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Jing M, Xi H, Liu Q, Zhu H, Sun Q, Zhang Y, Liu X, Ren W, Deng L, Zhou J. Correlation between left atrial appendage morphology based on fractal dimension quantification and its hemodynamic parameters in patients with atrial fibrillation. Clin Radiol 2024; 79:e1243-e1251. [PMID: 39054176 DOI: 10.1016/j.crad.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/24/2024] [Accepted: 05/01/2024] [Indexed: 07/27/2024]
Abstract
AIMS To investigate the relationship between left atrial appendage (LAA) morphology, quantified based on fractal dimension (FD), and LAA hemodynamic parameters in patients with atrial fibrillation (AF), in an effort to reveal the effect of LAA shape on blood flow. MATERIALS AND METHODS 225 patients with AF who underwent cardiac computed tomography angiography (CTA) and transesophageal echocardiography (TEE) were enrolled. LAA morphology was quantified based on FD on cardiac CTA images, and LAA hemodynamic parameters, including injection fraction (EF), filling peak flow velocity (FV), maximum speed of emptying (PEV), and wall motion velocity (WMV), were assessed using TEE. RESULTS We divided the patients with AF into two groups based on a mean LAA FD of 1.32: the low FD group (n=124) and the high FD group (n=101). Compared to the low FD group, there were more patients with LAA circulatory stasis/thrombus (P=0.008) in the high FD group, as well as lower LAA FV (P=0.004), LAA PEV (P=0.007), and LAA WMV (P=0.007). LAA FD was an independent and significant determinant of LAA EF (β = -11.755, P=0.001), LAA FV (β = -17.364, P=0.004), LAA PEV (β = -18.743, P<0.001), and LAA WMV (β = -7.740, P=0.001) in multiple linear regression analysis. CONCLUSIONS LAA FD is an essential determinant of LAA hemodynamic parameters, suggesting that the relatively complex morphology of the LAA may influence its hemodynamics, which can correlate with embolic events.
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Affiliation(s)
- M Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - H Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Q Liu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - H Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Q Sun
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Y Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - X Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - W Ren
- GE Healthcare, Computed Tomography Research Center, Beijing, China
| | - L Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - J Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Peng S, Li K, Man Y, Liu P. Identification of ferroptosis biomarkers and immune infiltration landscapes in atrial fibrillation: A bioinformatics analysis. Medicine (Baltimore) 2024; 103:e39777. [PMID: 39331874 DOI: 10.1097/md.0000000000039777] [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] [Indexed: 09/29/2024] Open
Abstract
Ferroptosis has been recognized as a critical factor in the development of atrial fibrillation (AF), but its precise mechanisms remain unclear. We downloaded the GSE115574 dataset from the gene expression omnibus database to analyze the expression levels of ferroptosis-related genes (FRGs) and identify differentially expressed genes (DEGs). Least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) machine learning techniques were employed to identify key genes associated with AF. The diagnostic performance of these genes was evaluated using Receiver operating characteristic curves (ROC) and validated in an independent AF dataset. miRNA and lncRNA predictions for potential binding to these key genes were conducted using miRBase, miRDB, and TargetScan. Furthermore, gene set enrichment analysis (GSEA) enrichment analysis, immune cell infiltration analysis, and targeted drug prediction were performed. The intersection of LASSO regression and SVM-RFE analyses identified 7 DEGs significantly associated with AF. Validation through ROC and an additional dataset confirmed the importance of MAPK14, CAV1, and ADAM23. Significant infiltration of memory B cells, regulatory T cells, and monocytes was observed in atrial tissues. Seventy-two miRNAs were predicted to potentially target MAPK14, and 2 drugs were identified as targeting CAV1. This study underscores the involvement of FRGs in AF through machine learning and validation approaches. The observed immune cell infiltration suggests a potential link between immune response and AF. The predicted ceRNA network offers new insights into gene regulation, presenting potential biomarkers and therapeutic targets for AF.
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Affiliation(s)
- Shaoyi Peng
- Department of Cardiology, Jiande First People's Hospital, Hangzhou, China
| | - Kaiyuan Li
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Yilong Man
- Department of Cardiology, Center Hospital of Shandong First Medical University, Jinan, China
| | - Peng Liu
- Department of Cardiology, Center Hospital of Shandong First Medical University, Jinan, China
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Chen C, Tian Q, Cheng C, Ji X, Feng M, Tan H, Zhou Q. Application Value and Safety Analysis of Warfarin, Rivaroxaban, and Dabigatran Ester in Elderly Patients With Atrial Fibrillation. Clin Cardiol 2024; 47:e70014. [PMID: 39248072 PMCID: PMC11381953 DOI: 10.1002/clc.70014] [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: 07/15/2024] [Revised: 08/21/2024] [Accepted: 08/27/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the application value and safety of Warfarin, Rivaroxaban, and Dabigatran in elderly patients with atrial fibrillation. METHODS A total of 180 elderly patients with atrial fibrillation admitted to our hospital were retrospectively analyzed. According to their anticoagulant treatment regimen, patients were divided into three groups: Warfarin (57 cases), Rivaroxaban (61 cases), and Dabigatran (62 cases). General demographic information was collected, and coagulation function indicators-including fibrinogen (FIB), thrombin time (PT), activated partial thrombin time (APTT), and D-dimer (D-D)-as well as liver function indexes-including total bilirubin (TbiL), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine transferase (ALT)-were compared before and after 4 weeks of treatment. RESULTS There were no significant differences in demographic characteristics such as gender, age, body mass index, or disease course among the three groups. The total effective rate in the Warfarin group (84.21%) was significantly lower than in the Rivaroxaban (98.36%) and Dabigatran (96.77%) groups (p < 0.05). However, there was no significant difference in the total effective rate between the Rivaroxaban and Dabigatran groups (p > 0.05). Additionally, no significant differences were found in the effects of the three drugs on coagulation function, liver function, or the incidence of bleeding (p = 0.052). CONCLUSION Warfarin, Rivaroxaban, and Dabigatran can effectively prevent thrombosis in elderly patients with atrial fibrillation, with Rivaroxaban and Dabigatran showing superior effectiveness. All three drugs demonstrated similar low rates of bleeding events and had no significant impact on coagulation and liver function.
