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Hautamäki M, Järvensivu-Koivunen M, Lyytikäinen LP, Eskola M, Lehtimäki T, Nikus K, Oksala N, Tynkkynen J, Hernesniemi J. The association between GRACE score at admission for myocardial infarction and the incidence of sudden cardiac arrests in long-term follow-up - the MADDEC study. SCAND CARDIOVASC J 2024; 58:2335905. [PMID: 38557164 DOI: 10.1080/14017431.2024.2335905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Background. Sudden cardiac arrest (SCA), often also leading to sudden cardiac death (SCD), is a common complication in coronary artery disease. Despite the effort there is a lack of applicable prediction tools to identify those at high risk. We tested the association between the validated GRACE score and the incidence of SCA after myocardial infarction. Material and methods. A retrospective analysis of 1,985 patients treated for myocardial infarction (MI) between January 1st 2015 and December 31st 2018 and followed until the 31st of December of 2021. The main exposure variable was patients' GRACE score at the point of admission and main outcome variable was incident SCA after hospitalization. Their association was analyzed by subdistribution hazard (SDH) model analysis. The secondary endpoints included SCA in patients with no indication to implantable cardioverter-defibrillator (ICD) device and incident SCD. Results. A total of 1985 patients were treated for MI. Mean GRACE score at baseline was 118.7 (SD 32.0). During a median follow-up time of 5.3 years (IQR 3.8-6.1 years) 78 SCA events and 52 SCDs occurred. In unadjusted analyses one SD increase in GRACE score associated with over 50% higher risk of SCA (SDH 1.55, 95% CI 1.29-1.85, p < 0.0001) and over 40% higher risk for SCD (1.42, 1.12-1.79, p = 0.0033). The associations between SCA and GRACE remained statistically significant even with patients without indication for ICD device (1.57, 1.30-1.90, p < 0.0001) as well as when adjusting with patients LVEF and omitting the age from the GRACE score to better represent the severity of the cardiac event. The association of GRACE and SCD turned statistically insignificant when adjusting with LVEF. Conclusions. GRACE score measured at admission for MI associates with long-term risk for SCA.
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Affiliation(s)
- Markus Hautamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Juho Tynkkynen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
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Jain H, Marsool MDM, Odat RM, Noori H, Jain J, Shakhatreh Z, Patel N, Goyal A, Gole S, Passey S. Emergence of Artificial Intelligence and Machine Learning Models in Sudden Cardiac Arrest: A Comprehensive Review of Predictive Performance and Clinical Decision Support. Cardiol Rev 2024:00045415-990000000-00260. [PMID: 38836621 DOI: 10.1097/crd.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Sudden cardiac death/sudden cardiac arrest (SCD/SCA) is an increasingly prevalent cause of mortality globally, particularly in individuals with preexisting cardiac conditions. The ambiguous premortem warnings and the restricted interventional window related to SCD account for the complexity of the condition. Current reports suggest SCD to be accountable for 20% of all deaths hence accurately predicting SCD risk is an imminent concern. Traditional approaches for predicting SCA, particularly "track-and-trigger" warning systems have demonstrated considerable inadequacies, including low sensitivity, false alarms, decreased diagnostic liability, reliance on clinician involvement, and human errors. Artificial intelligence (AI) and machine learning (ML) models have demonstrated near-perfect accuracy in predicting SCA risk, allowing clinicians to intervene timely. Given the constraints of current diagnostics, exploring the benefits of AI and ML models in enhancing outcomes for SCA/SCD is imperative. This review article aims to investigate the efficacy of AI and ML models in predicting and managing SCD, particularly targeting accuracy in prediction.
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Affiliation(s)
- Hritvik Jain
- From the Department of Internal Medicine, All India Institte of Medical Sciences (AIIMS), Jodhpur, India
| | | | - Ramez M Odat
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamid Noori
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jyoti Jain
- From the Department of Internal Medicine, All India Institte of Medical Sciences (AIIMS), Jodhpur, India
| | - Zaid Shakhatreh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nandan Patel
- From the Department of Internal Medicine, All India Institte of Medical Sciences (AIIMS), Jodhpur, India
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shrey Gole
- Department of Immunology and Rheumatology, Stanford University, CA; and
| | - Siddhant Passey
- Department of Internal Medicine, University of Connecticut Health Center, CT
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Sasaki S, Fujisaki K, Nishimura M, Nakano T, Abe M, Hanafusa N, Joki N. Association Between Disturbed Serum Phosphorus Levels and QT Interval Prolongation. Kidney Int Rep 2024; 9:1792-1801. [PMID: 38899225 PMCID: PMC11184388 DOI: 10.1016/j.ekir.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction QT interval prolongation is a risk factor for fatal arrhythmias and other cardiovascular complications. QT interval prolongation in patients on hemodialysis (HD) is not well understood. Hypocalcemia is a suspected, but poorly verified etiology in these patients, and the association between serum phosphorus levels and QT interval prolongation is unknown. We sought to determine the prevalence of QT interval prolongation in patients on HD and to verify the association between predialysis serum calcium (Ca) and phosphate (P) levels and QT interval prolongation. Methods A cross-sectional study was conducted on adult patients on maintenance HD who were enrolled in the Japanese Society for Dialysis Therapy and Renal Data Registry 2019. After assessing patient characteristics, linear regression analysis was performed with predialysis serum Ca and P levels as exposures and a rate-corrected QT (QTc) interval as the outcome. Results A total of 204,530 patients were analyzed with a mean QTc of 451.2 (standard deviation, 36.9) ms. After multivariable analysis, estimated change in QTc (coefficients; 95% confidence interval) per 1 mg/dl increase in serum Ca and P was -2.02 (-3.00 to -1.04) and 5.50 (3.92-7.09), respectively. In the restricted cubic spline curve, estimated change in QTc increased with lower values of serum Ca. The correlation between serum P and QTc showed a U-shaped curve. Conclusion Decreased serum Ca levels and decreased and increased serum P levels may be associated with QT interval prolongation in patients on maintenance HD.
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Affiliation(s)
- Sho Sasaki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | | | | | - Toshiaki Nakano
- Department of Medical and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women`s Medical University, Tokyo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Weizman O, Gandjbakhch E, Magnin-Poull I, Proukhnitzky J, Bordet C, Palmyre A, Bloch A, Fressart V, Charron P. Molecular genetic screening after non-ischaemic sudden cardiac arrest and no overt cardiomyopathy in real life: A major tool for the aetiological diagnostic work-up. Arch Cardiovasc Dis 2024; 117:382-391. [PMID: 38670870 DOI: 10.1016/j.acvd.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND With the development of advanced sequencing techniques, genetic testing has emerged as a valuable tool for the work-up of non-ischaemic sudden cardiac arrest (SCA). AIMS To evaluate the effectiveness of genetic testing in patients with unexplained SCA, according to clinical phenotype. METHODS All patients who underwent molecular genetic testing for non-ischaemic SCA with no left ventricular cardiomyopathy between 2012 and 2021 in two French university hospitals were included. RESULTS Of 66 patients (mean age 36.7±11.9years, 54.5% men), 21 (31.8%; 95% confidence interval 22.4-45.3%) carried a genetic variant: eight (12.1%) had a pathogenic or likely pathogenic (P/LP) variant and 13 (19.7%) had a variant of uncertain significance (VUS). Among 37 patients (56.1%) with no phenotypic clues, genetic testing identified a P/LP variant in five (13.5%), mainly in RYR2 (n=3) and SCN5A (n=2), and a VUS in nine (24.3%). None of the nine patients with phenotypic evidence of channelopathies had P/LP variants, but two had VUS in RYR2 and NKX2.5. Among the 20 patients with suspected arrhythmogenic cardiomyopathy, three P/LP variants (15.0%) and two VUS (10.0%) were found in DSC2, PKP2, SCN5A and DSG2, TRPM4, respectively. Genetic testing was performed sooner after cardiac arrest (P<0.001) and results were obtained more rapidly (P=0.02) after versus before 2016. CONCLUSION This study highlights the utility of molecular genetic testing with a genetic variant of interest identified in one-third of patients with unexplained SCA. Genetic testing was beneficial even in patients without phenotypic clues, with one-fourth of patients carrying a P/LP variant that could have direct implications.
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Affiliation(s)
- Orianne Weizman
- Cardiology department, Nancy university hospital, Nancy, France; AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France.
| | - Estelle Gandjbakhch
- AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | | | - Julie Proukhnitzky
- AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | - Céline Bordet
- AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | - Aurélien Palmyre
- AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - Adrien Bloch
- AP-HP, Biochemistry department, molecular cardiogenetics unit, Pitié-Salpêtrière hospital, Paris, France
| | - Véronique Fressart
- AP-HP, Biochemistry department, molecular cardiogenetics unit, Pitié-Salpêtrière hospital, Paris, France
| | - Philippe Charron
- AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France; AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France.
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Zhang S, Liu W, Xu B, Wang S, Du Z, Cheng W. Association of triglyceride glucose index and triglyceride glucose-body mass index with sudden cardiac arrest in the general population. Cardiovasc Diabetol 2024; 23:173. [PMID: 38762473 PMCID: PMC11102616 DOI: 10.1186/s12933-024-02275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) significantly contributes to cardiovascular disease (CVD) development. Triglyceride glucose (TyG) index and triglyceride glucose-body mass index (TyG-BMI) are recognised as convenient proxies for IR. However, their relationship with sudden cardiac arrest (SCA) remains unclear. METHODS This prospective cohort analysis included 355,242 UK Biobank participants with available TyG index and TyG-BMI data and no history of CVD. Cox proportional risk models assessed the association between the TyG index, TyG-BMI and SCA risk. Additionally, Accelerated Failure Time (AFT) models were employed to investigate the timing of SCA onset. The impact of dynamic increases in TyG index and TyG-BMI levels on SCA risk was examined using restricted cubic spline. RESULTS Over a median follow-up period of 165.4 months (interquartile range 156.5-174 months), 1,622 cases of SCA were recorded. Multivariate Cox regression analysis revealed a 9% increase in SCA risk per standard deviation increase in TyG index (adjusted hazard ratio (aHR) = 1.09, 95% confidence interval (CI) 1.04-1.15) and an 14% increase per standard deviation increase in TyG-BMI (aHR 1.14, 95% CI 1.09-1.2). AFT models indicated earlier median times to SCA occurrence with increasing quintiles of TyG index and TyG-BMI compared to the lowest quintile (P for trend < 0.05). SCA risk was linearly (P = 0.54) and non-linearly (P = 0.007) correlated with gradual increases in TyG index and TyG-BMI levels, respectively. Sex-stratified analyses showed stronger associations in women. CONCLUSIONS Higher TyG index and TyG-BMI levels are associated with an increased SCA risk and earlier onset, particularly in women.
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Affiliation(s)
- Shuijing Zhang
- The Affiliated Rehabilitation Hospital (Zhejiang Rehabilitation Medical Center)Zhejiang Chinese Medical University, Hangzhou, 310053, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Wenbing Liu
- The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Bin Xu
- The Affiliated Rehabilitation Hospital (Zhejiang Rehabilitation Medical Center)Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Shuguang Wang
- Zhejiang Greentown Cardiovascular Hospital, Hangzhou, 310053, China
| | - Zhongyan Du
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
- Key Laboratory of Blood-Stasis-Toxin Syndrome of Zhejiang Province, Hangzhou, 310053, China.
- Zhejiang Engineering Research Center for "Preventive Treatment" Smart Health of Traditional Chinese Medicine, Hangzhou, 310053, China.
| | - Wenke Cheng
- Medical Faculty, University of Leipzig, Liebigstr 27, Leipzig, 04103, Germany.
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Laurita KR, Piktel JS, Irish L, Nassal M, Cheng A, McCauley M, Pawlowski G, Dennis AT, Suen Y, Almahameed S, Ziv O, Gourdie RG, Wilson LD. Spontaneous Repolarization Alternans Causes VT/VF Rearrest That Is Suppressed by Preserving Gap Junctions. JACC Clin Electrophysiol 2024:S2405-500X(24)00262-7. [PMID: 38752959 DOI: 10.1016/j.jacep.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Ventricular tachycardia (VT)/ventricular fibrillation (VF) rearrest after successful resuscitation is common, and survival is poor. A mechanism of VT/VF, as demonstrated in ex vivo studies, is when repolarization alternans becomes spatially discordant (DIS ALT), which can be enhanced by impaired gap junctions (GJs). However, in vivo spontaneous DIS ALT-induced VT/VF has never been demonstrated, and the effects of GJ on DIS ALT and VT/VF rearrest are unknown. OBJECTIVES This study aimed to determine whether spontaneous VT/VF rearrest induced by DIS ALT occurs in vivo, and if it can be suppressed by preserving Cx43-mediated GJ coupling and/or connectivity. METHODS We used an in vivo porcine model of resuscitation from ischemia-induced cardiac arrest combined with ex vivo optical mapping in porcine left ventricular wedge preparations. RESULTS In vivo, DIS ALT frequently preceded VT/VF and paralleled its incidence at normal (37°C, n = 9) and mild hypothermia (33°C, n = 8) temperatures. Maintaining GJs in vivo with rotigaptide (n = 10) reduced DIS ALT and VT/VF incidence, especially during mild hypothermia, by 90% and 60%, respectively (P < 0.001; P < 0.013). Ex vivo, both rotigaptide (n = 5) and αCT11 (n = 7), a Cx43 mimetic peptide that promotes GJ connectivity, significantly reduced DIS ALT by 60% and 100%, respectively (P < 0.05; P < 0.005), and this reduction was associated with reduced intrinsic heterogeneities of action potential duration rather than changes in conduction velocity restitution. CONCLUSIONS These results provide the strongest in vivo evidence to date suggesting a causal relationship between spontaneous DIS ALT and VT/VF in a clinically realistic scenario. Furthermore, our results suggest that preserving GJs during resuscitation can suppress VT/VF rearrest.
