < 0.001), Af (HR = 3.059, p < 0.001), and VAs (HR = 3.617, p < 0.001) than controls. The risks of emergency visits (HR = 1.287, p < 0.001), hospital readmissions (HR = 1.591, p < 0.001), and pneumonia (HR = 1.672, p < 0.001) were also higher in the long QTcI group than in the control group. A dose-dependent response was evident between QTcI and mortality as well as arrhythmia risk. CONCLUSION Preoperative QTcI screening effectively risk-stratifies elderly surgical patients, with a QTcI≥500 ms being strongly predictive of short-term postoperative mortality and other complications. Incorporating QTcI assessment into the preoperative evaluation may guide perioperative monitoring and management.
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Affiliation(s)
- Chun-Ning Ho
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan; Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Wei-Chu Chung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan; Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
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Strenja I, Dadić-Hero E, Perković M, Šoša I. Fentanyl and Sudden Death-A Postmortem Perspective for Diagnosing and Predicting Risk. Diagnostics (Basel) 2024; 14:1995. [PMID: 39272779 PMCID: PMC11394624 DOI: 10.3390/diagnostics14171995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
Sudden, unexpected deaths are extremely difficult for families, especially when the victim is a child. Most sudden deaths occur due to cardiovascular issues, and a smaller number (approximately one-quarter) are attributed to other causes, such as epilepsy. The medicinal and non-medicinal use of the synthetic opioid fentanyl, which can cause breathing problems, is frequently involved in these deaths. It is also being found more often in autopsies of sudden death cases, and the number of overdose deaths from illicit drugs containing fentanyl is increasing. There are cases in which it is mixed with other drugs. A gene known as the KCNH2 gene or human ether-a-go-go-related gene (hERG), involved in the heart's electrical activity, can be related to abnormal heart rhythms. This gene, along with others, may play a role in sudden deaths related to fentanyl use. In response, we have examined the scientific literature on genetic variations in the KCNH2 gene that can cause sudden death, the impact of fentanyl on this process, and the potential benefits of genetic testing for the victims to offer genetic counseling for their family members.
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Affiliation(s)
- Ines Strenja
- Department of Neurology, University Hospital Centre Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Elizabeta Dadić-Hero
- Department of Psychiatry, University Hospital Centre Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Manuela Perković
- Department of Pathology and Cytology, Pula General Hospital, 52000 Pula, Croatia
| | - Ivan Šoša
- Department of Anatomy, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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Stojanovic M, Nikolic M, Nedeljkovic I, Gojkovic D. QT Prolongation Preceding Ventricular Fibrillation After Amiodarone Administration: A Case Report. Cureus 2024; 16:e63763. [PMID: 39099957 PMCID: PMC11296664 DOI: 10.7759/cureus.63763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 08/06/2024] Open
Abstract
Atrial fibrillation (AF) is the most common long-term arrhythmia in adults. Rhythm control in patients with AF involves efforts to restore and maintain sinus rhythm and is accomplished by medication, catheter ablation, or electrical cardioversion. Amiodarone represents one of the most commonly used antiarrhythmic medications. Prolonged use of amiodarone can lead to many side effects. One of the most severe side effects is drug-induced long QT syndrome (LQTS), which can cause malignant arrhythmias and sudden cardiac death. We presented a case of a 52-year-old male who was admitted to the Coronary Unit due to first diagnosed AF with a rapid ventricular response. After amiodarone infusion was administrated the patient lost consciousness and the monitor displayed torsades de pointes (TdP) ventricular tachycardia with rapid conversion to ventricular fibrillation (VF). Cardiac resuscitation with two direct current (DC) shocks was performed. The patient was stabilized, and restoration of sinus rhythm with significant QT prolongation on the ECG was noted. This is a rare case of short-term amiodarone administration causing LQTS, TdP, and VF. The findings or observations emphasize the significance of diligent ECG monitoring during amiodarone treatment.