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Affiliation(s)
- Cheng Chen
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Qing Tian
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Chong Cheng
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Xixin Ji
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Mengyun Feng
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Huiqun Tan
- Department of General Practice, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Qian Zhou
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
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Petzl AM, Jabbour G, Cadrin-Tourigny J, Pürerfellner H, Macle L, Khairy P, Avram R, Tadros R. Innovative approaches to atrial fibrillation prediction: should polygenic scores and machine learning be implemented in clinical practice? Europace 2024; 26:euae201. [PMID: 39073570 PMCID: PMC11332604 DOI: 10.1093/europace/euae201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
Atrial fibrillation (AF) prediction and screening are of important clinical interest because of the potential to prevent serious adverse events. Devices capable of detecting short episodes of arrhythmia are now widely available. Although it has recently been suggested that some high-risk patients with AF detected on implantable devices may benefit from anticoagulation, long-term management remains challenging in lower-risk patients and in those with AF detected on monitors or wearable devices as the development of clinically meaningful arrhythmia burden in this group remains unknown. Identification and prediction of clinically relevant AF is therefore of unprecedented importance to the cardiologic community. Family history and underlying genetic markers are important risk factors for AF. Recent studies suggest a good predictive ability of polygenic risk scores, with a possible additive value to clinical AF prediction scores. Artificial intelligence, enabled by the exponentially increasing computing power and digital data sets, has gained traction in the past decade and is of increasing interest in AF prediction using a single or multiple lead sinus rhythm electrocardiogram. Integrating these novel approaches could help predict AF substrate severity, thereby potentially improving the effectiveness of AF screening and personalizing the management of patients presenting with conditions such as embolic stroke of undetermined source or subclinical AF. This review presents current evidence surrounding deep learning and polygenic risk scores in the prediction of incident AF and provides a futuristic outlook on possible ways of implementing these modalities into clinical practice, while considering current limitations and required areas of improvement.
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Affiliation(s)
- Adrian M Petzl
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Gilbert Jabbour
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Heartwise (heartwise.ai), Montreal Heart Institute, Montreal, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Helmut Pürerfellner
- Department of Internal Medicine 2/Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Laurent Macle
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Paul Khairy
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Robert Avram
- Heartwise (heartwise.ai), Montreal Heart Institute, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Rafik Tadros
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
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Tamayo-Trujillo R, Paz-Cruz E, Cadena-Ullauri S, Guevara-Ramirez P, Ruiz-Pozo VA, Ibarra-Castillo R, Laso-Bayas JL, Zambrano AK. Exploring Atrial Fibrillation: Understanding the Complex Relation Between Lifestyle and Genetic Factors. J Med Cases 2024; 15:186-194. [PMID: 39091575 PMCID: PMC11287905 DOI: 10.14740/jmc4250] [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: 05/15/2024] [Accepted: 06/21/2024] [Indexed: 08/04/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death worldwide across diverse ethnic groups. Among these, atrial fibrillation (AF) stands as one of the most prevalent types of arrhythmias and the primary cause of stroke. Risk factors associated with AF include alcohol consumption, aging, high blood pressure, hypertension, inflammation, and genetic factors. A family history of CVD could indicate an increased risk. Consequently, genetic, and genomic testing should be performed to identify the molecular etiology of CVDs and assess at-risk patients. It is important to note that CVDs are the results of the complex interplay of genes and environmental factors, including ethnicity. In this case, the proband's clinic story includes a history of smoking abuse for 10 years (10 cigarettes per day), obesity, hypertension, and an associated familial history. These risk factors, along with genetic variants, could trigger the early onset of AF. In recent years, genetic and genomic studies have significantly advanced our understanding of CVD etiology, given that next-generation sequencing (NGS) allows for the identification of genetic variants that could contribute to these pathologies. Furthermore, NGS facilitates early diagnosis, personalized pharmacological approaches, and identification of novel biomarkers. Thus, NGS is a valuable tool in CVD management. However, such studies are limited in Ecuador, a low- and middle-income country. Several challenges contribute to this gap, encompassing economic, infrastructural, and educational obstacles. Notably, the cost of genetic and genomic studies may also pose a barrier, restricting access to a portion of the population. In this case report, we present a 56-year-old Ecuadorian woman, who has been diagnosed with AF; however, after performing NGS no disease-associated variants were found, despite having strong clinical signs and symptoms. In summary, this case report contributes valuable insights into the complex interplay between genetic and lifestyle factors in the development and management of AF. The case report aims to underscore the potential impact of genetic variants on disease risk, even when classified as variants of uncertain significance, and the importance of an integral approach to patient care that includes genetic screening, lifestyle interventions, and tailored pharmacological treatment.
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Affiliation(s)
- Rafael Tamayo-Trujillo
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- These authors contributed equally to this work and share first authorship
| | - Elius Paz-Cruz
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- These authors contributed equally to this work and share first authorship
| | - Santiago Cadena-Ullauri
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- These authors contributed equally to this work and share first authorship
| | - Patricia Guevara-Ramirez
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- These authors contributed equally to this work and share first authorship
| | - Viviana A. Ruiz-Pozo
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | | | | | - Ana Karina Zambrano
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
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Haq IU, Akhiyat N, Al-Shakarchi N, Siontis KC, Mulpuru SK, Sugrue A, Giudicessi J, Friedman PA, Asirvatham SJ, Killu AM. Atrial Fibrillation Substrate and Catheter Ablation Outcomes in MYBPC3- and MYH7-Mediated Hypertrophic Cardiomyopathy. JACC Clin Electrophysiol 2024; 10:1380-1391. [PMID: 38819352 DOI: 10.1016/j.jacep.2024.03.026] [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: 09/01/2023] [Revised: 02/26/2024] [Accepted: 03/16/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The effects of disease-causing MYBPC3 or MYH7 genetic variants on atrial myopathy, atrial fibrillation (AF) clinical course, and catheter ablation efficacy remain unclear. OBJECTIVES The aim of this study was to characterize the atrial substrate of patients with MYBPC3- or MYH7-mediated hypertrophic cardiomyopathy (HCM) and its impact on catheter ablation outcomes. METHODS A retrospective single-center study of patients with HCM who underwent genetic testing and catheter ablation for AF was performed. Patients with MYBPC3- or MYH7-mediated HCM formed the gene-positive cohort; those without disease-causative genetic variants formed the control cohort. High-density electroanatomical mapping was performed using a 3-dimensional mapping system, followed by radiofrequency ablation. RESULTS Twelve patients were included in the gene-positive cohort (mean age 55.6 ± 9.9 years, 83% men, 50% MYBPC3, 50% MYH7, mean ejection fraction 59.3% ± 13.7%, mean left atrial [LA] volume index 51.7 ± 13.1 mL/m2, mean LA pressure 20.2 ± 5.4 mm Hg) and 15 patients in the control arm (mean age 61.5 ± 12.6 years, 60% men, mean ejection fraction 64.9% ± 5.1%, mean LA volume index 54.1 ± 12.8 mL/m2, mean LA pressure 19.6 ± 5.41 mm Hg). Electroanatomical mapping demonstrated normal voltage in 87.7% ± 5.03% of the LA in the gene-positive cohort and 94.3% ± 3.58% of the LA in the control cohort (P < 0.001). Of the abnormal regions, intermediate scar (0.1-0.5 mV) accounted for 6.33% ± 1.97% in the gene-positive cohort and 3.07% ± 2.46% in the control cohort (P < 0.01). Dense scar (<0.1 mV) accounted for 5.93% ± 3.20% in the gene-positive cohort and 2.61% ± 2.19% in the control cohort (P < 0.01). Freedom from AF at 12 months was similar between the gene-positive (75%) and control (73%) cohorts (P = 0.92), though a greater number of procedures were required in the gene-positive cohort. CONCLUSIONS Patients with MYBPC3- or MYH7-mediated HCM undergoing AF ablation have appreciably more low-amplitude LA signals, suggestive of fibrosis. However, catheter ablation remains an effective rhythm-control strategy.