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Affiliation(s)
- Kenneth R Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Joseph S Piktel
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Laken Irish
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michelle Nassal
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aurelia Cheng
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew McCauley
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gary Pawlowski
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adrienne T Dennis
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yi Suen
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Soufian Almahameed
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ohad Ziv
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert G Gourdie
- Fralin Biomedical Research Institute, Virginia Tech University, Roanoke, Virginia, USA
| | - Lance D Wilson
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
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Mascarenhas L, Downey M, Schwartz G, Adabag S. Antiarrhythmic effects of metformin. Heart Rhythm O2 2024; 5:310-320. [PMID: 38840768 PMCID: PMC11148504 DOI: 10.1016/j.hroo.2024.04.003] [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] [Indexed: 06/07/2024] Open
Abstract
Atrial fibrillation/flutter (AF) is a major public health problem and is associated with stroke, heart failure, dementia, and death. It is estimated that 20%-30% of Americans will develop AF at some point in their life. Current medications to prevent AF have limited efficacy and significant adverse effects. Newer and safer therapies to prevent AF are needed. Ventricular arrhythmias are less prevalent than AF but may have significant consequences including sudden cardiac death. Metformin is the most prescribed, first-line medication for treatment of diabetes mellitus (DM). It decreases hepatic glucose production but also reduces inflammation and oxidative stress. Experimental studies have shown that metformin improves metabolic, electrical, and histologic risk factors associated with AF and ventricular arrhythmias. Furthermore, in large clinical observational studies, metformin has been associated with a reduced risk of AF in people with DM. These data suggest that metformin may have antiarrhythmic properties and may be a candidate to be repurposed as a medication to prevent cardiac arrhythmias. In this article, we review the clinical observational and experimental evidence for the association between metformin and cardiac arrhythmias. We also discuss the potential antiarrhythmic mechanisms underlying this association. Repurposing a well-tolerated, safe, and inexpensive medication to prevent cardiac arrhythmias has significant positive public health implications.
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Affiliation(s)
- Lorraine Mascarenhas
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael Downey
- Department of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Gregory Schwartz
- Cardiology Section, Rocky Mountain Regional VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado
| | - Selcuk Adabag
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Cardiology, Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota
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Roshanbinfar K, Schiffer M, Carls E, Angeloni M, Koleśnik-Gray M, Schruefer S, Schubert DW, Ferrazzi F, Krstić V, Fleischmann BK, Roell W, Engel FB. Electrically Conductive Collagen-PEDOT:PSS Hydrogel Prevents Post-Infarct Cardiac Arrhythmia and Supports hiPSC-Cardiomyocyte Function. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2403642. [PMID: 38653478 DOI: 10.1002/adma.202403642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Indexed: 04/25/2024]
Abstract
Myocardial infarction (MI) causes cell death, disrupts electrical activity, triggers arrhythmia, and results in heart failure, whereby 50-60% of MI-associated deaths manifest as sudden cardiac deaths (SCD). The most effective therapy for SCD prevention is implantable cardioverter defibrillators (ICDs). However, ICDs contribute to adverse remodeling and disease progression and do not prevent arrhythmia. This work develops an injectable collagen-PEDOT:PSS (poly(3,4-ethylenedioxythiophene) polystyrene sulfonate) hydrogel that protects infarcted hearts against ventricular tachycardia (VT) and can be combined with human induced pluripotent stem cell (hiPSC)-cardiomyocytes to promote partial cardiac remuscularization. PEDOT:PSS improves collagen gel formation, micromorphology, and conductivity. hiPSC-cardiomyocytes in collagen-PEDOT:PSS hydrogels exhibit near-adult sarcomeric length, improved contractility, enhanced calcium handling, and conduction velocity. RNA-sequencing data indicate enhanced maturation and improved cell-matrix interactions. Injecting collagen-PEDOT:PSS hydrogels in infarcted mouse hearts decreases VT to the levels of healthy hearts. Collectively, collagen-PEDOT:PSS hydrogels offer a versatile platform for treating cardiac injuries.
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Affiliation(s)
- Kaveh Roshanbinfar
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Miriam Schiffer
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Germany
| | - Esther Carls
- Department of Cardiac Surgery, UKB, University of Bonn, Germany
| | - Miriam Angeloni
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Maria Koleśnik-Gray
- Department of Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Staudtstr. 7, 91058, Erlangen, Germany
| | - Stefan Schruefer
- Institute of Polymer Materials, Department of Materials Science and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Martensstr. 7, 91058, Erlangen, Germany
| | - Dirk W Schubert
- Institute of Polymer Materials, Department of Materials Science and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Martensstr. 7, 91058, Erlangen, Germany
| | - Fulvia Ferrazzi
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Muscle Research Center Erlangen (MURCE), 91054, Erlangen, Germany
| | - Vojislav Krstić
- Department of Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Staudtstr. 7, 91058, Erlangen, Germany
| | - Bernd K Fleischmann
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Germany
| | - Wilhelm Roell
- Department of Cardiac Surgery, UKB, University of Bonn, Germany
| | - Felix B Engel
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
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Zuin M, Overvad TF, Albertsen IE, Bilato C, Piazza G. Trends of Pulmonary Embolism-Related Sudden Cardiac Death in the United States, 1999-2019. J Thromb Thrombolysis 2024; 57:483-491. [PMID: 38281229 DOI: 10.1007/s11239-024-02946-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Up-to-date population-based data on pulmonary embolism (PE)-related sudden cardiac death (SCD) mortality trends in the United States (US) are scant. We assess the current trends in PE-related SCD mortality in US over the past two decades and determine differences by sex, race, ethnicity, age, and census region. METHODS We extracted PE-related SCD mortality rates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2019, in patients aged ≥ 15 years old. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modeling and expressed as estimated average annual percentage change (AAPC) with relative 95% confidence intervals (CIs). RESULTS Between 1999 and 2019, the AAMR from acute PE-related SCD mortality in the US linearly increased [AAPC: +2.4% (95% CI: 2.2 to 2.6), p < 0.001)]. The AAMR increase was more pronounced in men [AAPC: +2.8% (95% CI: 2.6 to 2.9), p < 0.001], Whites [AAPC: +2.7% (95% CI: 2.3 to 3.1), p < 0.001], Latinx/Hispanic patients [AAPC:+2.0% (95% CI: 1.2 to 2.8), p < 0.001], subjects younger than 65 years [AAPC: +2.4% (95% CI: 2.1 to 2.6), p < 0.001] and in residents of rural areas [AAPC: +3.6% (95% CI: 3.3 to 3.9), p < 0.001]. Moreover, higher percentages of PE-related SCD and the relative absolute number of deaths were observed in the South compared with other geographical regions. CONCLUSIONS PE-related SCD mortality in the US has increased over the last two decades. Stratification by race, ethnicity, urbanization, and census region demonstrates ethnoracial and regional disparities that require further investigation and remedy.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
| | | | - Ida Ehlers Albertsen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gregory Piazza
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Adabag S, Gravely A, Kattel S, Buelt-Gebhardt M, Westanmo A. QT prolongation predicts all-cause mortality above and beyond a validated risk score. J Electrocardiol 2024; 83:1-3. [PMID: 38160528 DOI: 10.1016/j.jelectrocard.2023.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION QT prolongation is a risk factor for life-threatening arrhythmias and sudden cardiac death. In large cohorts, QT interval was associated with all-cause mortality, but these analyses may contain residual confounding. Whether the QT interval provides prognostic information above and beyond a validated mortality risk score is unknown. We hypothesized that QT interval on ECG will independently predict mortality after adjustment for the Care Assessment Needs (CAN) score, which was validated to predict mortality nationwide at the Veterans Administration (VA) (c-index 0.86). METHODS Outpatients with an ECG at the Minneapolis VA from 2012 to 2016 were included in this retrospective cohort study. ECGs with ventricular rate < 50 or > 100 beats/min and those with QRS > 120 ms were excluded. QT intervals were corrected (QTc) using the Bazett's formula. CAN score, calculated within 1-week of the ECG, was obtained from the VA Corporate Data Warehouse. RESULTS Of the 31,201 patients, 427 (1.4%) had QTc ≥ 500 ms, 1799 (5.8%) had QTc 470-500 ms and 28,975 (92.9%) had QTc < 470 ms. Compared to those with QTc < 470 ms, CAN-adjusted odds ratios (OR) for 1-year mortality (1.76 for QTc 470-500 and 2.70 for QTc > 500 ms; p < 0.0001 for both) and for 5-year mortality (1.75 for QTc 470-500 and 2.48 for QTc > 500 ms; p < 0.0001 for both) were significantly higher in those with longer QTc. C-index for CAN score and QTc predicting 1-year mortality was 0.837. CONCLUSIONS QT prolongation predicts all-cause mortality independently of a validated mortality risk prediction score.
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Affiliation(s)
- Selçuk Adabag
- Division of Cardiology, Minneapolis VA Health Care System, Minneapolis, MN, United States of America; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America.
| | - Amy Gravely
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Sharma Kattel
- Division of Cardiology, Minneapolis VA Health Care System, Minneapolis, MN, United States of America; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Melissa Buelt-Gebhardt
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Anders Westanmo
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, United States of America
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11
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Karim S, Chahal CAA, Sherif AA, Khanji MY, Scott CG, Chamberlain AM, Geske JB, Ommen SR, Gersh BJ, Somers VK, Brady PA, Lin G. Re-evaluating the Incidence and Prevalence of Clinical Hypertrophic Cardiomyopathy: An Epidemiological Study of Olmsted County, Minnesota. Mayo Clin Proc 2024; 99:362-374. [PMID: 38323940 DOI: 10.1016/j.mayocp.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To contemporaneously reappraise the incidence-rate, prevalence, and natural history of hypertrophic cardiomyopathy (HCM) in Olmsted County, Minnesota, from 1984 to 2015. PATIENTS AND METHODS A validated medical-record linkage system collecting information for residents of Olmsted County was used to identify all cases of HCM between January 1, 1984, and December 31, 2015. After adjudication of records from Mayo Clinic and Olmsted Medical Center, data relating to diagnoses and outcomes were abstracted. The calculated incidence rate and prevalence were standardized to the US 1980 White population (age- and sex-adjusted) and compared with a prior study examining the years 1975-1984. RESULTS Two hundred seventy subjects with HCM were identified. The age- and sex-adjusted incidence rate was 6.6 per 100,000 person-years, and the point prevalence of HCM on January 1, 2016, was 89 per 100,000 population. The incidence rate and point prevalence of HCM on January 1, 2016, standardized to the US 1980 White population (age- and sex-adjusted), were 6.7 (95% CI, 7.1 to 8.8) per 100,000 person-years and 81.5 per 100,000 population, respectively. The incidence rate of HCM increased each decade since the index study. Individuals with HCM had a higher overall standardized mortality rate than the general population with an observed to expected HR of 1.44 (95% CI, 1.21 to 1.71; P<.001) which improved by each decade. CONCLUSION The incidence and prevalence of HCM are higher than rates reported from a prior study in the same community examining the years 1975-1984, but lower than other study cohorts. The risk of mortality in HCM remains higher than expected, albeit with improvement in rates of mortality observed each decade during the study period.
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Affiliation(s)
- Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, UK
| | - C Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, UK; University of Pennsylvania, Pennsylvania, USA; Center for Inherited Cardiovascular Disease, WellSpan Health, Lancaster, PA, USA
| | - Akil A Sherif
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK; Newham University Hospital, Barts Health NHS Trust, London, UK
| | | | - Alanna M Chamberlain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter A Brady
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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12
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Nyman M, Stølen TO, Johnsen AB, Garten K, Burton FL, Smith GL, Loennechen JP. A comprehensive protocol combining in vivo and ex vivo electrophysiological experiments in an arrhythmogenic animal model. Am J Physiol Heart Circ Physiol 2024; 326:H203-H215. [PMID: 37975708 DOI: 10.1152/ajpheart.00358.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
Ventricular arrhythmias contribute significantly to cardiovascular mortality, with coronary artery disease as the predominant underlying cause. Understanding the mechanisms of arrhythmogenesis is essential to identify proarrhythmic factors and develop novel approaches for antiarrhythmic prophylaxis and treatment. Animal models are vital in basic research on cardiac arrhythmias, encompassing molecular, cellular, ex vivo whole heart, and in vivo models. Most studies use either in vivo protocols lacking important information on clinical relevance or exclusively ex vivo protocols, thereby missing the opportunity to explore underlying mechanisms. Consequently, interpretation may be difficult due to dissimilarities in animal models, interventions, and individual properties across animals. Moreover, proarrhythmic effects observed in vivo are often not replicated in corresponding ex vivo preparations during mechanistic studies. We have established a protocol to perform both an in vivo and ex vivo electrophysiological characterization in an arrhythmogenic rat model with heart failure following myocardial infarction. The same animal is followed throughout the experiment. In vivo methods involve intracardiac programmed electrical stimulation and external defibrillation to terminate sustained ventricular arrhythmia. Ex vivo methods conducted on the Langendorff-perfused heart include an electrophysiological study with optical mapping of regional action potentials, conduction velocities, and dispersion of electrophysiological properties. By exploring the retention of the in vivo proarrhythmic phenotype ex vivo, we aim to examine whether the subsequent ex vivo detailed measurements are relevant to in vivo pathological behavior. This protocol can enhance greater understanding of cardiac arrhythmias by providing a standardized, yet adaptable model for evaluating arrhythmogenicity or antiarrhythmic interventions in cardiac diseases.NEW & NOTEWORTHY Rodent models are widely used in arrhythmia research. However, most studies do not standardize clinically relevant in vivo and ex vivo techniques to support their conclusions. Here, we present a comprehensive electrophysiological protocol in an arrhythmogenic rat model, connecting in vivo and ex vivo programmed electrical stimulation with optical mapping. By establishing this protocol, we aim to facilitate the adoption of a standardized model for investigating arrhythmias, enhancing research rigor and comparability in this field.
