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Radu I, Farcas AO, Nyulas V, Radu CC, Brinzaniuc K. Sudden Cardiac Death-Etiology, Risk Factors and Demographic Characteristics: An Extensive Study of 1618 Forensic Autopsies. Diseases 2024; 12:168. [PMID: 39195167 DOI: 10.3390/diseases12080168] [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: 06/04/2024] [Revised: 06/25/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) is a major public health concern worldwide, affecting all age and social groups. METHODS In this retrospective study, of the 8265 autopsies performed in the Institute of Legal Medicine, 1618 cases of SCD were included. The aim of this study is to identify demographic characteristics, etiological factors, epidemiological characteristics and risk factors that lead to SCD. RESULTS The highest incidence of SCD was in age group 40-69 years (65.0%), 71.6% of this age group being men. Of the total number, 32.1% (520) occurred in the emergency room. The most common cause of sudden death is represented by coronary atherosclerotic disease, reported in 89.8% (1453) of cases, tricoronary lesions being found in 60% (870) of cases. Etiological factors of SCD encountered during autopsies were acute myocardial infarction in 13.9% (225), dilated cardiomyopathy 43.9% (710), cardiac hypertrophy 579 (36.07%), pericarditis 1.9% (30), myocarditis 1.73% (28) and adipositas cordis 5% (81). Along with epicardial fat and BMI, alcohol consumption was recorded in 17.9% (290), this being a potential trigger. CONCLUSIONS Based on forensic autopsy and histological findings, a wide variety of factors are involved in the etiopathogenesis of SCD, some of which can be eliminated through preventive measures implemented early.
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Affiliation(s)
- Ioana Radu
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Forensic Medicine Emergency County Hospital, "Constantin Opriș" Baia Mare, 430031 Baia Mare, Romania
| | - Anca Otilia Farcas
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Cell Biology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Victoria Nyulas
- Department of Informatics and Medical Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Carmen Corina Radu
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Klara Brinzaniuc
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Latola H, Mattila SM, Pakanen L, Holmström L, Kauppila J, Ukkola OH, Junttila MJ, Huikuri HV, Perkiömäki JS. Day-of-the-week variation of sudden unexpected cardiac death. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200246. [PMID: 38476977 PMCID: PMC10928361 DOI: 10.1016/j.ijcrp.2024.200246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
Background There has been some controversy about the day-of-the-week (septadian) variation of unexpected sudden cardiac death (SCD). Methods We evaluated the incidence of unexpected SCD on different days of the week in a consecutive series of 5869 SCD victims from Northern Finland [the FINGESTURE study (Finnish Genetic Study of Arrhythmic Events)]. As it is mandatory in Finland, a medico-legal autopsy was performed on all unexpected sudden death victims. The autopsies were performed between the years 1998-2017. Results The mean incidence of unexpected SCD was higher at weekends (during the days from Friday to Sunday, peaking on Saturday) than during the days from Monday to Thursday (8.54 ± 0.72 vs. 7.22 ± 0.19 SCDs per day of the week per 100,000 inhabitants per year, p < 0.001). Regardless of sex or ischemic versus non-ischemic etiology of SCD, the distribution of the occurrence of SCD among the days of the week was similar compared with the whole SCD cohort. Conclusion The incidence of unexpected SCD was highest at weekends (during the days from Friday to Sunday, peaking on Saturday).
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Affiliation(s)
- Hanna Latola
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Severi M. Mattila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
- Department of Forensic Medicine, Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Lauri Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Janna Kauppila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H. Ukkola
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V. Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S. Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Holmström L, Kauppila J, Vähätalo J, Pakanen L, Perkiömäki J, Huikuri H, Junttila J. Sudden cardiac death after alcohol intake: classification and autopsy findings. Sci Rep 2022; 12:16771. [PMID: 36202882 PMCID: PMC9537170 DOI: 10.1038/s41598-022-20250-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Alcohol is known to have an immediate effect on cardiac rhythm, and previous studies have found that a notable proportion of sudden cardiac deaths (SCD) occur after alcohol intake. The objective of the present study was to investigate the association between the timing of alcohol intake and SCD. Our study population is drawn from the Fingesture study, which includes 5869 consecutive SCD cases from Northern Finland who underwent medicolegal autopsy 1998–2017. Toxicological analysis was performed if there was any suspicion of toxic exposure, or if there was no obvious immediate cause of SCD at autopsy. We found that 1563 (27%) of all SCD victims had alcohol in blood or urine at autopsy (mean age (61 ± 10 years, 88% male). Eighty-six percent of alcohol-related SCD victims had higher urine alcohol concentration than blood alcohol concentration, referring to the late-stage inebriation. These results suggest that the majority of alcohol-related SCDs occur at the late stage of inebriation.