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Affiliation(s)
- Ikram U Haq
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/IkramHaqMD
| | - Nadia Akhiyat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nader Al-Shakarchi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Wang J, Liu Z, Zhang Y, Zhang M, Chen D, Zhang G. A method of identifying the high-risk mutations of sudden cardiac death at KCNQ1 and KCNH2 genes. J Forensic Leg Med 2024; 105:102707. [PMID: 38908219 DOI: 10.1016/j.jflm.2024.102707] [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: 11/10/2023] [Revised: 04/13/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Sudden Cardiac Death (SCD) often shows negative anatomy results after a systemic autopsy and the gene mutations of potassium channel play a key role in the etiology of SCD. We established a feasible system to detect SCD-related mutations and investigated the mutations at KCNQ1 and KCNH2 genes in the Chinese population. We established a mutation detection system combined with multiplex PCR, SNaPshot technique, and capillary electrophoresis. We genotyped 101 putative mutations at KCNQ1 and KCNH2 genes in 60 SCD of negative anatomy and 50 controls using the established assay and compared Odd Ratio (OR). Four coding variants were identified in the KCNQ1 gene: S546S, I145I, P448R, and G643S. The mutations of I145I and S546S did not differ significantly in the SCD compared with controls. 21 SCD individuals (35 %) and 1 control individual (2 %) showed a genotype of C/G at P448R (OR = 17.5, 95 % CI [2.40-127.82]). 24 SCD individuals (40 %) and 1 control individual (2 %) showed a genotype of C/G at G643S (OR = 20.0, 95 % CI [2.75-145.25]). We established a robust assay for rapid screening the putative SCD-related mutations in KCNQ1 and KCNH2 genes. The new assay in our study is easily amenable to the majority of laboratories without the need for new specialized equipment. Our method will meet the increasing requirement of mutation screening for SCD in regular DNA laboratories and will help screen mutations in those dead of SCD and their relatives.
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Affiliation(s)
- Jiaqi Wang
- School of Forensic Medicine, Shanxi Medical University, Shanxi, 030619, PR China
| | - Zidong Liu
- School of Forensic Medicine, Shanxi Medical University, Shanxi, 030619, PR China
| | - Yuxin Zhang
- School of Forensic Medicine, Shanxi Medical University, Shanxi, 030619, PR China
| | - Mingming Zhang
- School of Forensic Medicine, Shanxi Medical University, Shanxi, 030619, PR China
| | - Deqing Chen
- Department of Pathology, Forensic and Pathology Laboratory, Judicial Expertise Center, Jiaxing University Medical College, Jiaxing, Zhejiang, 314001, PR China.
| | - Gengqian Zhang
- School of Forensic Medicine, Shanxi Medical University, Shanxi, 030619, PR China.
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Huang W, Xu S, Zhou H, Ji W, Chen Y. Global association of incidence between atrial fibrillation and the major gastrointestinal cancers: An analysis based on the 2019 Global burden of disease study. Heliyon 2024; 10:e29929. [PMID: 38699016 PMCID: PMC11064153 DOI: 10.1016/j.heliyon.2024.e29929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Atrial Fibrillation (AF) and gastrointestinal (GI) cancers are age-related diseases with shared environmental risk factors and underlying biological mechanisms. This study aimed to assess the association between AF and GI cancers on a global scale, analyzing incidence data from 204 countries. This ecological study utilized data from the Global Burden of Disease. Spearman's correlation and logistic regression analyses were employed to assess the association between AF and specific GI cancers, including esophagus cancer (EC), colon and rectum cancer (CRC), liver cancer (LC), pancreatic cancer (PC), and stomach cancer (SC). AF, CRC and PC exhibited increasing crude incidence rates from 2000 to 2019, whereas EC and SC demonstrated decreasing trends specifically in females. From 2000 to 2010, there was a noticeable fall in the incidence rate of LC, which was followed by a minor growth through 2019. The age-standardized incidence rate (ASIR) of AF was positively correlated with CRC and PC, but a negative relationship with AF was revealed for EC. Unexpectedly, no significant relationship was discovered for SC and LC associated with AF. Logistic regression analysis revealed a positive correlation between a country's ASIR of AF and its ASIR of CRC, LC and PC. Conversely, these countries demonstrated a decreased ASIR for EC. Our findings showed a significant correlation between national incidence rates of AF with CRC and PC, worldwide. Countries with higher ASIR of AF had higher ASIR of CRC and PC. Additional research is necessary to confirm the association between GI cancers and AF at the individual level.
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Affiliation(s)
- Weipeng Huang
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Shangbo Xu
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Haoyue Zhou
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Weibiao Ji
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Yangbo Chen
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
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9
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Chen K, Zhang Y, Zhou S, Jin C, Xiang M, Ma H. The association between the basal metabolic rate and cardiovascular disease: A two-sample Mendelian randomization study. Eur J Clin Invest 2024; 54:e14153. [PMID: 38229569 DOI: 10.1111/eci.14153] [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: 07/20/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Mendelian randomization analysis was applied to elucidate the causal relationship between the basal metabolic rate (BMR) and common cardiovascular diseases. METHOD We choose BMR as exposure. BMR is the metabolic rate of the body when the basic physiological activities (blood circulation, breathing and constant body temperature) are maintained. The normal BMR is 1507 kcal/day for men and 1276 kcal/day for women. The dataset was drawn from the public GWAS dataset (GWAS ID: ukb-a-268), collected and analysed by UK biobank, containing 331,307 European males and females. SNPs independently and strongly associated with BMR were used as instrumental variables in the inverse variance weighted analysis. MR-Egger, weighted median, MR pleiotropy residual sum, and outlier methods were also performed, and the sensitivity was evaluated using horizontal pleiotropy and heterogeneity analyses to ensure the stability of the results. RESULTS An increased BMR is associated with a higher risk of cardiomyopathy (odds ratio [OR] = 2.00, 95% confidence interval [CI], 1.57-2.54, p = 1.87 × 10-8), heart failure (OR = 1.39, 95% CI, 1.27-2.51, p = 8.1 × 10-13), and valvular heart disease (OR = 1.18, 95% CI, 1.10-1.27, p = .00001). However, there was no clear association between BMR and the subtypes of other cardiovascular diseases, such as coronary disease (OR = .96, 95% CI, .85-1.08, p = .48651) and atrial fibrillation (AF) (OR = 1.85, 95% CI, 1.70-2.02, p = 6.28 × 10-44). CONCLUSION Our study reveals a possible causal effect of BMR on the risk of cardiomyopathy, heart failure and valvular disease, but not for coronary disease and AF.