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Affiliation(s)
- Mathias Nyman
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Tomas O Stølen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Berit Johnsen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin Garten
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Francis L Burton
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Godfrey L Smith
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Jan Pål Loennechen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
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13
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Bakker AM, Albrecht M, Verkaik BJ, de Jonge RCJ, Buysse CMP, Blom NA, Rammeloo LAJ, Verhagen JMA, Riedijk MA, Yap SC, Tan HL, Kammeraad JAE. Sudden cardiac arrest in infants and children: proposal for a diagnostic workup to identify the etiology. An 18-year multicenter evaluation in the Netherlands. Eur J Pediatr 2024; 183:335-344. [PMID: 37889292 PMCID: PMC10858117 DOI: 10.1007/s00431-023-05301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
Sudden cardiac arrest (SCA) studies are often population-based, limited to sudden cardiac death, and excluding infants. To guide prevention opportunities, it is essential to be informed of pediatric SCA etiologies. Unfortunately, etiologies frequently remain unresolved. The objectives of this study were to determine paediatric SCA etiology, and to evaluate the extent of post-SCA investigations and to assess the performance of previous cardiac evaluation in detecting conditions predisposing to SCA. In a retrospective cohort (2002-2019), all children 0-18 years with out-of-hospital cardiac arrest (OHCA) referred to Erasmus MC Sophia Children's Hospital or the Amsterdam UMC (tertiary-care university hospitals), with cardiac or unresolved etiologies were eligible for inclusion. SCA etiologies, cardiac and family history and etiologic investigations in unresolved cases were assessed. The etiology of arrest could be determined in 52% of 172 cases. Predominant etiologies in children ≥ 1 year (n = 99) were primary arrhythmogenic disorders (34%), cardiomyopathies (22%) and unresolved (32%). Events in children < 1 year (n = 73) were largely unresolved (70%) or caused by cardiomyopathy (8%), congenital heart anomaly (8%) or myocarditis (7%). Of 83 children with unresolved etiology a family history was performed in 51%, an autopsy in 51% and genetic testing in 15%. Pre-existing cardiac conditions presumably causative for SCA were diagnosed in 9%, and remained unrecognized despite prior evaluation in 13%. CONCLUSION SCA etiology remained unresolved in 83 of 172 cases (48%) and essential diagnostic investigations were often not performed. Over one-fifth of SCA patients underwent prior cardiac evaluation, which did not lead to recognition of a cardiac condition predisposing to SCA in all of them. The diagnostic post-SCA approach should be improved and the proposed standardized pediatric post-SCA diagnostics protocol may ensure a consistent and systematic evaluation process increasing the diagnostic yield. WHAT IS KNOWN • Arrests in infants remain unresolved in most cases. In children > 1 year, predominant etiologies are primary arrhythmia disorders, cardiomyopathy and myocarditis. • Studies investigating sudden cardiac arrest are often limited to sudden cardiac death (SCD) in 1 to 40 year old persons, excluding infants and successfully resuscitated children. WHAT IS NEW • In patients with unresolved SCA events, the diagnostic work up was often incompletely performed. • Over one fifth of victims had prior cardiac evaluation before the arrest, with either a diagnosed cardiac condition (9%) or an unrecognized cardiac condition (13%).
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Affiliation(s)
- Ashley M Bakker
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands
| | - Marijn Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bas J Verkaik
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Corinne M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nico A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Lukas A J Rammeloo
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maaike A Riedijk
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sing C Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Hanno L Tan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands.
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Biehl A, Taube M, Kotloski RJ, Kopacek K, Jones J, Gidal BE. Lamotrigine use and potential for adverse cardiac effects: A retrospective evaluation in a Veteran population. Epilepsy Behav 2023; 149:109496. [PMID: 37925869 DOI: 10.1016/j.yebeh.2023.109496] [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: 07/13/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To identify the impact of lamotrigine (LTG) on cardiac rhythm and conduction abnormalities for Veterans, an especially vulnerable population. BACKGROUND In October 2020 the US Food and Drug Administration (FDA) added a new warning to the label of lamotrigine (Lamictal™) regarding its potential to cause cardiac rhythm and conduction abnormalities [1]. This warning came following in vitro data which suggested Class IB antiarrhythmic effects occurring at clinically achievable concentrations of lamotrigine [2]. However, it is unclear whether the in vitro findings will result in adverse clinical outcomes. Our objective was to assess for evidence for adverse clinical outcomes in a vulnerable population and examine for subtler signs of an association between lamotrigine and cardiac rhythm disturbances. METHODS A retrospective chart review was conducted using records between 10-01-2017 and 07-06-2021, identifying patients at the William S. Middleton Memorial Veterans Hospital who were prescribed lamotrigine. Data collected included: dates of lamotrigine initiation or discontinuation, lamotrigine dosing over the time of the prescription and maximum lamotrigine dose, any cardiac-related ICD-10-CM codes or a history of a cardiology appointment, EKGs with any abnormalities or changes, any concomitantly prescribed medications with known potential to cause cardiac abnormalities, any cardiac deaths. This retrospective chart review was approved by the University of Wisconsin-Madison Institutional Review Board. RESULTS Two hundred and thirty-three (189 male) patients with a lamotrigine prescription and 41.2 % (n = 96) of these patients had an EKG performed while prescribed lamotrigine. The average age of patients was 64.3 ± 13.0 (range 29 to 90) years and mean maximum lamotrigine daily dose was 250.8 ± 148.2 mg (range 25 to 800 mg). Nearly half (47.9 %, 46/96) of the patients were prescribed a concomitant sodium channel blocking medication in addition to lamotrigine. Eighty-four of the patients (87.5 %, 84/96) had a cardiac diagnosis, while 12 (12.5 %, 12/96) did not. A total of 12 deaths occurred within the review period, with two cardiac deaths from congestive heart failure. Four cases did not have information on cause of death. No LTG-associated cardiac adverse effects were noted as part of clinical care, though rash was noted in 5 cases. A total of 7 (7.3 %, 7/96) patients were found to have EKG abnormalities potentially related to lamotrigine, including 7.1 % (6/84) of those with a cardiac diagnosis and 8.3 % (1/12) of those without a cardiac diagnosis. CONCLUSIONS While recent FDA warnings have suggested caution regarding cardiac complications associated with lamotrigine based on in vitro studies, the clinical implications are uncertain. Despite selecting a particularly vulnerable population, this retrospective chart review did not identify any deaths due to cardiac rhythm or conduction causes, nor demonstrate unambiguous cardiac complications related to lamotrigine. Even using permissive criteria (including any prolonged PR or QTc) to examine for subtle effects, only a low incidence (<10 %) of potential complications was found. Broader implications of this study are limited by the number of patients included and the retrospective nature of the study. Therefore, further studies are warranted to evaluate a link between cardiac complications and the use of lamotrigine, including the role of concomitant medications such as other sodium channel blocking agents and psychotropic medications.
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Affiliation(s)
- Alexis Biehl
- Wm. S. Middleton Memorial Veterans Hospital, Department of Pharmacy, 2500 Overlook Terrace, Madison, WI 53705, United States; University of Wisconsin School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States
| | - Maralena Taube
- Wm. S. Middleton Memorial Veterans Hospital, Department of Pharmacy, 2500 Overlook Terrace, Madison, WI 53705, United States
| | - Robert J Kotloski
- Wm. S. Middleton Memorial Veterans Hospital, Department of Neurology, 2500 Overlook Terrace, Madison, WI 53705, United States
| | - Karen Kopacek
- University of Wisconsin School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States
| | - John Jones
- Wm. S. Middleton Memorial Veterans Hospital, Department of Neurology, 2500 Overlook Terrace, Madison, WI 53705, United States
| | - Barry E Gidal
- University of Wisconsin School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
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15
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Jung E, Park JH, Ro YS, Ryu HH, Cha KC, Do Shin S, Hwang SO. Family history, socioeconomic factors, comorbidities, health behaviors, and the risk of sudden cardiac arrest. Sci Rep 2023; 13:21341. [PMID: 38049526 PMCID: PMC10696087 DOI: 10.1038/s41598-023-48357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023] Open
Abstract
Genetic, environment, and behaviour factors have a role in causing sudden cardiac arrest (SCA). We aimed to determine the strength of the association between various risk factors and SCA incidence. We conducted a multicentre case-control study at 17 hospitals in Korea from September 2017 to December 2020. The cases included out-of-hospital cardiac arrest aged 19-79 years with presumed cardiac aetiology. Community-based controls were recruited at a 1:1 ratio after matching for age, sex, and urban residence level. Multivariable conditional logistic regression analysis was conducted. Among the 1016 cases and 1731 controls, 948 cases and 948 controls were analysed. A parental history of SCA, low educational level, own heart disease, current smoking, and non-regular exercise were associated with SCA incidence (Adjusted odds ratio [95% confidence interval]: 2.51 [1.48-4.28] for parental history of SCA, 1.37 [1.38-2.25] for low edication level, 3.77 [2.38-5.90] for non-coronary artery heart disease, 4.47 [2.84-7.03] for coronary artery disease, 1.39 [1.08-1.79] for current smoking, and 4.06 [3.29-5.02] for non-regular exercise). Various risk factors related to genetics, environment, and behaviour were independently associated with the incidence of SCA. Establishing individualised SCA prevention strategies in addition to general prevention strategies is warranted.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea.
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Leo WZ, Chua D, Tan HC, Ho VK. Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study. Sci Rep 2023; 13:19852. [PMID: 37964016 PMCID: PMC10645752 DOI: 10.1038/s41598-023-46862-x] [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: 06/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.
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Affiliation(s)
- Wen Zhe Leo
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Damien Chua
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Hui Cheng Tan
- Department of Clinical Governance, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
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Makino T, Ichikawa T, Amino M, Nakamura M, Koshikawa M, Motoike Y, Nomura Y, Harada M, Sobue Y, Watanabe E, Kiyono K, Yoshioka K, Ikari Y, Ozaki Y, Izawa H. Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome-TWIST study. Ann Noninvasive Electrocardiol 2023; 28:e13069. [PMID: 37740449 PMCID: PMC10646380 DOI: 10.1111/anec.13069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/02/2023] [Accepted: 06/22/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND We aimed to investigate the association between ventricular repolarization instability and sustained ventricular tachycardia and ventricular fibrillation (VT/VF) occurring within 48 h (acute-phase VT/VF) after the onset of acute coronary syndrome (ACS) and the prognostic role of repolarization instability and heart rate variability (HRV) after discharge from the hospital. METHODS We studied 572 ACS patients with a left ventricular ejection fraction >35%. The ventricular repolarization instability was assessed by the beat-to-beat T-wave amplitude variability (TAV) using high-resolution 24-h Holter ECGs recorded at a median of 11 days from the date of admission. We calculated the HRV parameters including the deceleration capacity (DC) and non-Gaussian index calculated on a 25 s timescale (λ25s). The DC and λ25s were dichotomized based on previous studies' thresholds. RESULTS Acute-phase VT/VF developed in 43 (7.5%) patients. In-hospital mortality was significantly higher among VT/VF patients (4.7% vs. 0.9%, p = .03). An adjusted logistic model showed that the maximum TAV (odds ratio 1.02, 95% confidence interval [CI] 1.00-1.29, p = .04) was associated with acute-phase VT/VF. During a median follow-up period of 2.1 years, 19 (3.3%) patients had cardiac deaths or resuscitated cardiac arrest. Acute-phase VT/VF (p = .12) and TAV (p = .72) were not significant predictors of survival. An age and sex-adjusted Cox model showed that the DC (p < .01), λ25s (p < .01), and emergency coronary intervention (p < .01) were independent predictors. CONCLUSION T-wave amplitude variability was associated with acute-phase VT/VF, but the TAV was not predictive of survival post-discharge. The DC, λ25s, and emergency coronary intervention were independent predictors of survival.
