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Butler L, Ivanov A, Celik T, Karabayir I, Chinthala L, Hudson MM, Ness KK, Mulrooney DA, Dixon SB, Tootooni MS, Doerr AJ, Jaeger BC, Davis RL, McManus DD, Herrington D, Akbilgic O. Feasibility of remote monitoring for fatal coronary heart disease using Apple Watch ECGs. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:115-121. [PMID: 38989042 PMCID: PMC11232422 DOI: 10.1016/j.cvdhj.2024.03.007] [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] [Indexed: 07/12/2024] Open
Abstract
Background Fatal coronary heart disease (FCHD) is often described as sudden cardiac death (affects >4 million people/year), where coronary artery disease is the only identified condition. Electrocardiographic artificial intelligence (ECG-AI) models for FCHD risk prediction using ECG data from wearable devices could enable wider screening/monitoring efforts. Objectives To develop a single-lead ECG-based deep learning model for FCHD risk prediction and assess concordance between clinical and Apple Watch ECGs. Methods An FCHD single-lead ("lead I" from 12-lead ECGs) ECG-AI model was developed using 167,662 ECGs (50,132 patients) from the University of Tennessee Health Sciences Center. Eighty percent of the data (5-fold cross-validation) was used for training and 20% as a holdout. Cox proportional hazards (CPH) models incorporating ECG-AI predictions with age, sex, and race were also developed. The models were tested on paired clinical single-lead and Apple Watch ECGs from 243 St. Jude Lifetime Cohort Study participants. The correlation and concordance of the predictions were assessed using Pearson correlation (R), Spearman correlation (ρ), and Cohen's kappa. Results The ECG-AI and CPH models resulted in AUC = 0.76 and 0.79, respectively, on the 20% holdout and AUC = 0.85 and 0.87 on the Atrium Health Wake Forest Baptist external validation data. There was moderate-strong positive correlation between predictions (R = 0.74, ρ = 0.67, and κ = 0.58) when tested on the 243 paired ECGs. The clinical (lead I) and Apple Watch predictions led to the same low/high-risk FCHD classification for 99% of the participants. CPH prediction correlation resulted in an R = 0.81, ρ = 0.76, and κ = 0.78. Conclusion Risk of FCHD can be predicted from single-lead ECGs obtained from wearable devices and are statistically concordant with lead I of a 12-lead ECG.
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Affiliation(s)
- Liam Butler
- Cardiovascular Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alexander Ivanov
- Cardiovascular Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Turgay Celik
- Cardiovascular Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ibrahim Karabayir
- Cardiovascular Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lokesh Chinthala
- Center for Biomedical Informatics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | | | - Kiri K. Ness
- St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | | | - Mohammad S. Tootooni
- Health Informatics and Data Science, Loyola University Chicago, Maywood, Illinois
| | - Adam J. Doerr
- Department of Medicine, University of Massachusetts Chan Medical School, Massachusetts, Worcester, Massachusetts
| | - Byron C. Jaeger
- Division of Public Health Science, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Robert L. Davis
- Center for Biomedical Informatics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - David D. McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Massachusetts, Worcester, Massachusetts
| | - David Herrington
- Cardiovascular Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Oguz Akbilgic
- Cardiovascular Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Thakkar N, Alam P, Thaker A, Ahukla A, Shah J, Saxena D, Shah K. Incidence of Sudden Cardiac Death in Low- and Middle-Income Countries: A Systematic Review of Cohort Studies. Indian J Community Med 2024; 49:279-289. [PMID: 38665450 PMCID: PMC11042141 DOI: 10.4103/ijcm.ijcm_468_23] [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: 07/16/2023] [Accepted: 11/20/2023] [Indexed: 04/28/2024] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of mortality worldwide and, in recent years, has become an urgent public health concern in low- and middle-income countries (LMICs). Data from LMICs, however, remains limited. As such, the aim of this article is to systematically review the current literature on the incidence of SCD in LMICs to inform policymakers and identify potential research gaps. A search of PubMed and Embase was utilized to capture the targeted condition, outcome, and setting. Only peer-reviewed cohort studies in LMICs reporting SCD incidence estimates in the general population of individuals aged ≥1 year were eligible for selection. Papers providing incidence data for specific types of SCD, including sudden coronary death or death from sudden cardiac arrest, were also included. After deduplication, 1941 citations were identified and screened. Seven studies representing four countries-Cameroon, China, India, and Iran-met the criteria for inclusion and were considered in our analysis. The crude incidence rate for SCD ranged from 19.9 to 190 cases per 100,000 person-years, while age-adjusted rates ranged from 33.6 to 230 cases per 100,000 person-years. There was notable variability in methods utilized to ascertain SCD cases. These findings suggest that the incidence of all-cause SCD in LMICs and may exceed that of high-income countries; however, observed disparities may be partly attributable to differences in case ascertainment methods. Additional research is needed to better understand the true incidence of SCD in developing countries. It is crucial that future studies across regions utilize standard diagnostic criteria and methodology for identifying SCD, which would provide a framework by which to compare outcomes between settings.