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Affiliation(s)
- Kaijie Chen
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Zhang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siyu Zhou
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chengjiang Jin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Meixiang Xiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Ma
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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10
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Tubeeckx MRL, De Keulenaer GW, Heidbuchel H, Segers VFM. Pathophysiology and clinical relevance of atrial myopathy. Basic Res Cardiol 2024; 119:215-242. [PMID: 38472506 DOI: 10.1007/s00395-024-01038-0] [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: 09/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Atrial myopathy is a condition that consists of electrical, structural, contractile, and autonomic remodeling of the atria and is the substrate for development of atrial fibrillation, the most common arrhythmia. Pathophysiologic mechanisms driving atrial myopathy are inflammation, oxidative stress, atrial stretch, and neurohormonal signals, e.g., angiotensin-II and aldosterone. These mechanisms initiate the structural and functional remodeling of the atrial myocardium. Novel therapeutic strategies are being developed that target the pathophysiologic mechanisms of atrial myopathy. In this review, we will discuss the pathophysiology of atrial myopathy, as well as diagnostic and therapeutic strategies.
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Affiliation(s)
- Michiel R L Tubeeckx
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium.
| | - Gilles W De Keulenaer
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, ZNA Middelheim Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
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11
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Arabia G, Bellicini MG, Cersosimo A, Memo M, Mazzarotto F, Inciardi RM, Cerini M, Chen LY, Aboelhassan M, Benzoni P, Mitacchione G, Bontempi L, Curnis A. Ion channel dysfunction and fibrosis in atrial fibrillation: Two sides of the same coin. Pacing Clin Electrophysiol 2024; 47:417-428. [PMID: 38375940 DOI: 10.1111/pace.14944] [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: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common heart rhythm disorder that is associated with an increased risk of stroke and heart failure (HF). Initially, an association between AF and ion channel dysfunction was identified, classifying the pathology as a predominantly electrical disease. More recently it has been recognized that fibrosis and structural atrial remodeling play a driving role in the development of this arrhythmia also in these cases. PURPOSE Understanding the role of fibrosis in genetic determined AF could be important to better comprise the pathophysiology of this arrhythmia and to refine its management also in nongenetic forms. In this review we analyze genetic and epigenetic mechanisms responsible for AF and their link with atrial fibrosis, then we will consider analogies with the pathophysiological mechanism in nongenetic AF, and discuss consequent therapeutic options.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Angelica Cersosimo
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Mazzarotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- National Heart and Lung Institute, Imperial College London (F.M., J. Ware), London, UK
| | | | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Lin Yee Chen
- University of Minnesota (L.Y.C.), Minneapolis, USA
| | | | - Patrizia Benzoni
- Department of Biosciences, Università degli Studi di Milano, Milan, Italy
| | | | - Luca Bontempi
- Unit of Cardiology, Cardiac Electrophysiology and, Electrostimulation Laboratory, "Bolognini" Hospital of Seriate - ASST Bergamo Est, Bergamo, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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12
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Gong Q, LE X, Yu P, Zhuang L. Therapeutic advances in atrial fibrillation based on animal models. J Zhejiang Univ Sci B 2024; 25:135-152. [PMID: 38303497 PMCID: PMC10835209 DOI: 10.1631/jzus.b2300285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/14/2023] [Indexed: 02/03/2024]
Abstract
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia among humans, with its incidence increasing significantly with age. Despite the high frequency of AF in clinical practice, its etiology and management remain elusive. To develop effective treatment strategies, it is imperative to comprehend the underlying mechanisms of AF; therefore, the establishment of animal models of AF is vital to explore its pathogenesis. While spontaneous AF is rare in most animal species, several large animal models, particularly those of pigs, dogs, and horses, have proven as invaluable in recent years in advancing our knowledge of AF pathogenesis and developing novel therapeutic options. This review aims to provide a comprehensive discussion of various animal models of AF, with an emphasis on the unique features of each model and its utility in AF research and treatment. The data summarized in this review provide valuable insights into the mechanisms of AF and can be used to evaluate the efficacy and safety of novel therapeutic interventions.
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Affiliation(s)
- Qian Gong
- Institute of Genetics and Reproduction, College of Animal Sciences, Zhejiang University, Hangzhou 310058, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xuan LE
- Institute of Genetics and Reproduction, College of Animal Sciences, Zhejiang University, Hangzhou 310058, China
| | - Pengcheng Yu
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Lenan Zhuang
- Institute of Genetics and Reproduction, College of Animal Sciences, Zhejiang University, Hangzhou 310058, China.
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
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13
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Vinciguerra M, Dobrev D, Nattel S. Atrial fibrillation: pathophysiology, genetic and epigenetic mechanisms. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100785. [PMID: 38362554 PMCID: PMC10866930 DOI: 10.1016/j.lanepe.2023.100785] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia affecting up to 1% of the general population. Its prevalence dramatically increases with age and could reach up to ∼10% in the elderly. The management of AF is a complex issue that is object of extensive ongoing basic and clinical research, it depends on its genetic and epigenetic causes, and it varies considerably geographically and also according to the ethnicity. Mechanistically, over the last decade, Genome Wide Association Studies have uncovered over 100 genetic loci associated with AF, and have shown that European ancestry is associated with elevated risk of AF. These AF-associated loci revolve around different types of disturbances, including inflammation, electrical abnormalities, and structural remodeling. Moreover, the discovery of epigenetic regulatory mechanisms, involving non-coding RNAs, DNA methylation and histone modification, has allowed unravelling what modifications reshape the processes leading to arrhythmias. Our review provides a current state of the field regarding the identification and functional characterization of AF-related genetic and epigenetic regulatory networks, including ethnic differences. We discuss clear and emerging connections between genetic regulation and pathophysiological mechanisms of AF.