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Affiliation(s)
- Taro Makino
- Department of CardiologyHekinan City HospitalHekinanJapan
| | | | - Mari Amino
- Department of Cardiovascular MedicineTokai University School of MedicineIseharaJapan
| | - Mari Nakamura
- Department of Cardiovascular MedicineTokai University School of MedicineIseharaJapan
| | - Masayuki Koshikawa
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Yuji Motoike
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Yoshihiro Nomura
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Masahide Harada
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Yoshihiro Sobue
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
| | - Ken Kiyono
- Division of Bioengineering, Graduate School of Engineering ScienceOsaka UniversityToyonakaJapan
| | - Koichiro Yoshioka
- Department of Cardiovascular MedicineTokai University School of MedicineIseharaJapan
| | - Yuji Ikari
- Department of Cardiovascular MedicineTokai University School of MedicineIseharaJapan
| | - Yukio Ozaki
- Division of Cardiology, Department of Internal MedicineFujita Health University Okazaki Medical CenterOkazakiJapan
| | - Hideo Izawa
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
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18
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Pontone G, Guaricci AI, Fusini L, Baggiano A, Guglielmo M, Muscogiuri G, Volpe A, Abete R, Aquaro G, Barison A, Bogaert J, Camastra G, Carigi S, Carrabba N, Casavecchia G, Censi S, Cicala G, De Cecco CN, De Lazzari M, Di Giovine G, Di Roma M, Dobrovie M, Focardi M, Gaibazzi N, Gismondi A, Gravina M, Lanzillo C, Lombardi M, Lorenzoni V, Lozano-Torres J, Martini C, Marzo F, Masi A, Memeo R, Moro C, Nese A, Palumbo A, Pavon AG, Pedrotti P, Marra MP, Pica S, Pradella S, Presicci C, Rabbat MG, Raineri C, Rodriguez-Palomares JF, Sbarbati S, Schoepf UJ, Squeri A, Sverzellati N, Symons R, Tat E, Timpani M, Todiere G, Valentini A, Varga-Szemes A, Masci PG, Schwitter J. Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry. JACC Cardiovasc Imaging 2023; 16:1387-1400. [PMID: 37227329 DOI: 10.1016/j.jcmg.2023.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. OBJECTIVES The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. METHODS A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. RESULTS During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). CONCLUSIONS The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.
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Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | | | - Raffaele Abete
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Giovanni Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Andrea Barison
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | | | - Samuela Carigi
- Department of Cardiology, Infermi Hospital, Rimini, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department, Careggi Hospital, Florence, Italy
| | - Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Censi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Gloria Cicala
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Emory University, Atlanta, Georgia, USA
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | | | - Mauro Di Roma
- Radiology Department, Policlinico Casilino, Rome, Italy
| | - Monica Dobrovie
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Annalaura Gismondi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Jordi Lozano-Torres
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red-CV, CIBER CV, Spain
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Ambra Masi
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Memeo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Claudio Moro
- Department of Cardiology, ASST Monza, P.O. Desio, Italy
| | - Alberto Nese
- Dipartimento Neuro-Cardiovascolare, Ospedale Ca' Foncello Treviso, Treviso, Italy
| | - Alessandro Palumbo
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Giulia Pavon
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
| | - Patrizia Pedrotti
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Cristina Presicci
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois, USA; Edward Hines Jr VA Hospital, Hines, Illinois, USA
| | - Claudia Raineri
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - José F Rodriguez-Palomares
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red-CV, CIBER CV, Spain
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rolf Symons
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Emily Tat
- Loyola University of Chicago, Chicago, Illinois, USA
| | - Mauro Timpani
- U.O.C. Radiologia, "F. Spaziani" Hospital, Frosinone, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Juerg Schwitter
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland; Faculty of Medicine and Biology, University of Lausanne, UniL, Lausanne, Switzerland
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19
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Kutlu E, Avci E, Acar K. Postmortem biochemistry in deaths from ischemic heart disease. J Forensic Leg Med 2023; 100:102599. [PMID: 37839363 DOI: 10.1016/j.jflm.2023.102599] [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: 06/20/2023] [Revised: 09/05/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
Ischemic heart disease (IHD) is one of the leading causes of morbidity and sudden cardiac death worldwide and is an important public health problem. The presence of ischemia in clinical applications can be detected by ECG, biochemical markers, and radiological methods. Myocardial infarction is also frequently encountered in forensic autopsies. Postmortem diagnosis is determined as a result of histopathological examinations and additional exclusionary examinations (toxicology, microbiology, etc.). However, routine histopathological examinations are insufficient, especially when death occurs in the early period of ischemia. It creates a problem for forensic pathologists and forensic medicine specialists in such cases of sudden cardiac death. Postmortem biochemistry is one of the important and promising disciplines in which forensic applications work in order to diagnose these cases correctly. The issue of whether biomarkers used in the diagnosis of myocardial infarction in clinical studies can be used reliably in postmortem cases has been discussed by forensic medicine researchers for some time. This manuscript aims to review and summarize biomarkers belonging to various categories that have been studied in IHD-related deaths, in biological fluids taken at autopsy, or in animal experiments. Our study shows that the postmortem use of biochemical markers in the diagnosis of IHD yields promising results. However, it should not be forgotten that postmortem biochemistry is different from clinical applications due to its dynamics and that the body causes unpredictable changes in markers in the postmortem process. Therefore, comprehensive studies are needed to evaluate the postmortem stability of these markers in different biological fluids, their significance among various causes of death, and whether they are affected by any variable (Cardiopulmonary resuscitation, Postmortem interval, medications, etc.) before they are routinely applied. It is suggested by the authors that the cut-off values of biomarkers whose significance has been proven by these studies should be determined and that they should be used in this way in routine applications.
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Affiliation(s)
- Erdi Kutlu
- Department of Forensic Medicine, Ministry of Health Harakani State Hospital, Kars, Turkey.
| | - Esin Avci
- Department of Biochemistry, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Kemalettin Acar
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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20
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Gómez-Mesa JE, Márquez-Murillo M, Figueiredo M, Berni A, Jerez AM, Núñez-Ayala E, Pow-Chon F, Sáenz-Morales LC, Pava-Molano LF, Montes MC, Garillo R, Galindo-Coral S, Reyes-Caorsi W, Speranza M, Romero A. Inter-American Society of Cardiology (CIFACAH-ELECTROSIAC) and Latin-American Heart Rhythm Society (LAHRS): multidisciplinary review on the appropriate use of implantable cardiodefibrillator in heart failure with reduced ejection fraction. J Interv Card Electrophysiol 2023; 66:1211-1229. [PMID: 36469237 PMCID: PMC10333140 DOI: 10.1007/s10840-022-01425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Our main objective was to present a multidisciplinary review on the epidemiology of sudden cardiac death (SCD) and the tools that could be used to identify malignant ventricular arrhythmias (VAs) and to perform risk stratification. In addition, indications and contraindications for the use of implantable cardioverter defibrillator (ICD) in general and in special populations including the elderly and patients with chronic kidney disease (CKD) are also given. METHODS An expert group from the Inter American Society of Cardiology (IASC), through their HF Council (CIFACAH) and Electrocardiology Council (ElectroSIAC), together with the Latin American Heart Rhythm Society (LAHRS), reviewed and discussed the literature regarding the appropriate use of an ICD in people with heart failure (HF) with reduced ejection fraction (HFpEF). Indications and contraindications for the use of ICD are presented in this multidisciplinary review. RESULTS Numerous clinical studies have demonstrated the usefulness of ICD in both primary and secondary prevention of SCD in HFpEF. There are currently precise indications and contraindications for the use of these devices. CONCLUSIONS In some Latin American countries, a low rate of implantation is correlated with low incomes, but this is not the case for all Latin America. Determinants of the low rates of ICD implantation in many Latin American countries are still a matter of research. VA remains one of the most common causes of cardiovascular death associated with HFrEF and different tools are available for stratifying the risk of SCD in this population.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia.
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico.
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico.
| | - Manlio Márquez-Murillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
| | - Marcio Figueiredo
- University of Campinas (UNICAMP) Hospital, Campinas, Brazil
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - Ana Berni
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Hospital Angeles Pedregal, Mexico City, Mexico
| | - Ana Margarita Jerez
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto de Cardiología Y Cirugía Cardiovascular, La Habana, Cuba
| | - Elaine Núñez-Ayala
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Electrophysiology, Arrhythmias and Pacemaker Unit, CEDIMAT, Centro Cardiovascular, Santo Domingo, Dominican Republic
| | - Freddy Pow-Chon
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Luis Carlos Sáenz-Morales
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Luis Fernando Pava-Molano
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - María Claudia Montes
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Raúl Garillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Stephania Galindo-Coral
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Walter Reyes-Caorsi
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Comisión Honoraria Para La Salud Cardiovascular, Montevideo, Uruguay
| | - Mario Speranza
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Clínica Bíblica, Ciudad de Costa Rica, Costa Rica
| | - Alexander Romero
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Santo Tomas, Ciudad de Panama, Panama
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Boshen Y, Yuankang Z, Xinjie Z, Taixi L, Kaifan N, Zhixiang W, Juan S, Junli D, Suiji L, Xia L, Chengxing S. Triglyceride-glucose index is associated with the occurrence and prognosis of cardiac arrest: a multicenter retrospective observational study. Cardiovasc Diabetol 2023; 22:190. [PMID: 37501144 PMCID: PMC10375765 DOI: 10.1186/s12933-023-01918-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index is an efficient indicator of insulin resistance and is proven to be a valuable marker in several cardiovascular diseases. However, the relationship between TyG index and cardiac arrest (CA) remains unclear. The present study aimed to investigate the association of the TyG index with the occurrence and clinical outcomes of CA. METHODS In this retrospective, multicenter, observational study, critically ill patients, including patients post-CA, were identified from the eICU Collaborative Research Database and evaluated. The TyG index for each patient was calculated using values of triglycerides and glucose recorded within 24 h of intensive care unit (ICU) admission. In-hospital mortality and ICU mortality were the primary clinical outcomes. Logistic regression, restricted cubic spline (RCS), and correlation analyses were performed to explore the relationship between the TyG index and clinical outcomes. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. Subgroup analysis based on different modifiers was also performed. RESULTS Overall, 24,689 critically ill patients, including 1021 patients post-CA, were enrolled. The TyG index was significantly higher in patients post-CA than in those without CA (9.20 (8.72-9.69) vs. 8.89 (8.45-9.41)), and the TyG index had a moderate discrimination ability to identify patients with CA from the overall population (area under the curve = 0.625). Multivariate logistic regression indicated that the TyG index was an independent risk factor for in-hospital mortality (OR = 1.28, 95% CI: 1.03-1.58) and ICU mortality (OR = 1.27, 95% CI: 1.02-1.58) in patients post-CA. RCS curves revealed that an increased TyG index was linearly related to higher risks of in-hospital and ICU mortality (P for nonlinear: 0.225 and 0.271, respectively). Even after adjusting by PSM, IPTW, and OW, the TyG index remained a risk factor for in-hospital mortality and ICU mortality in patients experiencing CA, which was independent of age, BMI, sex, etc. Correlation analyses revealed that TyG index was negatively correlated with the neurological status of patients post-CA. CONCLUSION Elevated TyG index is significantly associated with the occurrence of CA and higher mortality risk in patients post-CA. Our findings extend the landscape of TyG index in cardiovascular diseases, which requires further prospective cohort study.
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Affiliation(s)
- Yang Boshen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Yuankang
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Xinjie
- Department of Respiratory Medicine, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Li Taixi
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niu Kaifan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Zhixiang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Juan
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Duan Junli
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Suiji
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China.
| | - Lu Xia
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shen Chengxing
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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22
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Forner J, Schupp T, Weidner K, Ruka M, Egner-Walter S, Behnes M, Akin M, Ayoub M, Mashayekhi K, Akin I, Rusnak J. Effect of Cardiovascular Risk Factors on 30-Day All-Cause Mortality in Cardiogenic Shock. J Clin Med 2023; 12:4870. [PMID: 37510985 PMCID: PMC10381971 DOI: 10.3390/jcm12144870] [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: 06/04/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Although previous studies investigated the influence of cardiovascular risk (CVR) factors in patients with acute coronary syndrome, data concerning the effect of CVR factors on the prognosis of patients with cardiogenic shock (CS) is scarce. Consecutive patients with CS were prospectively included from 2019 to 2021. The prognosis of patients with "low CVR" (i.e., 0-1 CVR factors) was compared to patients with "high CVR" (i.e., 2-4 CVR factors) according to presence or absence of arterial hypertension, diabetes mellitus, hyperlipidaemia or smoking. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier and Cox proportional regression analyses. 273 consecutive patients with CS were included. 28% presented with low CVR and 72% with high CVR. Within the entire study cohort, the risk of 30-day all-cause mortality did not differ between patients with high and low CVR (55% vs. 57%; log rank p = 0.727; HR = 0.942; 95% CI 0.663-1.338; p = 0.738). Even after multivariable adjustment, high CVR was not associated with an elevated risk of 30-day all-cause mortality (HR = 1.039; 95% CI 0.648-1.667; p = 0.873). The presence of arterial hypertension (55% vs. 58%; log rank p = 0.564; HR = 0.906; 95% CI 0.638-1.287; p = 0.582), diabetes mellitus (60% vs. 52%; log rank p = 0.215; HR = 1.213; 95% CI 0.881-1.671; p = 0.237) and a history of smoking (56% vs. 56%; log rank p = 0.725; HR = 0.945; 95% CI 0.679-1.315; p = 0.737) did not significantly influence short-term prognosis.. Only the absence of hyperlipidaemia significantly decreased the risk of all-cause mortality (65% vs. 51%; log rank p = 0.038; HR = 0.718; 95% CI 0.516-0.998; p = 0.049), which was no longer observed after multivariable adjustment (HR = 0.801; 95% CI 0.536-1.195; p = 0.277). In conclusion, neither the overall CVR nor individual CVR factors were associated with the risk of 30-day all-cause mortality in patients with CS.