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Affiliation(s)
- Milovan Stojanovic
- Department for Cardiovascular Diseases, Institute for Treatment and Rehabilitation Niska Banja, Nis, SRB
- Faculty of Medicine, Nis University, Nis, SRB
| | - Miroslav Nikolic
- Clinic for Cardiovascular Diseases, University Clinical Center Nis, Nis, SRB
| | - Ivana Nedeljkovic
- Clinic for Cardiovascular Diseases, University Clinical Center of Serbia, Belgrade, SRB
- Faculty of Medicine, Belgrade University, Belgrade, SRB
| | - Dejana Gojkovic
- Department for Cardiovascular Diseases, Institute for Treatment and Rehabilitation Niska Banja, Nis, SRB
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Tepes M, Krezic I, Vranes H, Smoday IM, Kalogjera L, Zizek H, Vukovic V, Oroz K, Kovac KK, Madzar Z, Rakic M, Miskic B, Sikiric S, Barisic I, Strbe S, Antunovic M, Novosel L, Kavelj I, Vlainic J, Dobric I, Staresinic M, Skrtic A, Seiwerth S, Blagaic AB, Sikiric P. Stable Gastric Pentadecapeptide BPC 157 Therapy: Effect on Reperfusion Following Maintained Intra-Abdominal Hypertension (Grade III and IV) in Rats. Pharmaceuticals (Basel) 2023; 16:1554. [PMID: 38004420 PMCID: PMC10675657 DOI: 10.3390/ph16111554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Given in reperfusion, the use of stable gastric pentadecapeptide BPC 157 is an effective therapy in rats. It strongly counteracted, as a whole, decompression/reperfusion-induced occlusion/occlusion-like syndrome following the worst circumstances of acute abdominal compartment and intra-abdominal hypertension, grade III and grade IV, as well as compression/ischemia-occlusion/occlusion-like syndrome. Before decompression (calvariectomy, laparotomy), rats had long-lasting severe intra-abdominal hypertension, grade III (25 mmHg/60 min) (i) and grade IV (30 mmHg/30 min; 40 mmHg/30 min) (ii/iii), and severe occlusion/occlusion-like syndrome. Further worsening was caused by reperfusion for 60 min (i) or 30 min (ii/iii). Severe vascular and multiorgan failure (brain, heart, liver, kidney, and gastrointestinal lesions), widespread thrombosis (peripherally and centrally) severe arrhythmias, intracranial (superior sagittal sinus) hypertension, portal and caval hypertension, and aortal hypotension were aggravated. Contrarily, BPC 157 therapy (10 µg/kg, 10 ng/kg sc) given at 3 min reperfusion times eliminated/attenuated venous hypertension (intracranial (superior sagittal sinus), portal, and caval) and aortal hypotension and counteracted the increases in organ lesions and malondialdehyde values (blood ˃ heart, lungs, liver, kidney ˃ brain, gastrointestinal tract). Vascular recovery promptly occurred (i.e., congested inferior caval and superior mesenteric veins reversed to the normal vessel presentation, the collapsed azygos vein reversed to a fully functioning state, the inferior caval vein-superior caval vein shunt was recovered, and direct blood delivery returned). BPC 157 therapy almost annihilated thrombosis and hemorrhage (i.e., intracerebral hemorrhage) as proof of the counteracted general stasis and Virchow triad circumstances and reorganized blood flow. In conclusion, decompression/reperfusion-induced occlusion/occlusion-like syndrome counteracted by BPC 157 therapy in rats is likely for translation in patients. It is noteworthy that by rapidly counteracting the reperfusion course, it also reverses previous ischemia-course lesions, thus inducing complete recovery.
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Affiliation(s)
- Marijan Tepes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, 31000 Osijek, Croatia;
- PhD Program Translational Research in Biomedicine-TRIBE, School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivan Krezic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Hrvoje Vranes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Ivan Maria Smoday
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Luka Kalogjera
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Helena Zizek
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Vlasta Vukovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Katarina Oroz
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Katarina Kasnik Kovac
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Zrinko Madzar
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Mislav Rakic
- Department of Abdominal Surgery, Clinical Hospital Dubrava, 10040 Zagreb, Croatia;
| | - Blazenka Miskic
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, 31000 Osijek, Croatia;
| | - Suncana Sikiric
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.S.); (S.S.)
| | - Ivan Barisic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Sanja Strbe
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Marko Antunovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Luka Novosel
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Ivana Kavelj
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Josipa Vlainic
- Laboratory for Advanced Genomics, Division of Molecular Medicine, Institute Ruder Boskovic, 10000 Zagreb, Croatia;
| | - Ivan Dobric
- Department of Surgery, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Mario Staresinic
- Department of Surgery, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Anita Skrtic
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.S.); (S.S.)