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Affiliation(s)
- Manlio Vinciguerra
- Department of Translational Stem Cell Biology, Research Institute, Medical University of Varna, Varna, Bulgaria
- Liverpool Centre for Cardiovascular Science, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Duisburg, Germany
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
| | - Stanley Nattel
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Duisburg, Germany
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Canada
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
- IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
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14
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Saha S, Linz D, Saha D, McEwan A, Baumert M. Overcoming Uncertainties in Electrogram-Based Atrial Fibrillation Mapping: A Review. Cardiovasc Eng Technol 2024; 15:52-64. [PMID: 37962813 DOI: 10.1007/s13239-023-00696-w] [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: 05/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
In clinical rhythmology, intracardiac bipolar electrograms (EGMs) play a critical role in investigating the triggers and substrates inducing and perpetuating atrial fibrillation (AF). However, the interpretation of bipolar EGMs is ambiguous due to several aspects of electrodes, mapping algorithms and wave propagation dynamics, so it requires several variables to describe the effects of these uncertainties on EGM analysis. In this narrative review, we critically evaluate the potential impact of such uncertainties on the design of cardiac mapping tools on AF-related substrate characterization. Literature suggest uncertainties are due to several variables, including the wave propagation vector, the wave's incidence angle, inter-electrode spacing, electrode size and shape, and tissue contact. The preprocessing of the EGM signals and mapping density will impact the electro-anatomical representation and the features extracted from the local electrical activities. The superposition of multiple waves further complicates EGM interpretation. The inclusion of these uncertainties is a nontrivial problem but their consideration will yield a better interpretation of the intra-atrial dynamics in local activation patterns. From a translational perspective, this review provides a concise but complete overview of the critical variables for developing more precise cardiac mapping tools.
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Affiliation(s)
- Simanto Saha
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia.
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Dyuti Saha
- Kumudini Women's Medical College, The University of Dhaka, Tangail, 1940, Dhaka, Bangladesh
| | - Alistair McEwan
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia
| | - Mathias Baumert
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5000, Australia
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15
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Popa-Fotea NM, Oprescu N, Scafa-Udriste A, Micheu MM. Impact of rs1805127 and rs55742440 Variants on Atrial Remodeling in Hypertrophic Cardiomyopathy Patients with Atrial Fibrillation: A Romanian Cohort Study. Int J Mol Sci 2023; 24:17244. [PMID: 38139087 PMCID: PMC10743528 DOI: 10.3390/ijms242417244] [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: 10/11/2023] [Revised: 11/25/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Atrial fibrillation (AFib) is characterized by a complex genetic component. We aimed to investigate the association between variations in genes related to cardiac ion handling and AFib in a cohort of Romanian patients with hypertrophic cardiomyopathy (HCM). Forty-five unrelated probands with HCM were genotyped by targeted next-generation sequencing (NGS) for 24 genes associated with cardiac ion homeostasis. Subsequently, the study cohort was divided into two groups based on the presence (AFib+) or absence (AFiB-) of AFib detected during ECG monitoring. We identified two polymorphisms (rs1805127 located in KCNE1 and rs55742440 located in SCN1B) linked to AFib susceptibility. In AFib+, rs1805127 was associated with increased indexed left atrial (LA) maximal volume (LAVmax) (58.42 ± 21 mL/m2 vs. 32.54 ± 6.47 mL/m2, p < 0.001) and impaired LA strain reservoir (LASr) (13.3 ± 7.5% vs. 24.4 ± 6.8%, p < 0.05) compared to those without respective variants. The rs55742440 allele was less frequent in patients with AFib+ (12 out of 25, 48%) compared to those without arrhythmia (15 out of 20, 75%, p = 0.05). Also, AFib+ rs55742440 carriers had significantly lower LAVmax compared to those who were genotype negative. Among patients with HCM and AFib+, the rs1805127 variant was accompanied by pronounced LA remodeling, whereas rs55742440's presence was related to a milder LA enlargement.
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Affiliation(s)
- Nicoleta-Monica Popa-Fotea
- Department 4—Cardio-Thoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania;
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania;
| | - Nicoleta Oprescu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania;
| | - Alexandru Scafa-Udriste
- Department 4—Cardio-Thoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania;
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania;
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania;
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16
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Hu Z, Ding L, Yao Y. Atrial fibrillation: mechanism and clinical management. Chin Med J (Engl) 2023; 136:2668-2676. [PMID: 37914663 PMCID: PMC10684204 DOI: 10.1097/cm9.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 11/03/2023] Open
Abstract
ABSTRACT Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with a range of symptoms, including palpitations, cognitive impairment, systemic embolism, and increased mortality. It places a significant burden on healthcare systems worldwide. Despite decades of research, the precise mechanisms underlying AF remain elusive. Current understanding suggests that factors like stretch-induced fibrosis, epicardial adipose tissue (EAT), chronic inflammation, autonomic nervous system (ANS) imbalances, and genetic mutations all play significant roles in its development. In recent years, the advent of wearable devices has revolutionized AF diagnosis, enabling timely detection and monitoring. However, balancing early diagnosis with efficient resource utilization presents new challenges for healthcare providers. AF management primarily focuses on stroke prevention and symptom alleviation. Patients at high risk of thromboembolism require anticoagulation therapy, and emerging pipeline drugs, particularly factor XI inhibitors, hold promise for achieving effective anticoagulation with reduced bleeding risks. The scope of indications for catheter ablation in AF has expanded significantly. Pulsed field ablation, as a novel energy source, shows potential for improving success rates while ensuring safety. This review integrates existing knowledge and ongoing research on AF pathophysiology and clinical management, with emphasis on diagnostic devices, next-generation anticoagulants, drugs targeting underlying mechanisms, and interventional therapies. It offers a comprehensive mosaic of AF, providing insights into its complexities.
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Affiliation(s)
| | | | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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17
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Rachieru C, Luca CT, Văcărescu C, Petrescu L, Cirin L, Cozma D. Future Perspectives to Improve CHA 2DS 2VASc Score: The Role of Left Atrium Remodelling, Inflammation and Genetics in Anticoagulation of Atrial Fibrillation. Clin Interv Aging 2023; 18:1737-1748. [PMID: 37873054 PMCID: PMC10590594 DOI: 10.2147/cia.s427748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
In 10% of ischemic strokes, non-valvular atrial fibrillation (NVAF) is detected retroactively. Milder, or even asymptomatic forms of NVAF have shown high mortality, thrombotic risk, and deterioration of cognitive function. The current guidelines for the diagnosis and treatment of AF contain "grey areas", such as the one related to anticoagulant treatment in men with CHA2DS2-VASc score 1 and women with score 2. Moreover, parameters such as renal function, patient weight or left atrium remodelling are missing from the recommended guidelines scores. Vulnerable categories of patients including the elderly population, high hemorrhagic risk patients or patients with newly diagnosed paroxysmal episodes of atrial high rate at device interrogation are at risk of underestimation of the thrombotic risk. This review presents a systematic exposure of the most important gaps in evaluation of thrombotic and hemorrhagic risk in patients with NVAF. The authors propose new algorithms and risk factors that should be taken into consideration for an accurate thrombotic and hemorrhagic risk estimation, especially in vulnerable categories of patients.