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Affiliation(s)
- Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center, University of Bochum, 32545 Bad Oeynhausen, Germany;
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (J.F.)
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
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Noordman ABP, Rienstra M, Blaauw Y, Mulder BA, Maass AH. Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients with Ventricular Arrhythmia of Unclear Cause in Secondary Prevention of Sudden Cardiac Death. J Clin Med 2023; 12:4479. [PMID: 37445514 DOI: 10.3390/jcm12134479] [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: 06/11/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
In this study, we sought to investigate the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapies and inappropriate shocks in secondary prevention ICD recipients with ventricular arrhythmia of unclear cause and ventricular arrhythmia in the context of underlying heart disease. In this retrospective study, consecutive patients with an ICD implanted for secondary prevention in the University Medical Center Groningen (UMCG), the Netherlands between 1 January 2012 and 31 December 2018 were included. Patients were classified as having ventricular arrhythmia of unclear cause if no clear cause was found which could explain the index ventricular arrhythmia. The primary outcome was appropriate ICD therapy. The study population consisted of 257 patients. In 220 patients, an underlying heart disease could be identified as the cause of ventricular arrhythmia, while 37 patients had an unclear cause of ventricular arrhythmia. The median age was 64 years (interquartile range (IQR) 53-72 years). Forty-five (18%) patients were women. During a median duration of follow-up of 6.2 years (IQR 4.8-7.8 years), appropriate ICD therapy occurred in 95 (37%) patients. This number was 90 (41%) in the group with a clear etiology and 5 (14%) in the group with an unclear etiology. In multivariable analysis, index ventricular arrhythmia of unclear cause was associated with fewer appropriate ICD therapies (HR 0.37 [95% CI 0.14-0.99]; p = 0.048), as well as an increased risk of inappropriate ICD shocks (HR 3.71 [95% CI 1.17-11.80]; p = 0.026). Index ventricular arrhythmia of unclear cause was significantly associated with fewer appropriate ICD therapies.
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Affiliation(s)
- Alwin B P Noordman
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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24
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Amoni M, Ingelaere S, Moeyersons J, Wets D, Tanushi A, Van Huffel S, Varon C, Sipido K, Claus P, Willems R. Regional beat-to-beat variability of repolarization increases during ischemia and predicts imminent arrhythmias in a pig model of myocardial infarction. Am J Physiol Heart Circ Physiol 2023; 325:H54-H65. [PMID: 37145956 PMCID: PMC10511165 DOI: 10.1152/ajpheart.00732.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/07/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
Ventricular arrhythmia (VT/VF) can complicate acute myocardial ischemia (AMI). Regional instability of repolarization during AMI contributes to the substrate for VT/VF. Beat-to-beat variability of repolarization (BVR), a measure of repolarization lability increases during AMI. We hypothesized that its surge precedes VT/VF. We studied the spatial and temporal changes in BVR in relation to VT/VF during AMI. In 24 pigs, BVR was quantified on 12-lead electrocardiogram recorded at a sampling rate of 1 kHz. AMI was induced in 16 pigs by percutaneous coronary artery occlusion (MI), whereas 8 underwent sham operation (sham). Changes in BVR were assessed at 5 min after occlusion, 5 and 1 min pre-VF in animals that developed VF, and matched time points in pigs without VF. Serum troponin and ST deviation were measured. After 1 mo, magnetic resonance imaging and VT induction by programmed electrical stimulation were performed. During AMI, BVR increased significantly in inferior-lateral leads correlating with ST deviation and troponin increase. BVR was maximal 1 min pre-VF (3.78 ± 1.36 vs. 5 min pre-VF, 1.67 ± 1.56, P < 0.0001). After 1 mo, BVR was higher in MI than in sham and correlated with the infarct size (1.43 ± 0.50 vs. 0.57 ± 0.30, P = 0.009). VT was inducible in all MI animals and the ease of induction correlated with BVR. BVR increased during AMI and temporal BVR changes predicted imminent VT/VF, supporting a possible role in monitoring and early warning systems. BVR correlated to arrhythmia vulnerability suggesting utility in risk stratification post-AMI.NEW & NOTEWORTHY The key finding of this study is that BVR increases during AMI and surges before ventricular arrhythmia onset. This suggests that monitoring BVR may be useful for monitoring the risk of VF during and after AMI in the coronary care unit settings. Beyond this, monitoring BVR may have value in cardiac implantable devices or wearables.
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Affiliation(s)
- Matthew Amoni
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Sebastian Ingelaere
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Jonathan Moeyersons
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Dries Wets
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Aldo Tanushi
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Carolina Varon
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- Microgravity Research Center, Université Libre de Bruxelles, Brussels, Belgium
| | - Karin Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Rik Willems
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
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25
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Ali AN, Abdeltawab HA, Eldamanhoury H, Aboulmaaty M. Risk factors of sudden cardiac death in Egyptian patients younger than 40 years. Egypt Heart J 2023; 75:45. [PMID: 37284888 DOI: 10.1186/s43044-023-00373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Sudden cardiac death in young people is a major problem. The causes are well known; however, they may not be discovered before the episode of sudden death. A challenge for the future is identifying patients at risk before an episode of sudden cardiac death. Development of preventive and educational programs is required to identify sudden cardiac death/sudden cardiac arrest (SCD/SCA) risk factors, causes and characteristics. We aimed to study the characteristics of SCD/SCA in a cohort of young Egyptian population. Our retrospective cohort study included 246 patients of SCD/SCA who were collected from 5000 records of arrhythmia patients from January 2010 till January 2020. The records of the specialized arrhythmia clinic were reviewed to collect the families of SCD/SCA. All patients and/or their first-degree relatives were subjected to thorough history taking and clinical evaluation and investigations. Comparisons were done regarding age group and presence of positive family history of SCD. RESULTS Males constituted 56.9% of the study population. Mean age was 26.6 ± 12.73 years. Positive family history was present in 202 (82.1%) cases. Sixty-one percent of the cases had history of syncopal attacks. SCD/SCA during non-exertion or sleep occurred in 50.4% of cases. Hypertrophic cardiomyopathy was the most common cause of SCD/SCA (20.3%), followed by dilated cardiomyopathy (19.1%), long QT Syndrome (11.4%), complete heart block (8.5%), and Brugada syndrome (6.8%). In the older age group of 18-40 years, hypertrophic cardiomyopathy was responsible for SCD in 44 patients (25.3%) versus 6 patients (8.3%) in younger age group (p-value: 0.003). DCM was also dominant in older age group (42 patients; 24.1%) versus 5 patients (6.9%) in younger age group. Hypertrophic cardiomyopathy was more prevalent in positive family history group (46 patients; 22.8%) versus 4 patients (9.1%) in negative family history group (p-value: 0.041). CONCLUSION Family history of SCD was the most common risk factor of SCD. The most common cause of SCD in young Egyptian patients below 40 years was hypertrophic cardiomyopathy, followed by dilated cardiomyopathy. Both diseases were more common in the age group between 18 and 40 years. Hypertrophic cardiomyopathy was more common in patients with positive family history of SCD/SCA.
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Affiliation(s)
- Ahmed Nabil Ali
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Hend Ali Abdeltawab
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hayam Eldamanhoury
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mervat Aboulmaaty
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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26
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Heshmatzad K, Naderi N, Maleki M, Abbasi S, Ghasemi S, Ashrafi N, Fazelifar AF, Mahdavi M, Kalayinia S. Role of non-coding variants in cardiovascular disease. J Cell Mol Med 2023; 27:1621-1636. [PMID: 37183561 PMCID: PMC10273088 DOI: 10.1111/jcmm.17762] [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: 10/31/2022] [Revised: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023] Open
Abstract
Cardiovascular diseases (CVDs) constitute one of the significant causes of death worldwide. Different pathological states are linked to CVDs, which despite interventions and treatments, still have poor prognoses. The genetic component, as a beneficial tool in the risk stratification of CVD development, plays a role in the pathogenesis of this group of diseases. The emergence of genome-wide association studies (GWAS) have led to the identification of non-coding parts associated with cardiovascular traits and disorders. Variants located in functional non-coding regions, including promoters/enhancers, introns, miRNAs and 5'/3' UTRs, account for 90% of all identified single-nucleotide polymorphisms associated with CVDs. Here, for the first time, we conducted a comprehensive review on the reported non-coding variants for different CVDs, including hypercholesterolemia, cardiomyopathies, congenital heart diseases, thoracic aortic aneurysms/dissections and coronary artery diseases. Additionally, we present the most commonly reported genes involved in each CVD. In total, 1469 non-coding variants constitute most reports on familial hypercholesterolemia, hypertrophic cardiomyopathy and dilated cardiomyopathy. The application and identification of non-coding variants are beneficial for the genetic diagnosis and better therapeutic management of CVDs.
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Affiliation(s)
- Katayoun Heshmatzad
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Niloofar Naderi
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Shiva Abbasi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Serwa Ghasemi
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Nooshin Ashrafi
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Amir Farjam Fazelifar
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Mohammad Mahdavi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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27
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Sato T, Kouzu H, Yano T, Sakuma I, Furuhashi M, Tohse N. Potential favorable action of sodium-glucose cotransporter-2 inhibitors on sudden cardiac death: a brief overview. Front Cardiovasc Med 2023; 10:1159953. [PMID: 37252114 PMCID: PMC10214280 DOI: 10.3389/fcvm.2023.1159953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
The primary pharmacological action of sodium-glucose co-transporter 2 (SGLT2) inhibitors is to inhibit the reabsorption of glucose and sodium ions from the proximal tubules of the kidney and to promote urinary glucose excretion. Notably, several clinical trials have recently demonstrated potent protective effects of SGLT2 inhibitors in patients with heart failure (HF) or chronic kidney disease (CKD), regardless of the presence or absence of diabetes. However, the impact of SGLT2 inhibitors on sudden cardiac death (SCD) or fatal ventricular arrhythmias (VAs), the pathophysiology of which is partly similar to that of HF and CKD, remains undetermined. The cardiorenal protective effects of SGLT2 inhibitors have been reported to include hemodynamic improvement, reverse remodeling of the failing heart, amelioration of sympathetic hyperactivity, correction of anemia and impaired iron metabolism, antioxidative effects, correction of serum electrolyte abnormalities, and antifibrotic effects, which may lead to prevent SCD and/or VAs. Recently, as possible direct cardiac effects of SGLT2 inhibitors, not only inhibition of Na+/H+ exchanger (NHE) activity, but also suppression of late Na+ current have been focused on. In addition to the indirect cardioprotective mechanisms of SGLT2 inhibitors, suppression of aberrantly increased late Na+ current may contribute to preventing SCD and/or VAs via restoration of the prolonged repolarization phase in the failing heart. This review summarizes the results of previous clinical trials of SGLT2 inhibitors for prevention of SCD, their impact on the indices of electrocardiogram, and the possible molecular mechanisms of their anti-arrhythmic effects.
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Affiliation(s)
- Tatsuya Sato
- Department of Cellular Physiology and Signal Transduction, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ichiro Sakuma
- Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Noritsugu Tohse
- Department of Cellular Physiology and Signal Transduction, Sapporo Medical University School of Medicine, Sapporo, Japan
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28
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Davis E, Fernando BC, Jusni LFJ, Hendryan KR, Kuatama R, Ridjab DA. Circulating magnesium as a potential risk stratification tool for sudden cardiac death: a systematic review. Herzschrittmacherther Elektrophysiol 2023; 34:153-160. [PMID: 37160637 DOI: 10.1007/s00399-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/06/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is one of the main causes of cardiovascular mortality and accounts for 15-20% of deaths worldwide. The current stratification strategy using depressed left ventricular ejection fraction is insufficient to stratify the risk of SCD, especially in the general population. In recent years, there has been increasing evidence showing the antiarrhythmic properties of magnesium. In this systematic review, the authors aim to determine circulating magnesium as a potential risk stratification tool for SCD. METHODS This systematic review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was conducted in July 2021 with sources from Google Scholar, PubMed, Science Direct, EBSCO Medline, and ProQuest. RESULTS A total of six studies were included in this review. Three studies conducted in the general population consistently showed lower risk of SCD in populations with high circulating magnesium. There was no association between circulating magnesium level and risk of SCD in intensive cardiac care unit (ICCU) patients, whilst the results were conflicting in congestive heart failure (CHF) patients. CONCLUSION High circulating magnesium might have the potential to be utilized as a risk stratification tool for SCD, especially in the general population. However, further study is needed to support this evidence.
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Affiliation(s)
- Edward Davis
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, 14440, Jakarta, Indonesia
| | - Bernard C Fernando
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, 14440, Jakarta, Indonesia
| | - Louis Fabio Jonathan Jusni
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, 14440, Jakarta, Indonesia
| | - Kevin R Hendryan
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, 14440, Jakarta, Indonesia
| | - Rexel Kuatama
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, 14440, Jakarta, Indonesia
| | - Denio A Ridjab
- Medical Education Unit, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya Rd. No. 2, 14440, North Jakarta, Indonesia.