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.S.); (S.S.)
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
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Bohny P, Boettger S, Jenewein J. Dose-dependent QTc interval prolongation under haloperidol and pipamperone in the management of delirium in a naturalistic setting. Front Psychiatry 2023; 14:1257755. [PMID: 37854439 PMCID: PMC10579563 DOI: 10.3389/fpsyt.2023.1257755] [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: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Delirium is an acute, life-threatening neuropsychiatric disorder frequently occurring among hospitalized patients. Antipsychotic medications are often recommended for delirium management but are associated with cardiovascular risks. This study aimed to investigate the frequency and magnitude of QTc interval prolongation and clinically relevant side effects occurring in delirium patients managed with haloperidol and/or pipamperone. Methods This descriptive retrospective cohort study evaluated 102 elderly (mean age: 73.2 years) inpatients with delirium treated with either haloperidol, pipamperone, a combination of both, or neither in a naturalistic setting over the course of up to 20 days or until the end of delirium. Results A total of 86.3% of patients were treated with haloperidol and/or pipamperone at a mean daily haloperidol-equipotent dose of 1.2 ± 1 mg. Non-cardiovascular side effects were registered in 2.9% of all patients and correlated with higher scores on the Delirium Observation Screening Scale. They did not occur more frequently under antipsychotic treatment. The frequency of QTc interval prolongation was comparably common among all groups, but prolongation magnitude was higher under antipsychotic treatment. It was positively correlated with antipsychotic dosage and the total number of QTc interval-prolonging substances administered. Critical QTc interval prolongation was registered in 21.6% (n = 19) of patients in the group treated with antipsychotics compared to 14.3% (n = 2) of patients in the unmedicated group; however, the difference was not statistically significant. Polypharmacy was associated with a higher risk of critical QTc interval prolongation and increased mortality during delirium. Conclusion Delirium treatment with haloperidol and/or pipamperone was not associated with a higher risk of QTc-interval prolongation in this naturalistic patient sample but was greater in magnitude and correlated with equipotent dosage and the number of QT interval-prolonging substances used. Polypharmacy was associated with higher mortality and increased risk of critical QTc prolongation.
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Affiliation(s)
- Philipp Bohny
- Center for Psychiatry and Psychotherapy, Triaplus Clinic Zugersee, Zug, Switzerland
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Soenke Boettger
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Privatklinik Hohenegg, Meilen, Switzerland
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Liantonio A, Bertini M, Mele A, Balla C, Dinoi G, Selvatici R, Mele M, De Luca A, Gualandi F, Imbrici P. Brugada Syndrome: More than a Monogenic Channelopathy. Biomedicines 2023; 11:2297. [PMID: 37626795 PMCID: PMC10452102 DOI: 10.3390/biomedicines11082297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Brugada syndrome (BrS) is an inherited cardiac channelopathy first diagnosed in 1992 but still considered a challenging disease in terms of diagnosis, arrhythmia risk prediction, pathophysiology and management. Despite about 20% of individuals carrying pathogenic variants in the SCN5A gene, the identification of a polygenic origin for BrS and the potential role of common genetic variants provide the basis for applying polygenic risk scores for individual risk prediction. The pathophysiological mechanisms are still unclear, and the initial thinking of this syndrome as a primary electrical disease is evolving towards a partly structural disease. This review focuses on the main scientific advancements in the identification of biomarkers for diagnosis, risk stratification, pathophysiology and therapy of BrS. A comprehensive model that integrates clinical and genetic factors, comorbidities, age and gender, and perhaps environmental influences may provide the opportunity to enhance patients' quality of life and improve the therapeutic approach.
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Affiliation(s)
- Antonella Liantonio
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.M.); (G.D.); (M.M.); (A.D.L.)
| | - Matteo Bertini
- Cardiological Center, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.B.)
| | - Antonietta Mele
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.M.); (G.D.); (M.M.); (A.D.L.)
| | - Cristina Balla
- Cardiological Center, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.B.)
| | - Giorgia Dinoi
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.M.); (G.D.); (M.M.); (A.D.L.)
| | - Rita Selvatici
- Medical Genetics Unit, Department of Mother and Child, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy;
| | - Marco Mele
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.M.); (G.D.); (M.M.); (A.D.L.)