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Affiliation(s)
- Ciprian Rachieru
- Faculty of Medicine, Department of Internal Medicine I, Discipline of Medical Semiology I “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Internal Medicine Department, County Emergency Hospital, Timisoara, 300079, Romania
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
| | - Cristina Văcărescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
| | - Lucian Petrescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Liviu Cirin
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Dragos Cozma
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania
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18
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Qian Y, Fei Z, Nian F. The Association Between Rheumatoid Arthritis and Atrial Fibrillation: Epidemiology, Pathophysiology and Management. Int J Gen Med 2023; 16:1899-1908. [PMID: 37223618 PMCID: PMC10202215 DOI: 10.2147/ijgm.s406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia with a significant increase in morbidity and mortality worldwide. Rheumatoid arthritis (RA), as a systemic inflammatory disease, affecting 0.5-1.0% of the adult population, is associated with increased incidence of cardiac arrhythmias such as AF. Several epidemiologic studies find that the risk of AF is increased in RA when compared with the general population. Other studies are inconsistent. Considering that inflammation plays an important role in AF, RA may be involved in the occurrence and development of AF. This review summarizes the epidemiology, pathophysiology, and management of AF in patients with RA.
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Affiliation(s)
- Yezhou Qian
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Zhangli Fei
- Department of Rheumatology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Feige Nian
- Department of Rheumatology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
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19
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Marston NA, Garfinkel AC, Kamanu FK, Melloni GM, Roselli C, Jarolim P, Berg DD, Bhatt DL, Bonaca MP, Cannon CP, Giugliano RP, O'Donoghue ML, Raz I, Scirica BM, Braunwald E, Morrow DA, Ellinor PT, Lubitz SA, Sabatine MS, Ruff CT. A polygenic risk score predicts atrial fibrillation in cardiovascular disease. Eur Heart J 2023; 44:221-231. [PMID: 35980763 DOI: 10.1093/eurheartj/ehac460] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Interest in targeted screening programmes for atrial fibrillation (AF) has increased, yet the role of genetics in identifying patients at highest risk of developing AF is unclear. METHODS AND RESULTS A total of 36,662 subjects without prior AF were analyzed from four TIMI trials. Subjects were divided into quintiles using a validated polygenic risk score (PRS) for AF. Clinical risk for AF was calculated using the CHARGE-AF model. Kaplan-Meier event rates, adjusted hazard ratios (HRs), C-indices, and net reclassification improvement were used to determine if the addition of the PRS improved prediction compared with clinical risk and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Over 2.3 years, 1018 new AF cases developed. AF PRS predicted a significant risk gradient for AF with a 40% increased risk per 1-SD increase in PRS [HR: 1.40 (1.32-1.49); P < 0.001]. Those with high AF PRS (top 20%) were more than two-fold more likely to develop AF [HR 2.45 (1.99-3.03), P < 0.001] compared with low PRS (bottom 20%). Furthermore, PRS provided an additional gradient of risk stratification on top of the CHARGE-AF clinical risk score, ranging from a 3-year incidence of 1.3% in patients with low clinical and genetic risk to 8.7% in patients with high clinical and genetic risk. The subgroup of patients with high clinical risk, high PRS, and elevated NT-proBNP had an AF risk of 16.7% over 3 years. The C-index with the CHARGE-AF clinical risk score alone was 0.65, which improved to 0.67 (P < 0.001) with the addition of NT-proBNP, and increased further to 0.70 (P < 0.001) with the addition of the PRS. CONCLUSION In patients with cardiovascular conditions, AF PRS is a strong independent predictor of incident AF that provides complementary predictive value when added to a validated clinical risk score and NT-proBNP.
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Affiliation(s)
- Nicholas A Marston
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Amanda C Garfinkel
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frederick K Kamanu
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Giorgio M Melloni
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David D Berg
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marc P Bonaca
- Department for Medicine, CPC Clinical Research, Aurora, CO, USA
| | - Christopher P Cannon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert P Giugliano
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle L O'Donoghue
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Itamar Raz
- Department for Medicine, Hebrew University Hospital, Jerusalem, Israel
| | - Benjamin M Scirica
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eugene Braunwald
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David A Morrow
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Marc S Sabatine
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian T Ruff
- Department for Medicine, TIMI Study Group, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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20
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Wang S, Chen H, Liu C, Wu M, Sun W, Liu S, Zheng Y, He W. Genetic variants, pathophysiological pathways, and oral anticoagulation in patients with hypertrophic cardiomyopathy and atrial fibrillation. Front Cardiovasc Med 2023; 10:1023394. [PMID: 37139132 PMCID: PMC10149704 DOI: 10.3389/fcvm.2023.1023394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Atrial fibrillation (AF) is commonly prevalent in patients with hypertrophic cardiomyopathy (HCM). However, whether the prevalence and incidence of AF are different between genotype-positive vs. genotype-negative patients with HCM remains controversial. Recent evidence has indicated that AF is often the first presentation of genetic HCM patients in the absence of a cardiomyopathy phenotype, implying the importance of genetic testing in this population with early-onset AF. However, the association of the identified sarcomere gene variants with HCM occurrence in the future remains unclear. How the identification of these cardiomyopathy gene variants should influence the use of anticoagulation therapy for a patient with early-onset AF is still undefined. In this review, we sought to assess the genetic variants, pathophysiological pathways, and oral anticoagulation in patients with HCM and AF.
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Affiliation(s)
- Shengnan Wang
- Department of Medical Genetics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - He Chen
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chunju Liu
- Department ofClinical Laboratory, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Mengxian Wu
- Department ofClinical Laboratory, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Wanlei Sun
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shenjian Liu
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Zheng
- Department of Medical Genetics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenfeng He
- Department of Medical Genetics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Correspondence: Wenfeng He
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21
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Mun D, Kang JY, Chun Y, Park DS, Kim H, Yun N, Lee SH, Joung B. Generation of two PITX2 knock-out human induced pluripotent stem cell lines using CRISPR/Cas9 system. Stem Cell Res 2022; 65:102940. [PMID: 36260954 DOI: 10.1016/j.scr.2022.102940] [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] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
PITX2 is a homeobox gene located in the human 4q25 locus and is commonly associated with atrial fibrillation (AF). Here, we generated two PITX2 knock-out human induced pluripotent stem cell (iPSC) lines using CRISPR/Cas9 genome editing. The edited iPSCs maintained fullpluripotency, normal karyotype and spontaneousdifferentiation capability. This cell line provides a suitable model for investigating the physiopathologyof PITX2 mutation in atrial fibrillation.