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Affiliation(s)
- Nandan Thakkar
- Office of Graduate Education, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Prima Alam
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abhi Thaker
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Aakansha Ahukla
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Jay Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Komal Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
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Carrington M, de Gouveia RH, Teixeira R, Corte-Real F, Gonçalves L, Providência R. Sudden death in young South European population: a cross-sectional study of postmortem cases. Sci Rep 2023; 13:22734. [PMID: 38123611 PMCID: PMC10733430 DOI: 10.1038/s41598-023-47502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
To describe the annual incidence and the leading causes of sudden non-cardiac and cardiac death (SCD) in children and young adult Portuguese population. We retrospectively reviewed autopsy of sudden unexpected deaths reports from the Portuguese National Institute of Legal Medicine and Forensic Sciences' database, between 2012 and 2016, for the central region of Portugal, Azores and Madeira (ages 1-40: 26% of the total population). During a 5-year period, 159 SD were identified, corresponding to an annual incidence of 2,4 (95%confidence interval, 1,5-3,6) per 100.000 people-years. Victims had a mean age of 32 ± 7 years-old, and 72,3% were male. There were 70,4% cardiac, 16,4% respiratory and 7,5% neurologic causes of SD. The most frequent cardiac anatomopathological diagnosis was atherosclerotic coronary artery disease (CAD) (33,0%). There were 15,2% victims with left ventricular hypertrophy, with a diagnosis of hypertrophic cardiomyopathy only possible in 2,7%. The prevalence of cardiac pathological findings of uncertain significance was 30,4%. In conclusion, the annual incidence of SD was low. Atherosclerotic CAD was diagnosed in 33,0% victims, suggesting the need to intensify primary prevention measures in the young. The high prevalence of pathological findings of uncertain significance emphasizes the importance of molecular autopsy and screening of first-degree relatives.
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Affiliation(s)
- Mafalda Carrington
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Rosa Henriques de Gouveia
- Forensic Pathology Department, Delegação do Centro, Instituto Nacional de Medicina Legal e Ciências Forenses, Coimbra, Portugal
- Pathology and Histology, Faculty of Life Sciences, University of Madeira, Funchal, Madeira, Portugal
- LANA - Laboratory of Clinical and Anatomical Pathology, Funchal, Madeira, Portugal
| | - Rogério Teixeira
- Medical Faculty, Coimbra University, Coimbra, Portugal
- Cardiology Department of Centro Hospitalar, Universitário de Coimbra, Coimbra, Portugal
| | - Francisco Corte-Real
- Forensic Pathology Department, Delegação do Centro, Instituto Nacional de Medicina Legal e Ciências Forenses, Coimbra, Portugal
- Medical Faculty, Coimbra University, Coimbra, Portugal
| | - Lino Gonçalves
- Medical Faculty, Coimbra University, Coimbra, Portugal
- Cardiology Department of Centro Hospitalar, Universitário de Coimbra, Coimbra, Portugal
| | - Rui Providência
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK.
- Institute of Health Informatics Research, University College of London, London, UK.