- Cardiothoracic Department, Policlinico Riuniti Foggia, 71122 Foggia, Italy
| | - Annamaria De Luca
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.M.); (G.D.); (M.M.); (A.D.L.)
| | - Francesca Gualandi
- Medical Genetics Unit, Department of Mother and Child, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy;
| | - Paola Imbrici
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.M.); (G.D.); (M.M.); (A.D.L.)
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7
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Strbe S, Smoday IM, Krezic I, Kalogjera L, Vukovic V, Zizek H, Gojkovic S, Vranes H, Barisic I, Sikiric S, Tepes M, Oroz K, Brkic F, Drinkovic M, Beketic Oreskovic L, Popic J, Boban Blagaic A, Skrtic A, Staresinic M, Seiwerth S, Sikiric P. Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy. Pharmaceuticals (Basel) 2023; 16:788. [PMID: 37375736 DOI: 10.3390/ph16060788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Even before behavioral disturbances, neuroleptics, amphetamine, and domperidone application rapidly emerged severe occlusion/occlusion-like syndrome, shared innate vascular and multiorgan failure in rats, comparable to occlusion/occlusion-like syndrome described with vessel(s) occlusion or similar noxious procedures application. As therapy, i.e., activation of the collateral pathways, "bypassing key" (activated azygos vein pathway, direct blood flow delivery), the stable gastric pentadecapeptide BPC 157 is a novel solution. Recently, BPC 157 therapy particularly counteracted neuroleptic- or L-NAME-induced catalepsy, lithium intoxication, and schizophrenia positive and negative symptoms (amphetamine/methamphetamine/apomorphine/ketamine). In rats with complete calvariectomy, medication (BPC 157 10 µg/kg, 10 ng/kg ip or ig) was given 5 min after distinctive dopamine agents (mg/kg ip) (haloperidol (5), fluphenazine (5), clozapine (10), risperidone (5), olanzapine (10), quetiapine (10), or aripiprazole (10), domperidone (25), amphetamine (10), and combined amphetamine and haloperidol) and assessed at 15 min thereafter. All neuroleptic-, domperidone-, and amphetamine-induced comparable vascular and multiorgan failure severe syndrome was alleviated with BPC 157 therapy as before major vessel(s) occlusion or other similar noxious procedures. Specifically, all severe lesions in the brain (i.e., immediate swelling, hemorrhage), heart (i.e., congestion, arrhythmias), and lung (i.e., congestion, hemorrhage), as well as congestion in the liver, kidney, and gastrointestinal (stomach) tract, were resolved. Intracranial (superior sagittal sinus), portal, and caval hypertension and aortal hypotension were attenuated or eliminated. BPC 157 therapy almost annihilated arterial and venous thrombosis, peripherally and centrally. Thus, rapidly acting Virchow triad circumstances that occur as dopamine central/peripheral antagonists and agonist essential class-points, fully reversed by BPC 157 therapy, might be overwhelming for both neuroleptics and amphetamine.
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Affiliation(s)
- Sanja Strbe
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Maria Smoday
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Krezic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Kalogjera
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vlasta Vukovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Helena Zizek
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Slaven Gojkovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Hrvoje Vranes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Barisic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Suncana Sikiric
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Marijan Tepes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Katarina Oroz
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Filip Brkic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Martin Drinkovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Jelena Popic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Anita Skrtic
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Mario Staresinic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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8
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Fernandes DDA, Camões GDF, Ferreira D, Queijo C, Fontes-Ribeiro C, Gonçalves L, Pina R, António N. Prevalence and risk factors for acquired long QT syndrome in the emergency department: a retrospective observational study. World J Emerg Med 2023; 14:454-461. [PMID: 37969211 PMCID: PMC10632761 DOI: 10.5847/wjem.j.1920-8642.2023.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Long QT syndrome (LQTS) is a heterogeneous syndrome that may be congenital or, more frequently, acquired. The real-world prevalence of acquired LQTS (aLQTS) in the emergency department (ED) remains to be determined. The aim of this study was to determine prevalence of aLQTS and its impact on symptoms on ED admissions. METHODS Electrocardiograms (ECG) of 5,056 consecutively patients admitted in the ED of a tertiary hospital between January 28th and March 17th of 2020 were reviewed. All patients with aLQTS were included. Clinical data with a focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without corrected QT (QTc) interval greater than 500 ms (value that is considered severely increased). RESULTS A total of 383 ECGs with prolonged QTc were recognized, corresponding to a prevalence of aLQTS at admission of 7.82%. Patients with aLQTS were more commonly men (53.3%) with an age of (73.49±14.79) years old and QTc interval of (505.3±32.4) ms. Only 20.4% of these patients with aLQTS were symptomatic. No ventricular arrhythmias were recorded. Patients with QT interval greater than 500 ms were more frequently female (59.5%; P<0.001) and were more frequently on QT prolonging drugs (77.3%; P=0.025). Main contributing factor was intake of antibiotics (odds ratio [OR] 4.680) followed by female gender (OR 2.473) and intake of antipsychotics (OR 1.925). CONCLUSION aLQTS is particularly prevalent in the ED. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made to avoid, detect and treat aLQTS as early as possible.