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Affiliation(s)
- Dasom Mun
- Division of Cardiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Ji-Young Kang
- Division of Cardiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Yumin Chun
- Division of Cardiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Da-Seul Park
- Division of Cardiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Hyoeun Kim
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Nuri Yun
- Institute of Life Science & Biotechnology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seung-Hyun Lee
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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Tijskens M, Bergonti M, Spera F, Ascione C, Saenen J, Huybrechts W, Miljoen H, Riva S, Wittock A, Heidbuchel H, Tondo C, Sarkozy A. Etiology and Outcome of Catheter Ablation in Patients With Onset of Atrial Fibrillation <45 Years of Age. Am J Cardiol 2022; 166:45-52. [PMID: 34961604 DOI: 10.1016/j.amjcard.2021.11.030] [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] [Received: 08/20/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
Etiologic factors and long-term outcomes of catheter ablation of atrial fibrillation (AF) in young patients have not been well characterized. This study aimed to analyze the etiologic factors and outcomes of pulmonary vein isolation (PVI) in patients with young-onset AF (young-AF, defined as having first documented episode <45 years). Consecutive patients with young-AF undergoing PVI (n = 197) in 2 academic centers were enrolled and followed for 36.1 ± 24.5 months. A control group of patients with AF onset ≥45 years (n = 554) was included. The most frequent risk factors in young-AF were intensive exercise (25%), moderate-to-heavy alcohol consumption (23%), and familial AF (22%). Compared with patients with AF onset ≥45-year, patients with young-AF were more often men (82% vs 66%, p <0.001), had more frequently paroxysmal AF (81% vs 60%, p <0.001), had less left atrial dilatation (40.9 ± 6.2 mm vs 44.2 ± 7.2 mm, p <0.001), and had lower 4-year recurrence rate after last PVI procedure (22% vs 45%, p <0.001). In young-AF, structural heart disease (SHD) was the only independent predictor of recurrence. Patients with young-AF selected to undergo cryoballoon (CB) ablation were younger (35.0 ± 7.7 vs 36.6 ± 6.7 years, p = 0.035) and had less persistent AF (6% vs 24%, p = 0.004) and coronary artery disease (2% vs 7%, p = 0.02) compared with radiofrequency ablation. After excluding patients with persistent AF and SHD, there was no difference in single procedural success between radiofrequency or CB PVI (27% vs 17%, p = 0.11). In conclusion, patients with young-AF have diverse etiologies and high single and multiprocedural PVI successes. SHD is the only independent predictor of recurrence. In patients with young-AF, there is a selection bias for CB ablation.
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Malakootian M, Jalilian M, Kalayinia S, Hosseini Moghadam M, Heidarali M, Haghjoo M. Whole-exome sequencing reveals a rare missense variant in DTNA in an Iranian pedigree with early-onset atrial fibrillation. BMC Cardiovasc Disord 2022; 22:37. [PMID: 35148685 PMCID: PMC8832862 DOI: 10.1186/s12872-022-02485-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is a morbid and heritable irregular cardiac rhythm that affects about 2%–3% of the population. Patients with early-onset AF have a strong genetic association with the disease; nonetheless, the exact underlying mechanisms need clarification. We herein present our evaluation of a 2-generation Iranian pedigree with early-onset AF. Whole-exome sequencing was applied to elucidate the genetic predisposition. Direct DNA sequencing was utilized to confirm and screen the variants in the proband and his available family members. The pathogenicity of the identified nucleotide variations was scrutinized via either segregation analysis in the family or in silico predictive software. The comprehensive variant analysis revealed a missense variant (c.G681C, p.E227D, rs1477078144) in the human α-dystrobrevin gene (DTNA), which is rare in genetic databases. Most in silico analyses have predicted this variant as a disease-causing variant, and the variant is co-segregated with the disease phenotype in the family. Previous studies have demonstrated the association between the DTNA gene and left ventricular noncompaction cardiomyopathy. Taken together, we provide the first evidence of an association between a nucleotide variation in the DTNA gene and early-onset AF in an Iranian family. However, the genetic testing of AF in the Iranian population is still limited. This finding not only further confirms the significant role of genetics in the incidence of early-onset AF but also expands the spectrum of the gene variations that lead to AF. Additionally, it may have further implications for the treatment and prevention of AF.
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Affiliation(s)
- Mahshid Malakootian
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Jalilian
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Hosseini Moghadam
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mona Heidarali
- Cardiac Electrophysiology Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr St, Hashemi-Rafsanjani Blvd, Tehran, Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr St, Hashemi-Rafsanjani Blvd, Tehran, Iran.
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A Higher Polygenic Risk Score Is Associated with a Higher Recurrence Rate of Atrial Fibrillation in Direct Current Cardioversion-Treated Patients. Medicina (B Aires) 2021; 57:medicina57111263. [PMID: 34833481 PMCID: PMC8624440 DOI: 10.3390/medicina57111263] [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: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Recurrence of atrial fibrillation (AF) within six months after sinus rhythm restoration with direct current cardioversion (DCC) is a significant treatment challenge. Currently, the factors influencing outcome are mostly unknown. Studies have found a link between genetics and the risk of AF and efficacy of rhythm control. The aim of this study was to examine the association between eight single-nucleotide variants (SNVs) and the risk of AF development and recurrence after DCC. Materials and Methods: Regarding the occurrence of AF, 259 AF cases and 108 controls were studied. Genotypes for the eight SNVs located in the genes CAV1, MYH7, SOX5, KCNN3, ZFHX3, KCNJ5 and PITX2 were determined using high-resolution melting analysis and confirmed with Sanger sequencing. Six months after DCC, a telephone interview was conducted to determine whether AF had recurred. A polygenic risk score (PRS) was calculated as the unweighted sum of risk alleles. Multivariate regression analyses were performed to assess SNV and PRS association with AF occurrence and recurrence after DCC. Results: The risk allele of rs2200733 (PITX2) was significantly associated with the development of AF (p = 0.012, OR = 2.31, 95% CI = 1.206–4.423). AF recurred in 60% of patients and the allele generally associated with a decreased risk of AF of rs11047543 (SOX5) was associated with a greater risk of AF recurrence (p = 0.014, OR = 0.223, 95% CI = 0.067–0.738). A PRS of greater than 7 was significantly associated (p = 0.008) with a higher likelihood of developing AF after DCC (OR = 4.174, 95% CI = 1.454–11.980). Conclusions: A higher PRS is associated with increased odds of AF recurrence after treatment with DCC. PITX2 (rs2200733) is significantly associated with an increased risk of AF. The protective allele of rs11047543 (SOX5) is associated with a greater risk of AF recurrence. Further studies are needed to predict the success of rhythm control and guide patient selection towards the most efficacious treatment.