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Blich M, Oron H, Darawsha W, Suleiman M, Gepstein L, Boulos M, Lorber A, Kchoury A. The role of genetic testing in the prevention, diagnosis, and prognosis of sudden cardiac arrest in children. J Arrhythm 2023; 39:607-612. [PMID: 37560270 PMCID: PMC10407164 DOI: 10.1002/joa3.12881] [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: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Determining the pathogenesis of sudden cardiac arrest (SCA) in children is crucial for its management and prognosis. Our aim is to analyze the role of broad genetic testing in the prevention, diagnosis, and prognosis of SCA in Children. METHODS ECG, 12-lead holter, exercise testing, cardiac imaging, familial study, and genetic testing were used to study 29 families, in whom a child experienced SCA. RESULTS After a thorough clinical and genetic evaluation a positive diagnosis was reached in 24/29 (83%) families. Inherited channelopathies (long QT syndrome and catecholaminergic polymorphic ventricular tachycardia) were the most prevalent 20/29 (69%) diagnosis, followed by cardiomyopathy 3/29 (10%). Broad genetic testing was positive in 17/24 (71%) cases. Using the Mann-Whitney test, we found that genetic testing (effect size = 0.625, p = 0.003), ECG (effect size = 0.61, p = 0.009), and exercise test (effect size = 0.63, p = 0.047) had the highest yield in reaching the final diagnosis. Genetic testing was the only positive test available for five (17%) families. Among 155 family members evaluated through cascade screening, 73 (47%) had a positive clinical evaluation and 64 (41%) carried a pathologic mutation. During 6 ± 4.8 years of follow-up, 58% of the survived children experienced an arrhythmic event. Of nine family members who had an ICD implant for primary prevention, four experienced appropriate ICD shock. CONCLUSIONS The major causes of SCA among children are genetic etiology, and genetic testing has a high yield. Family screening has an additional role in both the diagnosis and preventing of SCA.
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Affiliation(s)
- Miry Blich
- Inherited Arrhythmia ClinicRambam Health Care CampusHaifaIsrael
- Division of Pacing and ElectrophysiologyRambam Health Care CampusHaifaIsrael
| | - Hodaya Oron
- Inherited Arrhythmia ClinicRambam Health Care CampusHaifaIsrael
| | - Wisam Darawsha
- Division of Pacing and ElectrophysiologyRambam Health Care CampusHaifaIsrael
| | - Mahmoud Suleiman
- Division of Pacing and ElectrophysiologyRambam Health Care CampusHaifaIsrael
| | - Lior Gepstein
- Division of Pacing and ElectrophysiologyRambam Health Care CampusHaifaIsrael
| | - Monther Boulos
- Division of Pacing and ElectrophysiologyRambam Health Care CampusHaifaIsrael
| | - Avraham Lorber
- Department of Pediatric CardiologyRambam Health Care CampusHaifaIsrael
| | - Asaad Kchoury
- Department of Pediatric CardiologyRambam Health Care CampusHaifaIsrael
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Kelly KL, Lin PT, Basso C, Bois M, Buja LM, Cohle SD, d'Amati G, Duncanson E, Fallon JT, Firchau D, Fishbein G, Giordano C, Leduc C, Litovsky SH, Mackey-Bojack S, Maleszewski JJ, Michaud K, Padera RF, Papadodima SA, Parsons S, Radio SJ, Rizzo S, Roe SJ, Romero M, Sheppard MN, Stone JR, Tan CD, Thiene G, van der Wal AC, Veinot JP. Sudden cardiac death in the young: A consensus statement on recommended practices for cardiac examination by pathologists from the Society for Cardiovascular Pathology. Cardiovasc Pathol 2023; 63:107497. [PMID: 36375720 DOI: 10.1016/j.carpath.2022.107497] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac death is, by definition, an unexpected, untimely death caused by a cardiac condition in a person with known or unknown heart disease. This major international public health problem accounts for approximately 15-20% of all deaths. Typically more common in older adults with acquired heart disease, SCD also can occur in the young where the cause is more likely to be a genetically transmitted process. As these inherited disease processes can affect multiple family members, it is critical that these deaths are appropriately and thoroughly investigated. Across the United States, SCD cases in those less than 40 years of age will often fall under medical examiner/coroner jurisdiction resulting in scene investigation, review of available medical records and a complete autopsy including toxicological and histological studies. To date, there have not been consistent or uniform guidelines for cardiac examination in these cases. In addition, many medical examiner/coroner offices are understaffed and/or underfunded, both of which may hamper specialized examinations or studies (e.g., molecular testing). Use of such guidelines by pathologists in cases of SCD in decedents aged 1-39 years of age could result in life-saving medical intervention for other family members. These recommendations also may provide support for underfunded offices to argue for the significance of this specialized testing. As cardiac examinations in the setting of SCD in the young fall under ME/C jurisdiction, this consensus paper has been developed with members of the Society of Cardiovascular Pathology working with cardiovascular pathology-trained, practicing forensic pathologists.