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Affiliation(s)
- Diogo de Almeida Fernandes
- Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Guilherme de Freitas Camões
- Department of Internal Medicine, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Diana Ferreira
- Department of Internal Medicine, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Carolina Queijo
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
| | - Carlos Fontes-Ribeiro
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
| | - Rui Pina
- Department of Internal Medicine, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
| | - Natália António
- Department of Cardiology, Coimbra Hospital and University Centre (CHUC), Coimbra 3000-075, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra 3000-370, Portugal
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
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9
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Tadelle A. QT Interval Prolongation in Cirrhotic Cardiomyopathy. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s371615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Kofron CM, Choi BR, Coulombe KLK. Arrhythmia Assessment in Heterotypic Human Cardiac Myocyte-Fibroblast Microtissues. Methods Mol Biol 2022; 2485:147-157. [PMID: 35618904 PMCID: PMC10502739 DOI: 10.1007/978-1-0716-2261-2_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Risk assessment assays for chemically induced arrhythmia are critical, but significant limitations exist with current cardiotoxicity testing, including a focus on single select ion channels, the use of non-human species in vitro and in vivo, and limited direct physiological translation. To be predictive of actual adverse clinical arrhythmic risk, arrhythmia assessment models for chemicals and drugs should be fit-for-purpose and suited for evaluating compounds in which the mechanism of action may not be entirely known. Here, we describe methods for efficient and reliable screening for arrhythmogenic cardiotoxicity with a 3D human cardiac microtissue model using purified human-induced pluripotent stem cell (hiPSC)-derived cardiomyocytes and human cardiac fibroblasts. Applying optical mapping of voltage and calcium-sensitive dyes-an established approach to evaluate cardiac action potentials and calcium transients-to 3D heterotypic cardiac myocyte-fibroblast tissues allows for the generation and functional analysis of a large number of individual microtissues to provide greater throughput and high statistical power in analyses. Hundreds of microtissues in standard cell culture plates can be produced with low variability beat-to-beat, microtissue-to-microtissue, and across hiPSC-cardiomyocyte differentiation batches, reducing the number of microtissues required per condition for predictive outputs. The platform described here can be used as a sensitive, efficient, and predictive preclinical model validated for the purpose of assessing human pro-arrhythmic risk.
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Affiliation(s)
- Celinda M Kofron
- School of Engineering, Center for Biomedical Engineering, Brown University, Providence, RI, USA
| | - Bum-Rak Choi
- Cardiovascular Research Center, Cardiovascular Institute, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Kareen L K Coulombe
- School of Engineering, Center for Biomedical Engineering, Brown University, Providence, RI, USA.