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Affiliation(s)
- Lauri Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.
| | - Janna Kauppila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare (THL), Oulu, Finland.,Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
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Rücklová K, Dobiáš M, Bílek M, Pohlová Kučerová Š, Kulvajtová M, Tavačová T, Nagy I, Tomášek P. Burden of sudden cardiac death in persons aged 1-40 years in the Czech Republic. Cent Eur J Public Health 2022; 30:58-64. [PMID: 35421300 DOI: 10.21101/cejph.a6793] [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: 03/03/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to ascertain the incidence, circumstances and causes of sudden cardiac death in persons aged 1-40 years in the Czech Republic. METHODS De-identified autopsy reports of all individuals who died suddenly between the ages of 1-40 years during the period 2014-2019 inclusive in a selected area of the Czech Republic were analysed retrospectively. Persons with substantial cardiovascular pathology defined by histopathological criteria and those with a negative autopsy were included in the study. The latter were designated as sudden arrhythmic death syndrome. RESULTS In total, 245 sudden cardiac death cases were identified resulting in an incidence rate of 2.4/100,000 person-years. Among the deceased, we found an enormous gender gap with men representing 81% of cases. More than 80% of deaths occurred during everyday activities or sleep, whereas only 7% were sports-related. The most common cause of death was coronary artery disease detected in 38%, which was followed by cardiomyopathies in 15%, sudden arrhythmic death syndrome in 12%, left ventricular hypertrophy in 10%, and congenital heart defects in 7%. CONCLUSIONS Coronary artery disease is the predominant cause of sudden cardiac death in the young population of the Czech Republic. Hence, effective preventive measures targeted at the reduction of risk factors associated with early coronary artery disease should be reinforced. The second most prevalent cause in our population are potentially heritable heart conditions such as cardiomyopathies and sudden arrhythmic death syndrome. This fact has already prompted the introduction of molecular autopsy and cardiogenetic care for relatives in the Czech Republic.
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Affiliation(s)
- Kristina Rücklová
- University Hospital Kralovske Vinohrady and Third Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
| | - Martin Dobiáš
- Olomouc University Hospital, Institute of Forensic Medicine and Medical Law, Olomouc, Czech Republic
| | - Matěj Bílek
- Bulovka Hospital, Institute of Forensic Medicine, Prague, Czech Republic
| | - Štěpánka Pohlová Kučerová
- Department of Forensic Medicine, Faculty of Medicine in Hradec Kralove and University Hospital, Charles University, Hradec Kralove, Czech Republic
| | - Markéta Kulvajtová
- Faculty Hospital Kralovske Vinohrady, Institute of Forensic Medicine, Prague, Czech Republic
| | - Terézia Tavačová
- Motol University Hospital, Children's Heart Centre, Prague, Czech Republic
| | - Ivan Nagy
- Department of Applied Mathematics, Faculty of Transportation Sciences, Czech Technical University, Prague, Czech Republic
| | - Petr Tomášek
- Bulovka Hospital, Institute of Forensic Medicine, Prague, Czech Republic
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The association between alcohol intake shortly before arrest and survival outcomes of out-of-hospital cardiac arrest. Resuscitation 2022; 173:39-46. [DOI: 10.1016/j.resuscitation.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 12/17/2022]