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25
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Emmert DB, Vukovic V, Dordevic N, Weichenberger CX, Losi C, D’Elia Y, Volpato C, Hernandes VV, Gögele M, Foco L, Pontali G, Mascalzoni D, Domingues FS, Paulmichl R, Pramstaller PP, Pattaro C, Rossini A, Rainer J, Fuchsberger C, De Bortoli M. Genetic and Metabolic Determinants of Atrial Fibrillation in a General Population Sample: The CHRIS Study. Biomolecules 2021; 11:1663. [PMID: 34827661 PMCID: PMC8615508 DOI: 10.3390/biom11111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Atrial fibrillation (AF) is a supraventricular arrhythmia deriving from uncoordinated electrical activation with considerable associated morbidity and mortality. To expand the limited understanding of AF biological mechanisms, we performed two screenings, investigating the genetic and metabolic determinants of AF in the Cooperative Health Research in South Tyrol study. We found 110 AF cases out of 10,509 general population individuals. A genome-wide association scan (GWAS) identified two novel loci (p-value < 5 × 10-8) around SNPs rs745582874, next to gene PBX1, and rs768476991, within gene PCCA, with genotype calling confirmed by Sanger sequencing. Risk alleles at both SNPs were enriched in a family detected through familial aggregation analysis of the phenotype, and both rare alleles co-segregated with AF. The metabolic screening of 175 metabolites, in a subset of individuals, revealed a 41% lower concentration of lysophosphatidylcholine lysoPC a C20:3 in AF cases compared to controls (p-adj = 0.005). The genetic findings, combined with previous evidence, indicate that the two identified GWAS loci may be considered novel genetic rare determinants for AF. Considering additionally the association of lysoPC a C20:3 with AF by metabolic screening, our results demonstrate the valuable contribution of the combined genomic and metabolomic approach in studying AF in large-scale population studies.
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Affiliation(s)
- David B. Emmert
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Vladimir Vukovic
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
- Centre for Disease Control and Prevention, Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| | - Nikola Dordevic
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Christian X. Weichenberger
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Chiara Losi
- Department of Cardiology, Tappeiner F. Merano Hospital, 39012 Merano, Italy; (C.L.); (R.P.)
| | - Yuri D’Elia
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Claudia Volpato
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Vinicius V. Hernandes
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Luisa Foco
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Giulia Pontali
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
- Department of Cellular, Computational and Integrative Biology—CIBIO, University of Trento, 38122 Trento, Italy
| | - Deborah Mascalzoni
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
- Centre for Research, Ethics and Bioethics Uppsala University, SE-751 05 Uppsala, Sweden
| | - Francisco S. Domingues
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Rupert Paulmichl
- Department of Cardiology, Tappeiner F. Merano Hospital, 39012 Merano, Italy; (C.L.); (R.P.)
| | - Peter P. Pramstaller
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Alessandra Rossini
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Johannes Rainer
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Christian Fuchsberger
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
| | - Marzia De Bortoli
- Eurac Research, Institute for Biomedicine (Affiliated to the University of Lübeck), 39100 Bolzano, Italy; (D.B.E.); (V.V.); (N.D.); (C.X.W.); (Y.D.); (C.V.); (V.V.H.); (M.G.); (L.F.); (G.P.); (D.M.); (F.S.D.); (P.P.P.); (C.P.); (A.R.); (J.R.)
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Krishnan A, Chilton E, Raman J, Saxena P, McFarlane C, Trollope AF, Kinobe R, Chilton L. Are Interactions between Epicardial Adipose Tissue, Cardiac Fibroblasts and Cardiac Myocytes Instrumental in Atrial Fibrosis and Atrial Fibrillation? Cells 2021; 10:2501. [PMID: 34572150 PMCID: PMC8467050 DOI: 10.3390/cells10092501] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
Atrial fibrillation is very common among the elderly and/or obese. While myocardial fibrosis is associated with atrial fibrillation, the exact mechanisms within atrial myocytes and surrounding non-myocytes are not fully understood. This review considers the potential roles of myocardial fibroblasts and myofibroblasts in fibrosis and modulating myocyte electrophysiology through electrotonic interactions. Coupling with (myo)fibroblasts in vitro and in silico prolonged myocyte action potential duration and caused resting depolarization; an optogenetic study has verified in vivo that fibroblasts depolarized when coupled myocytes produced action potentials. This review also introduces another non-myocyte which may modulate both myocardial (myo)fibroblasts and myocytes: epicardial adipose tissue. Epicardial adipocytes are in intimate contact with myocytes and (myo)fibroblasts and may infiltrate the myocardium. Adipocytes secrete numerous adipokines which modulate (myo)fibroblast and myocyte physiology. These adipokines are protective in healthy hearts, preventing inflammation and fibrosis. However, adipokines secreted from adipocytes may switch to pro-inflammatory and pro-fibrotic, associated with reactive oxygen species generation. Pro-fibrotic adipokines stimulate myofibroblast differentiation, causing pronounced fibrosis in the epicardial adipose tissue and the myocardium. Adipose tissue also influences myocyte electrophysiology, via the adipokines and/or through electrotonic interactions. Deeper understanding of the interactions between myocytes and non-myocytes is important to understand and manage atrial fibrillation.
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Affiliation(s)
- Anirudh Krishnan
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Emily Chilton
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada;
| | - Jaishankar Raman
- Austin & St Vincent’s Hospitals, Melbourne University, Melbourne, VIC 3010, Australia;
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC 3217, Australia
- Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA
- School of Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, QLD 4814, Australia;
| | - Craig McFarlane
- Centre for Tropical Bioinformatics and Molecular Biology, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Alexandra F. Trollope
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Robert Kinobe
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Lisa Chilton
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
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27
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McNeill A. Clinical genetics-it's polygenic. Eur J Hum Genet 2021; 29:1037. [PMID: 34267340 DOI: 10.1038/s41431-021-00931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alisdair McNeill
- Department of Neuroscience, The University of Sheffield, Sheffield, UK. .,Sheffield Clinical Genetics Department, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
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28
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Clausen AG, Vad OB, Andersen JH, Olesen MS. Loss-of-Function Variants in the SYNPO2L Gene Are Associated With Atrial Fibrillation. Front Cardiovasc Med 2021; 8:650667. [PMID: 33768119 PMCID: PMC7985167 DOI: 10.3389/fcvm.2021.650667] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022] Open
Abstract
Multiple genome-wide association studies (GWAS) have identified numerous loci associated with atrial fibrillation (AF). However, the genes driving these associations and how they contribute to the AF pathogenesis remains poorly understood. To identify genes likely to be driving the observed association, we searched the FinnGen study consisting of 12,859 AF cases and 73,341 controls for rare genetic variants predicted to cause loss-of-function. A specific splice site variant was found in the SYNPO2L gene, located in an AF associated locus on chromosome 10. This variant was associated with an increased risk of AF with a relatively high odds ratio of 3.5 (p = 9.9 × 10-8). SYNPO2L is an important gene involved in the structural development and function of the cardiac myocyte and our findings thus support the recent suggestions that AF can present as atrial cardiomyopathy.
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Affiliation(s)
- Alexander Guldmann Clausen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Bundgaard Vad
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Husted Andersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Salling Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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