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11
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Effects of opioid receptor agonist and antagonist medications on electrocardiogram changes and presentation of cardiac arrhythmia: review article. J Interv Card Electrophysiol 2021; 63:471-500. [PMID: 34674120 DOI: 10.1007/s10840-021-01072-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Mortality associated with prescription opioids has significantly increased over the past few decades and is considered a global pandemic. Prescribed opioids can cause cardiac arrhythmias, leading to fatal outcomes and unexpected death, even in the absence of structural cardiac disease. Despite the extent of cardiac toxicity and death associated with these medications, there is limited data to suggest their influences on cardiac electrophysiology and arrhythmias, with the exception of methadone. The goal of our review is to describe the possible mechanisms and to review the different ECG changes and arrhythmias that have been reported. METHODS A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct to identify studies that demonstrated the use of prescription opioids leading to electrocardiogram (ECG) changes and cardiac arrhythmias. RESULTS Many of the commonly prescribed opioid medications can uniquely effect the ECG, and can lead to the development of various cardiac arrhythmias. One of the most significant side effects of these drugs is QTc interval prolongation, especially when administered to patients with a baseline risk for QTc prolongation. A prolonged QTc interval can cause lethal torsades de pointes and ventricular fibrillation. Obtaining an ECG at baseline, following a dosage increase, or after switching an opioid medication, is appropriate in patients taking certain prescribed opioids. Opioids are often used first line for the treatment of acute and chronic pain, procedural sedation, medication opioid use disorders, and maintenance therapy. CONCLUSIONS To reduce the risk of cardiac arrhythmias and to improve patient outcomes, consideration of accurate patient selection, concomitant medications, electrolyte monitoring, and vigilant ECG monitoring should be considered.
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12
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Anderson A, Vo BN, de Velasco EMF, Hopkins CR, Weaver CD, Wickman K. Characterization of VU0468554, a New Selective Inhibitor of Cardiac G Protein-Gated Inwardly Rectifying K + Channels. Mol Pharmacol 2021; 100:540-547. [PMID: 34503975 DOI: 10.1124/molpharm.121.000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022] Open
Abstract
G protein-gated inwardly rectifying K+ (GIRK) channels are critical mediators of excitability in the heart and brain. Enhanced GIRK-channel activity has been implicated in the pathogenesis of supraventricular arrhythmias, including atrial fibrillation. The lack of selective pharmacological tools has impeded efforts to investigate the therapeutic potential of cardiac GIRK-channel interventions in arrhythmias. Here, we characterize a recently identified GIRK-channel inhibitor, VU0468554. Using whole-cell electrophysiological approaches and primary cultures of sinoatrial nodal cells and hippocampal neurons, we show that VU0468554 more effectively inhibits the cardiac GIRK channel than the neuronal GIRK channel. Concentration-response experiments suggest that VU0468554 inhibits Gβγ-activated GIRK channels in noncompetitive and potentially uncompetitive fashion. In contrast, VU0468554 competitively inhibits GIRK-channel activation by ML297, a GIRK-channel activator containing the same chemical scaffold as VU0468554. In the isolated heart model, VU0468554 partially reversed carbachol-induced bradycardia in hearts from wild-type mice but not Girk4-/- mice. Collectively, these data suggest that VU0468554 represents a promising new pharmacological tool for targeting cardiac GIRK channels with therapeutic implications for relevant cardiac arrhythmias. SIGNIFICANCE STATEMENT: Although cardiac GIRK-channel inhibition shows promise for the treatment of supraventricular arrhythmias, the absence of subtype-selective channel inhibitors has hindered exploration into this therapeutic strategy. This study utilizes whole-cell patch-clamp electrophysiology to characterize the new GIRK-channel inhibitor VU0468554 in human embryonic kidney 293T cells and primary cultures. We report that VU0468554 exhibits a favorable pharmacodynamic profile for cardiac over neuronal GIRK channels and partially reverses GIRK-mediated bradycardia in the isolated mouse heart model.
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Affiliation(s)
- Allison Anderson
- Graduate Program in Pharmacology (A.A., B.N.V.) and Department of Pharmacology (E.M.F.d.V., K.W.), University of Minnesota, Minneapolis, Minnesota; Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska (C.R.H.); and Departments of Pharmacology and Chemistry and Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee (C.D.W.)
| | - Baovi N Vo
- Graduate Program in Pharmacology (A.A., B.N.V.) and Department of Pharmacology (E.M.F.d.V., K.W.), University of Minnesota, Minneapolis, Minnesota; Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska (C.R.H.); and Departments of Pharmacology and Chemistry and Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee (C.D.W.)
| | - Ezequiel Marron Fernandez de Velasco
- Graduate Program in Pharmacology (A.A., B.N.V.) and Department of Pharmacology (E.M.F.d.V., K.W.), University of Minnesota, Minneapolis, Minnesota; Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska (C.R.H.); and Departments of Pharmacology and Chemistry and Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee (C.D.W.)