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Kauppila JP, Pakanen L, Porvari K, Vähätalo J, Holmström L, Perkiömäki JS, Huikuri HV, Junttila MJ. Blood alcohol levels in Finnish victims of non-ischaemic sudden cardiac death. Ann Med 2021; 53:413-419. [PMID: 33645352 PMCID: PMC7928009 DOI: 10.1080/07853890.2021.1890204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/09/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-ischaemic heart disease (NIHD) is the underlying pathology in∼20% of all sudden cardiac deaths (SCDs). Heavy drinking is known to be associated with SCD due to ischaemic heart disease, but studies on association of recent alcohol consumption and SCD in patients with NIHD are scarce. We evaluated the blood alcohol levels of autopsy verified non-ischaemic SCD victims. METHODS Study population was derived from the Finnish Genetic Study of Arrhythmic Events (Fingesture) (n = 5869, mean age 65 ± 12, 79% males). All deaths occurred in Northern Finland during 1998-2017. All victims underwent a medico-legal autopsy. Subjects of SCD due to ischaemic heart disease were excluded. RESULTS A total of 1301 (mean age 57 ± 12, 78% males) victims of SCD due to NIHD were included in the study. The blood ethanol level was elevated in 543 (42%) subjects, out of which the blood alcohol level was ≥0.10%in 339 (62%) subjects and ≥0.15%in 252 (46%) subjects. Male SCD victims had alcohol in blood more frequently compared to females (45% versus 31%, p < .001). CONCLUSION Elevated blood alcohol level is common in SCD victims due to NIHD, especially in males. Recent alcohol consumption might contribute to the subsequent SCD in many non-ischaemic SCD victims.KEY MESSAGESElevated blood alcohol level is common in victims of sudden cardiac death due to non-ischaemic heart disease, especially in males.Recent alcohol consumption may contribute to the subsequent death in many nonischemic sudden cardiac death victims.
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Affiliation(s)
- Janna P. Kauppila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Katja Porvari
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Lauri Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S. Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V. Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M. Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Vähätalo J, Holmström L, Pakanen L, Kaikkonen K, Perkiömäki J, Huikuri H, Junttila J. Coronary Artery Disease as the Cause of Sudden Cardiac Death Among Victims < 50 Years of Age. Am J Cardiol 2021; 147:33-38. [PMID: 33621522 DOI: 10.1016/j.amjcard.2021.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
Coronary artery disease (CAD) is the most common cause of sudden cardiac death (SCD). Atherosclerosis increases with age, but also many victims of SCD in young and middle-aged population have CAD at autopsy. The purpose of this study was to determine the characteristics and autopsy findings of SCD due to CAD among victims of SCD under the age of 50. Fingesture is a population-based study consisting of consecutive series of victims of autopsy verified SCD in Northern Finland between the years 1998 to 2017 (n = 5,869). Histological examinations were part of all autopsies and a toxicology investigation was performed if needed. Analyses included information accumulated from death certificates, medical records, autopsy data, standardized questionnaire to the closest family members of the victims of SCD and police reports of the conditions of the death. Overall, 10.4% of all SCDs occurred among victims under the age of 50 years (610 victims). Most common underlying cause of SCD among these younger SCD victims was CAD (43.6%). The prevalence of CAD as the cause of SCD became more common in young SCD victims after the age of 35 years. The mean age of ischemic SCD victims was 44±5 years and most were men (89.5%). Most victims (90.2%) had no clinical diagnosis of CAD, however 33.8% had an autopsy evidence of silent myocardial infarction. SCD occurred during physical activity in 24.1%. Three-vessel disease was detected in 44.4% of the study victims. Cardiac hypertrophy (58.3%) and myocardial fibrosis (82.6%) were also common. At least 1 cardiovascular risk factor was present in 64.7% of SCD victims. In conclusion, most SCDs among victims < 50 years of age are due to CAD.
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Huikuri HV, Junttila MJ. Editorial commentary: Paradigm shift in the circadian and septadian patterns of sudden cardiac death: Fact or fiction? Trends Cardiovasc Med 2020; 31:177-178. [PMID: 32146016 DOI: 10.1016/j.tcm.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, University Hospital of Oulu, and University of Oulu, Finland.