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Affiliation(s)
| | | | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
| | | | | | | | | | - Emily Duncanson
- Jesse E. Edwards Registry of Cardiovascular Disease, St. Paul, MN, USA
| | | | | | | | | | | | | | | | | | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Switzerland
| | | | | | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | | | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
| | | | | | - Mary N Sheppard
- St. George's Medical School, University of London, London, United Kingdom
| | | | | | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
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De novo mutations in childhood cases of sudden unexplained death that disrupt intracellular Ca2+ regulation. Proc Natl Acad Sci U S A 2021; 118:2115140118. [PMID: 34930847 PMCID: PMC8719874 DOI: 10.1073/pnas.2115140118] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 01/04/2023] Open
Abstract
Approximately 400 United States children 1 y of age and older die suddenly from unexplained causes annually. We studied whole-exome sequence data from 124 “trios” (decedent child and living parents) to identify genetic risk factors. Nonsynonymous mutations, mostly de novo (present in child but absent in both biological parents), were highly enriched in genes associated with cardiac and seizure disorders relative to controls, and contributed to 9% of deaths. We found significant overtransmission of loss-of-function or pathogenic missense variants in cardiac and seizure disorder genes. Most pathogenic variants were de novo in origin, highlighting the importance of trio studies. Many of these pathogenic de novo mutations altered a protein network regulating calcium-related excitability at submembrane junctions in cardiomyocytes and neurons. Sudden unexplained death in childhood (SUDC) is an understudied problem. Whole-exome sequence data from 124 “trios” (decedent child, living parents) was used to test for excessive de novo mutations (DNMs) in genes involved in cardiac arrhythmias, epilepsy, and other disorders. Among decedents, nonsynonymous DNMs were enriched in genes associated with cardiac and seizure disorders relative to controls (odds ratio = 9.76, P = 2.15 × 10−4). We also found evidence for overtransmission of loss-of-function (LoF) or previously reported pathogenic variants in these same genes from heterozygous carrier parents (11 of 14 transmitted, P = 0.03). We identified a total of 11 SUDC proband genotypes (7 de novo, 1 transmitted parental mosaic, 2 transmitted parental heterozygous, and 1 compound heterozygous) as pathogenic and likely contributory to death, a genetic finding in 8.9% of our cohort. Two genes had recurrent missense DNMs, RYR2 and CACNA1C. Both RYR2 mutations are pathogenic (P = 1.7 × 10−7) and were previously studied in mouse models. Both CACNA1C mutations lie within a 104-nt exon (P = 1.0 × 10−7) and result in slowed L-type calcium channel inactivation and lower current density. In total, six pathogenic DNMs can alter calcium-related regulation of cardiomyocyte and neuronal excitability at a submembrane junction, suggesting a pathway conferring susceptibility to sudden death. There was a trend for excess LoF mutations in LoF intolerant genes, where ≥1 nonhealthy sample in denovo-db has a similar variant (odds ratio = 6.73, P = 0.02); additional uncharacterized genetic causes of sudden death in children might be discovered with larger cohorts.