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29
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Marchal GA, Biasci V, Loew LM, Biggeri A, Campione M, Sacconi L. Optogenetic manipulation of cardiac repolarization gradients using sub-threshold illumination. Front Physiol 2023; 14:1167524. [PMID: 37215182 PMCID: PMC10196067 DOI: 10.3389/fphys.2023.1167524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction: Mechanisms underlying cardiac arrhythmias are typically driven by abnormalities in cardiac conduction and/or heterogeneities in repolarization time (RT) across the heart. While conduction slowing can be caused by either electrophysiological defects or physical blockade in cardiac tissue, RT heterogeneities are mainly related to action potential (AP) prolongation or abbreviation in specific areas of the heart. Importantly, the size of the area with altered RT and the difference between the short RT and long RT (RT gradient) have been identified as critical determinators of arrhythmogenicity. However, current experimental methods for manipulating RT gradient rely on the use of ion channel inhibitors, which lack spatial and temporal specificity and are commonly only partially reversible. Therefore, the conditions facilitating sustained arrhythmia upon the presence of RT heterogeneities and/or defects in cardiac conduction remain to be elucidated. Methods: We here employ an approach based on optogenetic stimulation in a low-intensity fashion (sub-threshold illumination), to selectively manipulate cardiac electrical activity in defined areas of the heart. Results: As previously described, subthreshold illumination is a robust tool able to prolong action potentials (AP), decrease upstroke velocity as well as slow cardiac conduction, in a fully reversible manner. By applying a patterned sub-threshold illumination in intact mouse hearts constitutively expressing the light-gated ion channel channelrhodopsin-2 (ChR2), we optically manipulate RT gradients and cardiac conduction across the heart in a spatially selective manner. Moreover, in a proof-of-concept assessment we found that in the presence of patterned sub-threshold illumination, mouse hearts were more susceptible to arrhythmias. Hence, this optogenetic-based approach may be able to mimic conduction slowing and RT heterogeneities present in pathophysiological conditions.
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Affiliation(s)
- Gerard A. Marchal
- European Laboratory for Non-Linear Spectroscopy—LENS, Florence, Italy
- National Institute of Optics (INO-CNR), Florence, Italy
- Institute of Clinical Physiology (IFC-CNR), Pisa, Italy
| | - Valentina Biasci
- European Laboratory for Non-Linear Spectroscopy—LENS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Leslie M. Loew
- Center for Cell Analysis and Modeling, University of Connecticut, Farmington, CT, United States
| | - Annibale Biggeri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marina Campione
- Institute of Neuroscience (IN-CNR) and Department of Biomedical Science University of Padua, Padua, Italy
| | - Leonardo Sacconi
- Institute of Clinical Physiology (IFC-CNR), Pisa, Italy
- Institute for Experimental Cardiovascular Medicine, University Heart Center and Medical Faculty, University of Freiburg, Freiburg, Germany
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30
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McLeod EV, Walsh JC, Haigney MC, Franzos MA, Hellwig LD. Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population: A Military Case Series. Am J Forensic Med Pathol 2023:00000433-990000000-00071. [PMID: 37093871 DOI: 10.1097/paf.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
ABSTRACT Sudden cardiac death (SCD) is defined as death from cardiac causes with loss of consciousness occurring within 1 hour of a change in cardiovascular status. As subset, SCD associated with physical exertion (SCD/E) can be defined as a cardiac event whose symptoms start during or within 1 hour of physical exertion. The US military represents a unique opportunity for studying SCD/E because of medical screening at recruitment, mandatory physical training, an active surveillance system, and centralized autopsy services. Because of medical screening, recruits are presumed healthy, but significant conditions can go undetected. We present 4 diverse cases of SCD/E in the military setting. Sudden cardiac death associated with physical exertion is often the first indication of a serious occult cardiac pathology. Postmortem genetic testing revealed a causative pathogenic mutation in 1 of 4 cases, enabling genetic testing of family members to prevent similar catastrophic loss of life, underscoring the importance of postmortem evaluation including genetic testing. Further investigations will help direct screening and prevention to capture those at risk for SCD. The cases presented in this series are a sample of the diverse etiologies and contexts surrounding SCD/E in the military setting that have been captured by Armed Forces Medical Examiner System.
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Affiliation(s)
- Elizabeth V McLeod
- From the National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD
| | - John C Walsh
- Forensic Pathology Investigations, Armed Forces Medical Examiner System, Dover, DE
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Buchan S, Kar R, John M, Post A, Razavi M. Electrical Stimulation for Low-Energy Termination of Cardiac Arrhythmias: a Review. Cardiovasc Drugs Ther 2023; 37:323-340. [PMID: 34363570 DOI: 10.1007/s10557-021-07236-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
Cardiac arrhythmias are a leading cause of morbidity and mortality in the developed world, estimated to be responsible for hundreds of thousands of deaths annually. Our understanding of the electrophysiological mechanisms of such arrhythmias has grown since they were formally characterized in the late nineteenth century, and this has led to the development of numerous devices and therapies that have markedly improved outcomes for patients affected by such conditions. Despite these advancements, the application of a single large shock remains the clinical standard for treating deadly tachyarrhythmias. Such defibrillating shocks are undoubtedly effective in terminating such arrhythmias; however, they are applied without forewarning, contributing to the patient's stress and anxiety; they can be intensely painful; and they can have adverse psychological and physiological effects on patients. In recent years, there has been interest in developing defibrillation protocols that can terminate arrhythmias without crossing the human pain threshold for energy delivery, generally estimated to be between 0.1 and 1 J. In this article, we review existing literature on the development of such low-energy defibrillation methods and their underlying mechanisms, in an attempt to broadly describe the current landscape of these technologies.
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Affiliation(s)
- Skylar Buchan
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Ronit Kar
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.,Department of Biomedical Engineering, The University of Texas At Austin, Austin, TX, 78712, USA
| | - Mathews John
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Allison Post
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA. .,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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Cavalcante CHL, Primo PEO, Sales CAF, Caldas WL, Silva JHM, Souza AH, Marinho ES, Pedrosa RC, Marques JAL, Santos HS, Madeiro JPV. Sudden cardiac death multiparametric classification system for Chagas heart disease's patients based on clinical data and 24-hours ECG monitoring. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:9159-9178. [PMID: 37161238 DOI: 10.3934/mbe.2023402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
About 6.5 million people are infected with Chagas disease (CD) globally, and WHO estimates that $ > million people worldwide suffer from ChHD. Sudden cardiac death (SCD) represents one of the leading causes of death worldwide and affects approximately 65% of ChHD patients at a rate of 24 per 1000 patient-years, much greater than the SCD rate in the general population. Its occurrence in the specific context of ChHD needs to be better exploited. This paper provides the first evidence supporting the use of machine learning (ML) methods within non-invasive tests: patients' clinical data and cardiac restitution metrics (CRM) features extracted from ECG-Holter recordings as an adjunct in the SCD risk assessment in ChHD. The feature selection (FS) flows evaluated 5 different groups of attributes formed from patients' clinical and physiological data to identify relevant attributes among 57 features reported by 315 patients at HUCFF-UFRJ. The FS flow with FS techniques (variance, ANOVA, and recursive feature elimination) and Naive Bayes (NB) model achieved the best classification performance with 90.63% recall (sensitivity) and 80.55% AUC. The initial feature set is reduced to a subset of 13 features (4 Classification; 1 Treatment; 1 CRM; and 7 Heart Tests). The proposed method represents an intelligent diagnostic support system that predicts the high risk of SCD in ChHD patients and highlights the clinical and CRM data that most strongly impact the final outcome.
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Affiliation(s)
- Carlos H L Cavalcante
- Federal Institute of Education and Technology of Ceara, Maracanau, Ceara, Brazil
- State University of Ceara - Center for Science and Technology, Fortaleza, Ceara, Brazil
| | - Pedro E O Primo
- Computer Science Department - Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Carlos A F Sales
- Federal Institute of Education and Technology of Ceara, Maracanau, Ceara, Brazil
| | - Weslley L Caldas
- Computer Science Department - Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - João H M Silva
- Oswaldo Cruz Foundation (Fiocruz), Eusebio, Ceara, Brazil
| | - Amauri H Souza
- Federal Institute of Education and Technology of Ceara, Maracanau, Ceara, Brazil
| | - Emmanuel S Marinho
- State University of Ceara - Center for Science and Technology, Fortaleza, Ceara, Brazil
| | - Roberto C Pedrosa
- Edson Saad Heart Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João A L Marques
- Laboratory of Applied Neurosciences -University of Saint Joseph, Macau SAR, China
| | - Hélcio S Santos
- State University of Ceara - Center for Science and Technology, Fortaleza, Ceara, Brazil
| | - João P V Madeiro
- Computer Science Department - Federal University of Ceara, Fortaleza, Ceara, Brazil
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Koivunen M, Tynkkynen J, Oksala N, Eskola M, Hernesniemi J. Incidence of sudden cardiac arrest and sudden cardiac death after unstable angina pectoris and myocardial infarction. Am Heart J 2023; 257:9-19. [PMID: 36384178 DOI: 10.1016/j.ahj.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sudden cardiac arrests (SCA) and sudden cardiac deaths (SCD) are believed to account for a large proportion of deaths due to cardiovascular causes. The purpose of this study is to provide comprehensive information on the epidemiology of SCAs and SCDs after acute coronary syndrome. METHODS The incidence of SCA (including SCDs) was studied retrospectively among 10,316 consecutive patients undergoing invasive evaluation for acute coronary syndrome (ACS) between 2007 and 2018 at Tays Heart Hospital (sole provider of specialized cardiac care for a catchment area of over 0.5 million residents). Baseline and follow-up information was collected by combining information from the hospital's electronic health records, death certificate data, and a full-disclosure review of written patient records and accounts of the circumstances leading to death. RESULTS During 12 years of follow-up, the cumulative incidence of SCAs (including SCDs) was 9.8% (0.8% annually) and that of SCDs 5.4% (0.5% annually). Cumulative incidence of SCAs in patients with ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina pectoris were: 11.9%,10.2% and 5.7% at 12 years. SCAs accounted for 30.5% (n = 528/1,732) of all deaths due to cardiovascular causes. The vast majority of SCAs (95.6%) occurred in patients without implantable cardioverter defibrillator (ICD) devices or among patients with no recurrent hospitalizations for coronary artery disease (89.1%). CONCLUSIONS SCAs accounted for less than a third of all deaths due to cardiovascular causes among patients with previous ACS. Incidence of SCA is highest among STEMI and NSTEMI patients. After the hospital discharge, most of SCAs happen to NSTEMI patients.
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Affiliation(s)
- Minna Koivunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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Zhang J, Mu L, Zhang D, Rajbhandari-Thapa J, Chen Z, Pagán JA, Li Y, Son H, Liu J. Spatiotemporal Optimization for the Placement of Automated External Defibrillators Using Mobile Phone Data. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2023; 12:91. [PMID: 37808120 PMCID: PMC10557972 DOI: 10.3390/ijgi12030091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
With over 350,000 cases occurring each year, out-of-hospital cardiac arrest (OHCA) remains a severe public health concern in the United States. The correct and timely use of automated external defibrillators (AEDs) has been widely acknowledged as an effective measure to improve the survival rate of OHCA. While general guidelines have been provided by the American Heart Association (AHA) for AED deployment, the lack of detailed instructions hindered the adoption of such guidelines under dynamic scenarios with various time and space distributions. Formulating the AED deployment as a location optimization problem under budget and resource constraints, we proposed an overlayed spatio-temporal optimization (OSTO) method, which accounted for the spatiotemporal heterogeneity of potential OHCAs. To highlight the effectiveness of the proposed model, we applied the proposed method to Washington DC using user-generated anonymized mobile device location data. The results demonstrated that optimization-based planning provided an improved AED coverage level. We further evaluated the effectiveness of adding additional AEDs by analyzing the cost-coverage increment curve. In general, our framework provides a systematic approach for municipalities to integrate inclusive planning and budget-limited efficiency into their final decision-making. Given the high practicality and adaptability of the framework, the OSTO is highly amenable to different healthcare facilities' deployment tasks with flexible demand and resource restraints.
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Affiliation(s)
- Jielu Zhang
- Department of Geography, University of Georgia, Athens, GA 30602, USA
| | - Lan Mu
- Department of Geography, University of Georgia, Athens, GA 30602, USA
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, New York, NY 11501, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
- School of Economics, University of Nottingham Ningbo China, Ningbo 315100, China
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Heejung Son
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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35
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Braund S, Leviel J, Morau E, Deneux-Tharaux C, Verspyck E. Maternal sudden death: A nationwide retrospective study. BJOG 2023; 130:257-263. [PMID: 36156354 PMCID: PMC10092016 DOI: 10.1111/1471-0528.17294] [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: 06/07/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the prevalence of maternal sudden death (MSD) and to compare the characteristics of death between women with explained and unexplained sudden death. DESIGN A national retrospective study in France. POPULATION Maternal deaths related to an unexpected sudden cardiac arrest were extracted from the French National Confidential Enquiry into Maternal Deaths database for 2007-2012. METHODS Maternal, pregnancy, sudden death characteristics and maternal investigations were compared between women with explained and unexplained cause of death. RESULTS A total of 83 maternal sudden deaths and 4 949 890 live births occurred over the period studied, thus accounting for 16% of all maternal deaths (n = 510). Death was explained in 51 (61%) women and unexplained in 32 women (39%). Compared with women with unexplained death, women with explained death were more often found to have in-hospital cardiac arrest (47% versus 12%, P < 0.01), witnessed cardiac arrest (86% versus 62%, P = 0.03) and in-hospital death (82% versus 47%, P < 0.01). Postmortem investigations such as autopsy and/or CT scan (65% versus 31%, P < 0.01) were also more often carried out in women with explained death. The proportion of deaths for which the preventability factors could not be assessed was 58% among unexplained MSD and 7% among explained MSD. CONCLUSION Maternal sudden death is a rare event but accounts for a high proportion of all maternal deaths. This highlights the importance of providing training in diagnostic and management strategy for care providers. Systematic postmortem investigations are required to help understand causes and improve practices.