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center, University Hospital of Oulu, and University of Oulu, Finland
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Sudden cardiac death associated to substances of abuse and psychotropic drugs consumed by young people: A population study based on forensic autopsies. Drug Alcohol Depend 2019; 201:23-28. [PMID: 31174141 DOI: 10.1016/j.drugalcdep.2019.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Toxic substances are one of the main risk factors for sudden cardiac death (SCD) in young people. However, there is limited information about this matter based on clinical research. The aim of this study was to analyze the use of substances of abuse (legal and illicit) and prescribed psychotropic drugs in young people who died by SCD. METHODS A population-based study performed in 15-35-year-olds who died by SCD in Biscay (Basque-Country) between 1991 and 2016. Cases were analyzed prospectively by a complete autopsy, toxicological and histopathological studies. A case was considered positive for exposure to cardiotoxic substances if smoking status was diagnosed or if toxicological analysis detected any drug associated with increased risk of SCD. RESULTS There were 204 SCD; 98 (48%) were exposed to a cardiotoxic substance, including smoking status (n = 72) and/or positive toxicology (n = 58). Illicit drugs (n = 29, mainly cannabis and cocaine), ethanol (n = 25), and prescribed psychotropic drugs (n = 11) were detected. Positive cases were more frequent in males than in females (54% vs. 19%). They were also more common in subjects who died by acute (86%) and chronic (71%) ischemic heart disease than in myocardial diseases (33%) and sudden arrhythmic death syndrome (36%). All positive cases of illicit drugs were males. Smoking status was very high in deaths due to acute ischemic heart disease. CONCLUSIONS The proportion of users of substances of abuse was unexpectedly high, even more prevalent than other cardiovascular risk factors. Toxic substances could play an important role as triggers of SCD in young people.
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Mustroph J, Lebek S, Maier LS, Neef S. Mechanisms of cardiac ethanol toxicity and novel treatment options. Pharmacol Ther 2018; 197:1-10. [PMID: 30557629 DOI: 10.1016/j.pharmthera.2018.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ethanol can acutely and chronically alter cardiomyocyte and whole-organ function in the heart. Importantly, ethanol acutely and chronically predisposes to arrhythmias, while chronic abuse can induce heart failure. However, the molecular mechanisms of ethanol toxicity in the heart are incompletely understood. In this review, we summarize the current mechanistic knowledge on cardiac ethanol toxicity, with a focus on druggable pathways. Ethanol effects on excitation-contraction coupling, oxidative stress, apoptosis, and cardiac metabolism, as well as effects of ethanol metabolites will be discussed. Important recent findings have been gained by investigation of acute ethanol effects. These include a renewed focus on reactive oxygen species (ROS) and induction of SR Ca2+ leak by CaMKII-mediated pathways downstream of ROS. Furthermore, a clinical outlook into potential novel treatment options is provided.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Simon Lebek
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Stefan Neef
- Department of Internal Medicine II, University Medical Center Regensburg, Germany.
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Mustroph J, Wagemann O, Lebek S, Tarnowski D, Ackermann J, Drzymalski M, Pabel S, Schmid C, Wagner S, Sossalla S, Maier LS, Neef S. SR Ca 2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure. J Mol Cell Cardiol 2018; 116:81-90. [PMID: 29410242 DOI: 10.1016/j.yjmcc.2018.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
AIMS Ethanol has acute negative inotropic and arrhythmogenic effects. The underlying mechanisms, however, are largely unknown. Sarcoplasmic reticulum Ca2+-leak is an important mechanism for reduced contractility and arrhythmias. Ca2+-leak can be induced by oxidative stress and Ca2+/Calmodulin-dependent protein kinase II (CaMKII). Therefore, we investigated the influence of acute ethanol exposure on excitation-contraction coupling in atrial and ventricular cardiomyocytes. METHODS AND RESULTS Isolated human atrial and murine atrial or ventricular cardiomyocytes were preincubated for 30 min and then superfused with control solution or solution containing ethanol. Ethanol had acute negative inotropic and positive lusitropic effects in human atrial muscle strips and murine ventricular cardiomyocytes. Accordingly, Ca2+-imaging indicated lower Ca2+-transient amplitudes and increased SERCA2a activity, while myofilament Ca2+-sensitivity was reduced. SR Ca2+-leak was assessed by measuring Ca2+-sparks. Ethanol induced severe SR Ca2+-leak in human atrial cardiomyocytes (calculated leak: 4.60 ± 0.45 mF/F0 vs 1.86 ± 0.26 in control, n ≥ 80). This