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Frontera A, Anselmino M, Matta M, Baccelli A, Vlachos K, Bonsignore A, Camaioni C, Notarstefano P, Mahida S, Nesti M, Sacher F, Tunzi R, Landoni G, Aschieri D, Castelli V, Hocini M, Jaïs P, Gaita F, Derval N, Haïssaguerre M. Ante-mortem characterization of sudden deaths as first-manifestation in Italy. J Interv Card Electrophysiol 2021; 63:267-274. [PMID: 33638776 PMCID: PMC8983542 DOI: 10.1007/s10840-021-00949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE There is a relative paucity of data on ante-mortem clinical characteristics of young (age 1 to 35 years) sudden death (SD) victims. The aim of the study was to characterize ante-mortem characteristics of SD victims, in a selected national cohort identified by a web search. METHODS A dataset of all SD (January 2010 and December 2015) was built from national forensic data and medical records, integrated with Google search model. Families were contacted to obtain consent for interviews. Data were obtained on ante-mortem symptoms. ECG characteristics and autopsy data were available. RESULTS Out of 301 SD cases collected, medical and family history was available in 132 (43.9%). Twenty-eight (21.1%) had a positive family history for SD. SD occurred during sport/effort in 76 (57.6%). One hundred twelve (85%) SD cases had no prior reported symptoms. Autopsy data were available in 100/132 (75.8%) cases: an extra cardiac cause was identified in 20 (20%). Among the 61 cases with a cardiac diagnosis, 21 (34%) had hypertrophic cardiomyopathy. Among the 19 (19%) victims without structural abnormalities, molecular autopsy identified pathogenic variants for channelopathies in 9 cases. Ten (10%) victims had no identifiable cause. CONCLUSIONS Most SD were due to cardiac causes and occurred in previously asymptomatic patients. SD events mainly occurred during strenuous activity. In a minority of cases, no cause was identified. The web-based selection criteria, and incomplete data retrieval, need to be carefully taken into account for data interpretation and reproducibility.
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Affiliation(s)
- Antonio Frontera
- Arrhythmology Department, IRCCS San Raffaele Scientific Institute and San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.,Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Matteo Anselmino
- Cardiology Division, "Città Della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Matta
- Cardiology Division, "Città Della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Baccelli
- Arrhythmology Department, IRCCS San Raffaele Scientific Institute and San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Konstantinos Vlachos
- Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | | | - Claudia Camaioni
- Cardiology Department, Istituto clinico Città Studi, Milan, Italy
| | | | - Saagar Mahida
- Liverpool Centre for Cardiovascular sciences, and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Martina Nesti
- Cardiology Department, San Donato Hospital, Arezzo, Italy
| | - Frederic Sacher
- Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Roberto Tunzi
- Cardiology Department, University of Bari, Bari, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniela Aschieri
- Cardiology Department, Castel San Giovanni Hospital, Piacenza, Italy
| | | | - Meleze Hocini
- Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Fiorenzo Gaita
- Cardiology Division, "Città Della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nicolas Derval
- Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | - Michel Haïssaguerre
- Electrophysiology Department, LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
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Couper K, Putt O, Field R, Poole K, Bradlow W, Clarke A, Perkins GD, Royle P, Yeung J, Taylor-Phillips S. Incidence of sudden cardiac death in the young: a systematic review. BMJ Open 2020; 10:e040815. [PMID: 33033034 PMCID: PMC7542928 DOI: 10.1136/bmjopen-2020-040815] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To summarise studies describing incidence of sudden cardiac death in a general population of young individuals to inform screening policy. DESIGN Systematic review. DATA SOURCES Database searches of MEDLINE, EMBASE and the Cochrane library (all inception to current) on 29 April 2019 (updated 16 November 2019), and forward/backward citation tracking of eligible studies. STUDY ELIGIBILITY CRITERIA All studies that reported incidence of sudden cardiac death in young individuals (12-39 years) in a general population, with no restriction on language or date. Planned subgroups were incidence by age, sex, race and athletic status (including military personnel). DATA EXTRACTION Two reviewers independently assessed study eligibility, extracted study data and assessed risk of bias using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. ANALYSIS Reported incidence of sudden cardiac death in the young per 100 000 person-years. RESULTS 38 studies that reported incidence across five continents. We identified substantial heterogeneity in population, sudden cardiac death definition, and case ascertainment methods, precluding meta-analysis. Median reported follow-up years was 6.97 million (IQR 2.34 million-23.70 million) and number of sudden cardiac death cases was 64 (IQR 40-251). In the general population, the median of reported incidence was 1.7 sudden cardiac death per 100 000 person-years (IQR 1.3-2.6, range 0.75-11.9). Most studies (n=14, 54%) reported an incidence between one and two cases per 100 000 person-years. Incidence was higher in males and older individuals. CONCLUSIONS This systematic review identified variability in the reported incidence of sudden cardiac death in the young across studies. Most studies reported an incidence between one and two cases per 100 000 person-years. PROSPERO REGISTRATION NUMBER CRD42019120563.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Putt