| | - Corey R Hopkins
- Graduate Program in Pharmacology (A.A., B.N.V.) and Department of Pharmacology (E.M.F.d.V., K.W.), University of Minnesota, Minneapolis, Minnesota; Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska (C.R.H.); and Departments of Pharmacology and Chemistry and Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee (C.D.W.)
| | - C David Weaver
- Graduate Program in Pharmacology (A.A., B.N.V.) and Department of Pharmacology (E.M.F.d.V., K.W.), University of Minnesota, Minneapolis, Minnesota; Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska (C.R.H.); and Departments of Pharmacology and Chemistry and Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee (C.D.W.)
| | - Kevin Wickman
- Graduate Program in Pharmacology (A.A., B.N.V.) and Department of Pharmacology (E.M.F.d.V., K.W.), University of Minnesota, Minneapolis, Minnesota; Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska (C.R.H.); and Departments of Pharmacology and Chemistry and Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee (C.D.W.)
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13
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A predictive in vitro risk assessment platform for pro-arrhythmic toxicity using human 3D cardiac microtissues. Sci Rep 2021; 11:10228. [PMID: 33986332 PMCID: PMC8119415 DOI: 10.1038/s41598-021-89478-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiotoxicity of pharmaceutical drugs, industrial chemicals, and environmental toxicants can be severe, even life threatening, which necessitates a thorough evaluation of the human response to chemical compounds. Predicting risks for arrhythmia and sudden cardiac death accurately is critical for defining safety profiles. Currently available approaches have limitations including a focus on single select ion channels, the use of non-human species in vitro and in vivo, and limited direct physiological translation. We have advanced the robustness and reproducibility of in vitro platforms for assessing pro-arrhythmic cardiotoxicity using human induced pluripotent stem cell-derived cardiomyocytes and human cardiac fibroblasts in 3-dimensional microtissues. Using automated algorithms and statistical analyses of eight comprehensive evaluation metrics of cardiac action potentials, we demonstrate that tissue-engineered human cardiac microtissues respond appropriately to physiological stimuli and effectively differentiate between high-risk and low-risk compounds exhibiting blockade of the hERG channel (E4031 and ranolazine, respectively). Further, we show that the environmental endocrine disrupting chemical bisphenol-A (BPA) causes acute and sensitive disruption of human action potentials in the nanomolar range. Thus, this novel human 3D in vitro pro-arrhythmic risk assessment platform addresses critical needs in cardiotoxicity testing for both environmental and pharmaceutical compounds and can be leveraged to establish safe human exposure levels.
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14
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Afsin A, Asoglu R, Kobat MA, Asoglu E, Suner A. Evaluation of Index of Cardio-Electrophysiological Balance in Patients With Atrial Fibrillation on Antiarrhythmic-Drug Therapy. Cardiol Res 2021; 12:37-46. [PMID: 33447324 PMCID: PMC7781268 DOI: 10.14740/cr1185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Index of cardio-electrophysiological balance (iCEB) has been described as a novel risk marker for predicting malignant ventricular arrhythmia. There remains limited evidence on the effects of amiodarone and propafenone used for sinus rhythm maintenance on iCEB in patients with atrial fibrillation (AF). The aim of this study was to evaluate iCEB in patients with AF on antiarrhythmic-drug therapy. METHODS A total of 108 patients with AF (68 patients using amiodarone and 40 patients using propafenone) and 50 healthy subjects were included in the study. All groups underwent a standard 12-lead surface electrocardiogram. QRS duration, QT, T wave peak-to-end (Tp-e) intervals, iCEB (QT/QRS) and iCEBc (heart rate-corrected QT (QTc)/QRS) rates were calculated from the electrocardiogram and compared between groups. RESULTS QT, Tp-e intervals and Tp-e/QT ratio were significantly longer in the amiodarone group than the propafenone and control groups (P < 0.001, for all). iCEB was similar in the amiodarone and control groups (4.4 ± 0.6 and 4.2 ± 0.4; P > 0.05), while iCEB values in the propafenone group were significantly lower than the amiodarone group and control groups (3.9 ± 0.5; P < 0.001). There was a significantly difference in iCEBc values among the amiodarone, control and propafenone groups (4.8 ± 0.6, 4.6 ± 0.4 and 4.3 ± 0.6; P < 0.001, respectively). CONCLUSIONS In this study, higher iCEBc parameters were observed in patients using amiodarone, while iCEBc values were lowest among patients with AF using propafenone. Further studies are needed to determine whether these electrophysiological changes are associated with ventricular arrhythmias for patients with AF on antiarrhythmic-drug therapy.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Ramazan Asoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Mehmet Ali Kobat