effect was dose-dependent, while spontaneous arrhythmogenic Ca2+-waves increased ~5-fold, as investigated in murine cardiomyocytes. Delayed afterdepolarizations, which can result from increased SR Ca2+-leak, were significantly increased by ethanol. Measurements using the reactive oxygen species (ROS) sensor CM-H2DCFDA showed increased ROS-stress in ethanol treated cells. ROS-scavenging with N-acetylcysteine prevented negative inotropic and positive lusitropic effects in human muscle strips. Ethanol-induced Ca2+-leak was abolished in mice with knockout of NOX2 (the main source for ROS in cardiomyocytes). Importantly, mice with oxidation-resistant CaMKII (Met281/282Val mutation) were protected from ethanol-induced Ca2+-leak. CONCLUSION We show for the first time that ethanol acutely induces strong SR Ca2+-leak, also altering excitation-contraction coupling. Acute negative inotropic effects of ethanol can be explained by reduced systolic Ca2+-release. Mechanistically, ROS-production via NOX2 and oxidative activation of CaMKII appear to play central roles. This provides a mechanism for the arrhythmogenic and negative inotropic effects of ethanol and suggests a druggable target (CaMKII).
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Affiliation(s)
- Julian Mustroph
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Olivia Wagemann
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Simon Lebek
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Daniel Tarnowski
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Jasmin Ackermann
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Marzena Drzymalski
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Steffen Pabel
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Dept. of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Samuel Sossalla
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Lars S Maier
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Neef
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
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Bébarová M, Horáková Z, Kula R. Addictive drugs, arrhythmias, and cardiac inward rectifiers. Europace 2017; 19:346-355. [PMID: 27302393 DOI: 10.1093/europace/euw071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/20/2016] [Indexed: 12/30/2022] Open
Abstract
In many addictive drugs including alcohol and nicotine, proarrhythmic effects were reported. This review provides an overview of the current knowledge in this field (with a focus on the inward rectifier potassium currents) to promote the lacking data and appeal for their completion, thus, to improve understanding of the proarrhythmic potential of addictive drugs.
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Sorkin T, Sheppard MN. Sudden unexplained death in alcohol misuse (SUDAM) patients have different characteristics to those who died from sudden arrhythmic death syndrome (SADS). Forensic Sci Med Pathol 2017; 13:278-283. [PMID: 28668989 PMCID: PMC5554285 DOI: 10.1007/s12024-017-9877-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
There is growing awareness of sudden unexplained death in alcohol misuse (SUDAM) in which there is no obvious cause of death, no evidence of acute alcohol toxicity or alcoholic ketoacidosis, and the heart is morphologically normal. This study describes the characteristics of a cohort with SUDAM from a tertiary cardiovascular referral center and compares the findings with those of individuals who died from sudden arrhythmic death syndrome (SADS). Cases in this retrospective cross-sectional study were identified from a database of referrals to our center spanning approximately 40 years. Cases with recorded heavy use of alcohol and non-alcohol users were selected, then limited to those with SUDAM or SADS aged 16 to 64 years. 62 cases of SUDAM and 41 cases of SADS were identified. The SUDAM group were older than the SADS group; mean age 35.8 years and 27.7 years respectively (P=0.0002). There was also a higher incidence of significant psychiatric illness in SUDAM (19.7%) than SADS (2.4%) cases. Post mortem liver examination was more likely to reveal heavy livers in SUDAM than SADS (2196.1g and 1572.4g respectively; P=0.0033) and more fatty liver change (24.2% and 2.4%). SUDAM tends to occur in individuals who are older and have heavier livers than those with SADS. Psychiatric illness is also more common. SADS, unlike SUDAM, is often associated with heritable channelopathies that may affect surviving family members. Therefore, differentiating between SUDAM and SADS identifies families likely to benefit from screening for these mutations, thus preventing further sudden arrhythmic deaths.
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Affiliation(s)
- Tracy Sorkin
- St George's Healthcare NHS Trust, Cellular Pathology, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Mary N Sheppard
- CRY Department of Cardiovascular Pathology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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