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Affiliation(s)
- Sophia Braund
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Juliette Leviel
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France.,Department of Gynaecology and Obstetrics, Hospital center Eure Seine, Evreux, France
| | - Estelle Morau
- Department of Anaesthetics, Nîmes University Hospital, Nîmes, France
| | - Catherine Deneux-Tharaux
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
| | - Eric Verspyck
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France
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36
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Haugsten Hansen M, Sadredini M, Hasic A, Anderson ME, Sjaastad I, Korseberg Stokke M. CaMKII and reactive oxygen species contribute to early reperfusion arrhythmias, but oxidation of CaMKIIδ at methionines 281/282 is not a determining factor. J Mol Cell Cardiol 2023; 175:49-61. [PMID: 36528076 DOI: 10.1016/j.yjmcc.2022.12.002] [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: 07/21/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Available evidence suggest that Ca2+/calmodulin-dependent protein kinase type IIδ (CaMKIIδ) and reactive oxygen species (ROS) are important in early ischemia-reperfusion arrhythmias (IRA). Since ROS can activate CaMKIIδ by oxidation of two methionines at positions 281/282, oxidized-CaMKIIδ (Ox-CaMKIIδ) has been proposed to be important for IRA. However, direct evidence for this is missing. METHODS We exposed Langendorff-perfused hearts and ventricular cardiomyocytes from C57BL/6 mice to global and simulated ischemia, respectively, and recorded arrhythmic events during early reperfusion. Hearts were collected for immunoblotting of key phosphoproteins. We evaluated the effects of beta-adrenoceptor stimulation, inhibition of CaMKII, and reduced ROS levels with isoprenaline, KN93/AIP and N-acetylcysteine (NAC), respectively. We further tested the importance of Ox-CaMKIIδ by using hearts and cardiomyocytes from mice with CaMKIIδ resistant to oxidation of methionines 281 and 282 (MMVV). RESULTS Hearts treated with KN93, AIP or NAC had lower incidence of early IRA, and NAC-treated cardiomyocytes had lower incidence of arrhythmogenic events. However, hearts from MMVV mice had a similar incidence of early IRA to wild type mice (WT), and MMVV and WT cardiomyocytes had a similar frequency of Ca2+ waves and Ca2+ sparks. Immunoblotting confirmed high levels of oxidation in early reperfusion, but revealed no significant differences in the phosphorylation levels of Ca2+-handling proteins in MMVV and WT hearts. CONCLUSIONS Although CaMKII and ROS both contribute to early IRA, hearts from mice with CaMKII resistant to oxidation at methionines 281/282 were not protected from such arrhythmias, suggesting that oxidation at these sites is not a determining factor.
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Affiliation(s)
- Marie Haugsten Hansen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mani Sadredini
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Almira Hasic
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mark E Anderson
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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Abstract
Research conducted in the past 15 years has yielded crucial insights that are reshaping our understanding of the systems physiology of branched-chain amino acid (BCAA) metabolism and the molecular mechanisms underlying the close relationship between BCAA homeostasis and cardiovascular health. The rapidly evolving literature paints a complex picture, in which numerous tissue-specific and disease-specific modes of BCAA regulation initiate a diverse set of molecular mechanisms that connect changes in BCAA homeostasis to the pathogenesis of cardiovascular diseases, including myocardial infarction, ischaemia-reperfusion injury, atherosclerosis, hypertension and heart failure. In this Review, we outline the current understanding of the major factors regulating BCAA abundance and metabolic fate, highlight molecular mechanisms connecting impaired BCAA homeostasis to cardiovascular disease, discuss the epidemiological evidence connecting BCAAs with various cardiovascular disease states and identify current knowledge gaps requiring further investigation.
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Affiliation(s)
- Robert W McGarrah
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA.
| | - Phillip J White
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Duke University, Durham, NC, USA.
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA.
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Distinct Subtypes of Hepatorenal Syndrome and Associated Outcomes as Identified by Machine Learning Consensus Clustering. Diseases 2023; 11:diseases11010018. [PMID: 36810532 PMCID: PMC9944494 DOI: 10.3390/diseases11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The utilization of multi-dimensional patient data to subtype hepatorenal syndrome (HRS) can individualize patient care. Machine learning (ML) consensus clustering may identify HRS subgroups with unique clinical profiles. In this study, we aim to identify clinically meaningful clusters of hospitalized patients for HRS using an unsupervised ML clustering approach. METHODS Consensus clustering analysis was performed based on patient characteristics in 5564 patients primarily admitted for HRS in the National Inpatient Sample from 2003-2014 to identify clinically distinct HRS subgroups. We applied standardized mean difference to evaluate key subgroup features, and compared in-hospital mortality between assigned clusters. RESULTS The algorithm revealed four best distinct HRS subgroups based on patient characteristics. Cluster 1 patients (n = 1617) were older, and more likely to have non-alcoholic fatty liver disease, cardiovascular comorbidities, hypertension, and diabetes. Cluster 2 patients (n = 1577) were younger and more likely to have hepatitis C, and less likely to have acute liver failure. Cluster 3 patients (n = 642) were younger, and more likely to have non-elective admission, acetaminophen overdose, acute liver failure, to develop in-hospital medical complications and organ system failure, and to require supporting therapies, including renal replacement therapy, and mechanical ventilation. Cluster 4 patients (n = 1728) were younger, and more likely to have alcoholic cirrhosis and to smoke. Thirty-three percent of patients died in hospital. In-hospital mortality was higher in cluster 1 (OR 1.53; 95% CI 1.31-1.79) and cluster 3 (OR 7.03; 95% CI 5.73-8.62), compared to cluster 2, while cluster 4 had comparable in-hospital mortality (OR 1.13; 95% CI 0.97-1.32). CONCLUSIONS Consensus clustering analysis provides the pattern of clinical characteristics and clinically distinct HRS phenotypes with different outcomes.
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Leiva O, Bohart I, Ahuja T, Park D. Off-Target Effects of Cancer Therapy on Development of Therapy-Induced Arrhythmia: A Review. Cardiology 2023; 148:324-334. [PMID: 36702116 PMCID: PMC10614257 DOI: 10.1159/000529260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Advances in cancer therapeutics have improved overall survival and prognosis in this patient population; however, this has come at the expense of cardiotoxicity including arrhythmia. SUMMARY Cancer and its therapies are associated with cardiotoxicity via several mechanisms including inflammation, cardiomyopathy, and off-target effects. Among cancer therapies, anthracyclines and tyrosine kinase inhibitors (TKIs) are particularly known for their pro-arrhythmia effects. In addition to cardiomyopathy, anthracyclines may be pro-arrhythmogenic via reactive oxygen species (ROS) generation and altered calcium handling. TKIs may mediate their cardiotoxicity via inhibition of off-target tyrosine kinases. Ibrutinib-mediated inhibition of CSK may be responsible for the increased prevalence of atrial fibrillation. Further investigation is warranted to further elucidate the mechanisms behind arrhythmias in cancer therapies. KEY MESSAGES Arrhythmias are a common cardiotoxicity of cancer therapies. Cancer therapies may induce arrhythmias via off-target effects. Understanding the mechanisms underlying arrhythmogenesis associated with cancer therapies may help design cancer therapies that can avoid these toxicities.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Isaac Bohart
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Tania Ahuja
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - David Park
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
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40
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Niort BC, Recalde A, Cros C, Brette F. Critical Link between Calcium Regional Heterogeneity and Atrial Fibrillation Susceptibility in Sheep Left Atria. J Clin Med 2023; 12:jcm12030746. [PMID: 36769395 PMCID: PMC9917890 DOI: 10.3390/jcm12030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Atrial fibrillation is the most sustained form of arrhythmia in the human population that leads to important electrophysiological and structural cardiac remodeling as it progresses into a chronic form. Calcium is an established key player of cellular electrophysiology in the heart, yet to date, there is no information that maps calcium signaling across the left atrium. OBJECTIVE The aim of this study is to determine whether calcium signaling is homogenous throughout the different regions of the left atrium. This work tests the hypothesis that differences across the healthy left atrium contribute to a unique, region-dependent calcium cycling and participates in the pro-arrhythmic activity during atrial fibrillation. METHODS An animal model relevant to human cardiac function (the sheep) was used to characterize both the electrical activity and the calcium signaling of three distinct left atrium regions (appendage, free wall and pulmonary veins) in control conditions and after acetylcholine perfusion (5 μM) to induce acute atrial fibrillation. High-resolution dual calcium-voltage optical mapping on the left atria of sheep was performed to explore the spatiotemporal dynamics of calcium signaling in relation to electrophysiological properties. RESULTS Action potential duration (at 80% repolarization) was not significantly different in the three regions of interest for the three pacing sites. In contrast, the time to 50% calcium transient decay was significantly different depending on the region paced and recorded. Acetylcholine perfusion and burst pacing-induced atrial fibrillation when pulmonary veins and appendage regions were paced but not when the free wall region was. Dantrolene (a ryanodine receptor blocker) did not reduce atrial fibrillation susceptibility. CONCLUSION These data provide the first evidence of heterogenous calcium signaling across the healthy left atrium. Such basal regional differences may be exacerbated during the progression of atrial fibrillation and thus play a crucial role in focal arrhythmia initiation without ryanodine receptor gating modification.
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Affiliation(s)
- Barbara C. Niort
- Centre de Recherche Cardio-Thoracique de Bordeaux (CRCTB), Inserm U1045, Univeristé de Bordeaux, F-33000 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33600 Pessac, France
| | - Alice Recalde
- Centre de Recherche Cardio-Thoracique de Bordeaux (CRCTB), Inserm U1045, Univeristé de Bordeaux, F-33000 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33600 Pessac, France
| | - Caroline Cros
- Centre de Recherche Cardio-Thoracique de Bordeaux (CRCTB), Inserm U1045, Univeristé de Bordeaux, F-33000 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33600 Pessac, France
| | - Fabien Brette
- Centre de Recherche Cardio-Thoracique de Bordeaux (CRCTB), Inserm U1045, Univeristé de Bordeaux, F-33000 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33600 Pessac, France
- Phymedexp Inserm, CNRS, Université de Montpellier, CHRU, F-34295 Montpellier, France
- Correspondence:
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Hogea T, Suciu BA, Ivănescu AD, Carașca C, Chinezu L, Arbănași EM, Russu E, Kaller R, Arbănași EM, Mureșan AV, Radu CC. Increased Epicardial Adipose Tissue (EAT), Left Coronary Artery Plaque Morphology, and Valvular Atherosclerosis as Risks Factors for Sudden Cardiac Death from a Forensic Perspective. Diagnostics (Basel) 2023; 13:diagnostics13010142. [PMID: 36611434 PMCID: PMC9818730 DOI: 10.3390/diagnostics13010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: In sudden cardiac deaths (SCD), visceral adipose tissue has begun to manifest interest as a standalone cardiovascular risk factor. Studies have shown that epicardial adipose tissue can be seen as a viable marker of coronary atherosclerosis. This study aimed to evaluate, from a forensic perspective, the correlation between body mass index (BMI), heart weight, coronary and valvular atherosclerosis, left ventricular morphology, and the thickness of the epicardial adipose tissue (EAT) in sudden cardiac deaths, establishing an increased thickness of EAT as a novel risk factor. Methods: This is a retrospective case−control descriptive study that included 80 deaths that were autopsied, 40 sudden cardiac deaths, and 40 control cases who hanged themselves and had unknown pathologies prior to their death. In all the autopsies performed, the thickness of the epicardial adipose tissue was measured in two regions of the left coronary artery, and the left ventricular morphology, macro/microscopically quantified coronary and valvular atherosclerosis, and weight of the heart were evaluated. Results: This study revealed a higher age in the SCD group (58.82 ± 9.67 vs. 53.4 ± 13.00; p = 0.03), as well as a higher incidence in females (p = 0.03). In terms of heart and coronary artery characteristics, there were higher values of BMI (p = 0.0009), heart weight (p < 0.0001), EAT of the left circumflex artery (LCx) (p < 0.0001), and EAT of the left anterior descending artery (LAD) (p < 0.0001). In the multivariate analysis, a high baseline value of BMI (OR: 4.05; p = 0.004), heart weight (OR: 5.47; p < 0.001), EAT LCx (OR: 23.72; p < 0.001), and EAT LAD (OR: 21.07; p < 0.001) were strong independent predictors of SCD. Moreover, age over 55 years (OR: 2.53; p = 0.045), type Vb plaque (OR: 17.19; p < 0.001), mild valvular atherosclerosis (OR: 4.88; p = 0.002), and moderate left ventricle dilatation (OR: 16.71; p = 0.008) all act as predictors of SCD. Conclusions: The data of this research revealed that higher baseline values of BMI, heart weight, EAT LCx, and EAT LAD highly predict SCD. Furthermore, age above 55 years, type Vb plaque, mild valvular atherosclerosis, and left ventricle dilatation were all risk factors for SCD.