- Department of Cardiology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Emin Asoglu
- Department of Cardiology, Mardin State Hospital, Mardin, Turkey
| | - Arif Suner
- Department of Cardiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
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15
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Kharkovskaya EЕ, Osipov GV, Mukhina IV. Ventricular fibrillation induced by 2-aminoethoxydiphenyl borate under conditions of hypoxia/reoxygenation. Minerva Cardioangiol 2020; 68:619-628. [DOI: 10.23736/s0026-4725.20.05376-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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16
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Afsin A, Ecemis K, Asoglu R. Effects of Short-Term Hydroxychloroquine Plus Moxifloxacin Therapy on Corrected QT Interval and Tp-e Interval in Patients With COVID-19. J Clin Med Res 2020; 12:604-611. [PMID: 32849949 PMCID: PMC7430923 DOI: 10.14740/jocmr4288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Limited data are available regarding hydroxychloroquine (HCQ) and moxifloxacin (MOX) in patients with possible coronavirus disease 2019, (COVID-19). Both drugs may increase risk of malignant ventricular arrhythmias associated with prolongation of QT interval. Methods A total of 76 subjects with chest tomography findings compatible with COVID-19 pneumonia were enrolled in the study. Standard 12-lead electrocardiogram (ECG) was repeated on days 2 and 5 in patients receiving a combination of HCQ + MOX. Heart rate, QT interval, Tp-e interval, and Tp-e/QT ratio were measured. Results The mean age of the patients was 61.7 ± 14.8 years and 54% had hypertension. Compared to day 2, ECG on day 5 showed significant increases in QT interval (370.8 ± 32.5 vs. 381.0 ± 29.3, respectively, P = 0.001), corrected QT (QTc) interval (424 (403 - 436) vs. 442 (420 - 468), respectively, P < 0.001), Tp-e interval (60 (55 - 70) vs. 65 (57 - 75), respectively, P < 0.001), cTp-e interval (72.2 ± 12.9 vs. 75.4 ± 12.7, respectively, P < 0.001). Moreover, a slight decrease in Tp-e/QT ratio was observed (0.17 ± 0.03 vs. 0.17 ± 0.02, P = 0.030). QTc was > 500 ms in 5% of the patients, and 8% of patients had an increase in QTc interval > 60 ms. Tp-e/QT ratio was > 0.23 in 4% of patients. Five patients died due to pulmonary failure without evidence of ventricular arrhythmia. No ventricular arrhythmia events, including torsades de pointes (TdP), were observed. Conclusions HCQ + MOX combination therapy led to increases in QTc interval, Tp-e interval, and cTp-e interval. However, this therapy did not cause ventricular arrhythmia in the short-term observation.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, Kahta State Hospital, Adiyaman, Turkey
| | - Kenan Ecemis
- Department of Infectious Diseases and Clinical Microbiology, Kahta State Hospital, Adiyaman, Turkey
| | - Ramazan Asoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
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Jungbauer CG, Maier LS. [Proarrhythmic adverse effects of nonarrhythmic drugs]. Herzschrittmacherther Elektrophysiol 2019; 30:262-267. [PMID: 31444571 DOI: 10.1007/s00399-019-00635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
Acquired QT prolongation is almost exclusively the result of inhibition of the potassium channel Ikr. Especially hospitalized patients have a high risk to suffer from Torsade de points (TdP). Therefore, any prescription of drugs with the potential for QT prolongation should involve the consideration of the necessity of the agent and interaction with other QT prolonging drugs. The website www.crediblemed.com helps to identify the risk for TdP of each drug. During drug prescription, it is necessary to monitor QTc with regular ECGs; QTc prolongation >500 ms or QTc increase >60 ms should trigger end of drug administration followed by monitoring of the patient according to the individual risk for TdP.
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Affiliation(s)
- C G Jungbauer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland.
| | - L S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland
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