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Affiliation(s)
- Timur Hogea
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Bogdan Andrei Suciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Adrian Dumitru Ivănescu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Cosmin Carașca
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Correspondence: ; Tel.: +40-751-065-887
| | - Laura Chinezu
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Emil Marian Arbănași
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Réka Kaller
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Corina Carmen Radu
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Jin MN, Seo J, Kim BG, Kim GS, Lee HY, Byun YS, Kim BO. Association of physical activity with the risk of major adverse cardiac and cerebrovascular events and mortality in patients with concomitant atrial fibrillation and coronary artery disease. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Although regular physical activity benefits cardiovascular health, there is a concern that intense exercise is linked to the promotion of atrial fibrillation (AF) and coronary plaque rupture. However, the impact of physical activity on the outcomes of patients with concomitant AF and coronary artery disease (CAD) remains unclear. This study aimed to evaluate the association with clinical outcomes according to the level of physical activity in patients with concomitant AF and CAD.
Methods
We assessed 551 patients with AF and CAD (mean age, 67.1 ± 9.8 years) who completed a self-reported questionnaire for physical activity from 2015 to 2020 in a single tertiary-care hospital. Physical activity levels were converted into metabolic equivalent of task (MET) per week and categorized to correspond with multiple public health recommendations. We examined the association between physical activity, all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE).
Results
The risks of all-cause mortality (P for linear trend = 0.017) and MACCE (P for linear trend = 0.05) appeared inverse trend with a greater level of physical activity. Compared with inactive patients, patients who met the recommended target range of physical activity (500–1,000 MET-min/week: unadjusted hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.36–0.99) and highly active patients who exceeded the minimum recommended level (≥ 1,000 MET-min/week: unadjusted HR = 0.47, 95% CI = 0.25–0.88) had a lower risk of all-cause mortality in the unadjusted model; however, these associations did not remain significant after adjusting for the model. There was no evidence of increased risk of all-cause mortality and MACCE at levels of physical activity above the recommended target range, even with vigorous-intensity physical activity exceeding the recommended target range.
Conclusions
There appears to be an inverse trend between physical activity levels and all-cause mortality and MACCE in patients with concomitant AF and CAD. No excess risk of mortality or MACCE was found at exercise levels above the recommended target range. Further large-scale studies are warranted to create an improved evidence base concerning the effects of physical activity in patients with AF and CAD.
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Ripplinger CM, Glukhov AV, Kay MW, Boukens BJ, Chiamvimonvat N, Delisle BP, Fabritz L, Hund TJ, Knollmann BC, Li N, Murray KT, Poelzing S, Quinn TA, Remme CA, Rentschler SL, Rose RA, Posnack NG. Guidelines for assessment of cardiac electrophysiology and arrhythmias in small animals. Am J Physiol Heart Circ Physiol 2022; 323:H1137-H1166. [PMID: 36269644 PMCID: PMC9678409 DOI: 10.1152/ajpheart.00439.2022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. Although recent advances in cell-based models, including human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM), are contributing to our understanding of electrophysiology and arrhythmia mechanisms, preclinical animal studies of cardiovascular disease remain a mainstay. Over the past several decades, animal models of cardiovascular disease have advanced our understanding of pathological remodeling, arrhythmia mechanisms, and drug effects and have led to major improvements in pacing and defibrillation therapies. There exist a variety of methodological approaches for the assessment of cardiac electrophysiology and a plethora of parameters may be assessed with each approach. This guidelines article will provide an overview of the strengths and limitations of several common techniques used to assess electrophysiology and arrhythmia mechanisms at the whole animal, whole heart, and tissue level with a focus on small animal models. We also define key electrophysiological parameters that should be assessed, along with their physiological underpinnings, and the best methods with which to assess these parameters.
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Affiliation(s)
- Crystal M. Ripplinger
- 1Department of Pharmacology, University of California Davis School of Medicine, Davis, California
| | - Alexey V. Glukhov
- 2Department of Medicine, Cardiovascular Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew W. Kay
- 3Department of Biomedical Engineering, The George Washington University, Washington, District of Columbia
| | - Bastiaan J. Boukens
- 4Department Physiology, University Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands,5Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nipavan Chiamvimonvat
- 1Department of Pharmacology, University of California Davis School of Medicine, Davis, California,6Department of Internal Medicine, University of California Davis School of Medicine, Davis, California,7Veterans Affairs Northern California Healthcare System, Mather, California
| | - Brian P. Delisle
- 8Department of Physiology, University of Kentucky, Lexington, Kentucky
| | - Larissa Fabritz
- 9University Center of Cardiovascular Science, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf with DZHK Hamburg/Kiel/Luebeck, Germany,10Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Thomas J. Hund
- 11Department of Internal Medicine, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio,12Department of Biomedical Engineering, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Bjorn C. Knollmann
- 13Vanderbilt Center for Arrhythmia Research and Therapeutics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Na Li
- 14Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Katherine T. Murray
- 15Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Steven Poelzing
- 16Virginia Tech Carilon School of Medicine, Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech, Roanoke, Virginia,17Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - T. Alexander Quinn
- 18Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada,19School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carol Ann Remme
- 20Department of Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Stacey L. Rentschler
- 21Cardiovascular Division, Department of Medicine, Washington University in Saint Louis, School of Medicine, Saint Louis, Missouri
| | - Robert A. Rose
- 22Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,23Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nikki G. Posnack
- 24Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia,25Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
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Next-generation sequencing of postmortem molecular markers to support for medicolegal autopsy. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2022. [DOI: 10.1016/j.fsir.2022.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Garrett EP, Hightower B, Walters C, Srouji D, Chronister J, Torgerson T, Hartwell M, McIntire R, Love M, Vassar M. Quality of reporting among systematic reviews underpinning the ESC/ACC guidelines on ventricular arrhythmias and sudden cardiac death. BMJ Evid Based Med 2022; 27:352-360. [PMID: 35277437 DOI: 10.1136/bmjebm-2021-111859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The main objective of this study was to assess the methodological and reporting quality of the systematic reviews (SRs) supporting the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) clinical practice guidelines (CPGs) recommendations for the management of patients with ventricular arrhythmias and sudden cardiac death (SCD). As a secondary objective, we sought to determine: (1) the proportion of Cochrane SRs were cited; and (2) whether Cochrane SRs scored higher on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) appraisals. DESIGN Cross-sectional analysis. MAIN OUTCOME MEASURES We searched for CPGs published by the ESC and the ACC from 2010 to 2020. We selected the CPGs for ventricular arrhythmias and the prevention of SCD. The reference sections were searched for SRs. Two independent investigators evaluated eligible SR using the PRISMA checklist and the AMSTAR-2 assessment tool. RESULTS Two CPGs for ventricular arrhythmia and SCD were included in this study. Fifty-five SRs were included in our analysis. Across all SRs, the mean PRISMA score was 0.70. The lowest scoring PRISMA item related to the presence of a pre-published protocol (item 5, score 0.17). Overall, 40% of included SRs were found to have 'critically low' AMSTAR-2 ratings. One of the lowest scoring items for AMSTAR-2 was reporting of sources of funding (item 10). The 4 Cochrane SRs that were included scored higher on both assessment tools than non-Cochrane studies, specifically in PRISMA overall completion (88.7% vs 69.7%). CONCLUSION Our study suggests the methodological and reporting quality of SRs used within ESC and ACC CPGs is insufficient, as demonstrated by the lack of adherence to both AMSTAR-2 and PRISMA checklists. Given the importance of CPGs on clinical decision making, and ultimately patient care, the methodological rigour and quality reporting within SRs used in CPGs should be held to the highest standard within the field of cardiology.
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Affiliation(s)
- Elizabeth Payton Garrett
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Brooke Hightower
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Corbin Walters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Derek Srouji
- Department of Internal Medicine, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Justin Chronister
- Department of Internal Medicine, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ryan McIntire
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mitchell Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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46
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Explaining predictive factors in patient pathways using autoencoders. PLoS One 2022; 17:e0277135. [DOI: 10.1371/journal.pone.0277135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
This paper introduces an end-to-end methodology to predict a pathway-related outcome and identifying predictive factors using autoencoders. A formal description of autoencoders for explainable binary predictions is presented, along with two objective functions that allows for filtering and inverting negative examples during training. A methodology to model and transform complex medical event logs is also proposed, which keeps the pathway information in terms of events and time, as well as the hierarchy information carried in medical codes. A case study is presented, in which the short-term mortality after the implementation of an Implantable Cardioverter-Defibrillator is predicted. Proposed methodologies have been tested and compared to other predictive methods, both explainable and not explainable. Results show the competitiveness of the method in terms of performances, particularly the use of a Variational Auto Encoder with an inverse objective function. Finally, the explainability of the method has been demonstrated, allowing for the identification of interesting predictive factors validated using relative risks.
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Abstract
The global burden caused by cardiovascular disease is substantial, with heart disease representing the most common cause of death around the world. There remains a need to develop better mechanistic models of cardiac function in order to combat this health concern. Heart rhythm disorders, or arrhythmias, are one particular type of disease which has been amenable to quantitative investigation. Here we review the application of quantitative methodologies to explore dynamical questions pertaining to arrhythmias. We begin by describing single-cell models of cardiac myocytes, from which two and three dimensional models can be constructed. Special focus is placed on results relating to pattern formation across these spatially-distributed systems, especially the formation of spiral waves of activation. Next, we discuss mechanisms which can lead to the initiation of arrhythmias, focusing on the dynamical state of spatially discordant alternans, and outline proposed mechanisms perpetuating arrhythmias such as fibrillation. We then review experimental and clinical results related to the spatio-temporal mapping of heart rhythm disorders. Finally, we describe treatment options for heart rhythm disorders and demonstrate how statistical physics tools can provide insights into the dynamics of heart rhythm disorders.
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Affiliation(s)
- Wouter-Jan Rappel
- Department of Physics, University of California San Diego, La Jolla, CA 92037
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48
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Hwang JC, Kim M, Kim S, Seo H, An S, Jang EH, Han SY, Kim MJ, Kim NK, Cho SW, Lee S, Park JU. In situ diagnosis and simultaneous treatment of cardiac diseases using a single-device platform. SCIENCE ADVANCES 2022; 8:eabq0897. [PMID: 36103536 PMCID: PMC9473581 DOI: 10.1126/sciadv.abq0897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 06/07/2023]
Abstract
The in situ diagnosis of cardiac activities with simultaneous therapeutic electrical stimulation of the heart is key to preventing cardiac arrhythmia. Here, we present an unconventional single-device platform that enables in situ monitoring even in a wet condition and control of beating heart motions without interferences to the recording signal. This platform consists of the active-matrix array of pressure-sensitive transistors for detecting cardiac beatings, biocompatible, low-impedance electrodes for cardiac stimulations, and an alginate-based hydrogel adhesive for attaching this platform conformally to the epicardium. In contrast to conventional electrophysiological sensing using electrodes, the pressure-sensitive transistors measured mechanophysiological characteristics by monitoring the spatiotemporal distributions of cardiac pressures during heart beating motions. In vivo tests show mechanophysiological readings having good correlation with electrocardiography and negligible interference with the electrical artifacts caused during cardiac stimulations. This platform can therapeutically synchronize the rhythm of abnormal heartbeats through efficient pacing of cardiac arrhythmia.
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Affiliation(s)
- Jae Chul Hwang
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Moohyun Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Sumin Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Hunkyu Seo
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Soohwan An
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Seung Yeop Han
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Mi Jung Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- KIURI Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Nam Kyun Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Seung-Woo Cho
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Jang-Ung Park
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- KIURI Institute, Yonsei University, Seoul 03722, Republic of Korea
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Zhou Y, Suo W, Zhang X, Lv J, Liu Z, Liu R. Roles and mechanisms of quercetin on cardiac arrhythmia: A review. Biomed Pharmacother 2022; 153:113447. [DOI: 10.1016/j.biopha.2022.113447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/02/2022] Open
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50
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SGLT2 Inhibitor Empagliflozin Modulates Ion Channels in Adult Zebrafish Heart. Int J Mol Sci 2022; 23:ijms23179559. [PMID: 36076956 PMCID: PMC9455557 DOI: 10.3390/ijms23179559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/14/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022] Open
Abstract
Empagliflozin, an inhibitor of sodium-glucose co-transporter 2 (iSGLT2), improves cardiovascular outcomes in patients with and without diabetes and possesses an antiarrhythmic activity. However, the mechanisms of these protective effects have not been fully elucidated. This study aimed to explore the impact of empagliflozin on ion channel activity and electrophysiological characteristics in the ventricular myocardium. The main cardiac ionic currents (INa, ICaL, ICaT, IKr, IKs) and action potentials (APs) were studied in zebrafish. Whole-cell currents were measured using the patch clamp method in the isolated ventricular cardiomyocytes. The conventional sharp glass microelectrode technique was applied for the recording of APs from the ventricular myocardium of the excised heart. Empagliflozin pretreatment compared to the control group enhanced potassium IKr step current density in the range of testing potentials from 0 to +30 mV, IKr tail current density in the range of testing potentials from +10 to +70 mV, and IKs current density in the range of testing potentials from −10 to +20 mV. Moreover, in the ventricular myocardium, empagliflozin pretreatment shortened AP duration APD as shown by reduced APD50 and APD90. Empagliflozin had no influence on sodium (INa) and L- and T-type calcium currents (ICaL and ICaT) in zebrafish ventricular cardiomyocytes. Thus, we conclude that empagliflozin increases the rapid and slow components of delayed rectifier K+ current (IKr and IKs). This mechanism could be favorable for cardiac protection.
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