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Richard Field
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kurtis Poole
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - William Bradlow
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aileen Clarke
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pamela Royle
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Joyce Yeung
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sian Taylor-Phillips
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
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Huang WC, Huang HT, Chen PY, Wang WC, Ko TM, Shrestha S, Yang CD, Tai CS, Chiew MY, Chou YP, Hu YF, Huang HD. SVAD: A genetic database curates non-ischemic sudden cardiac death-associated variants. PLoS One 2020; 15:e0237731. [PMID: 32813752 PMCID: PMC7437891 DOI: 10.1371/journal.pone.0237731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
Sudden cardiac death (SCD) is an important cause of mortality worldwide. It accounts for approximately half of all deaths from cardiovascular disease. While coronary artery disease and acute myocardial infarction account for the majority of SCD in the elderly population, inherited cardiac diseases (inherited CDs) comprise a substantial proportion of younger SCD victims with a significant genetic component. Currently, the use of next-generation sequencing enables the rapid analysis to investigate relationships between genetic variants and inherited CDs causing SCD. Genetic contribution to risk has been considered an alternate predictor of SCD. In the past years, large numbers of SCD susceptibility variants were reported, but these results are scattered in numerous publications. Here, we present the SCD-associated Variants Annotation Database (SVAD) to facilitate the interpretation of variants and to meet the needs of data integration. SVAD contains data from a broad screening of scientific literature. It was constructed to provide a comprehensive collection of genetic variants along with integrated information regarding their effects. At present, SVAD has accumulated 2,292 entries within 1,239 variants by manually surveying pertinent literature, and approximately one-third of the collected variants are pathogenic/likely-pathogenic following the ACMG guidelines. To the best of our knowledge, SVAD is the most comprehensive database that can provide integrated information on the associated variants in various types of inherited CDs. SVAD represents a valuable source of variant information based on scientific literature and benefits clinicians and researchers, and it is now available on http://svad.mbc.nctu.edu.tw/.
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Affiliation(s)
- Wei-Chih Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Hsin-Tzu Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Industrial Development Graduate Program of College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Po-Yuan Chen
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Wei-Chi Wang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Tai-Ming Ko
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, R.O.C
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Sirjana Shrestha
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Chi-Dung Yang
- Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, China
- School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, China
| | - Chun-San Tai
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Men-Yee Chiew
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Yu-Pao Chou
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- * E-mail: (HDH); (YFH)
| | - Hsien-Da Huang
- Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, China
- School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail: (HDH); (YFH)
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10
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Jin Y, Song S, Zhang L, Trisolini MG, Labresh KA, Smith SC, Zheng Z. Disparities in Premature Cardiac Death Among US Counties From 1999-2017: Temporal Trends and Key Drivers. J Am Heart Assoc 2020; 9:e016340. [PMID: 32750296 PMCID: PMC7792253 DOI: 10.1161/jaha.120.016340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
Background Disparities in premature cardiac death (PCD) might stagnate the progress toward the reduction of PCD in the United States and worldwide. We estimated disparities across US counties in PCD rates and investigated county-level factors related to the disparities. Methods and Results We used US mortality data for cause-of-death and demographic data from death certificates and county-level characteristics data from multiple databases. PCD was defined as any death that occurred at an age between 35 and 74 years with an underlying cause of death caused by cardiac disease based on International Classification of Diseases, Tenth Revision (ICD-10), codes. Of the 1 598 173 PCDs that occurred during 1999-2017, 60.9% were out of hospital. Although the PCD rates declined from 1999-2017, the proportion of out-of-hospital PCDs among all cardiac deaths increased from 58.3% to 61.5%. The geographic disparities in PCD rates across counties widened from 1999 (Theil index=0.10) to 2017 (Theil index=0.23), and within-state differences accounted for the majority of disparities (57.4% in 2017). The disparities in out-of-hospital PCD rates (and in-hospital PCD rates) associated with demographic composition were 36.51% (and 37.51%), socioeconomic features were 18.64% (and 18.36%), healthcare environment were 18.64% (and 13.90%), and population health status were 23.73% (and 30.23%). Conclusions Disparities in PCD rates exist across US counties, which may be related to the decelerated trend of decline in the rates among middle-aged adults. The slower declines in out-of-hospital rates warrants more precision targeting and sustained efforts to ensure progress at better levels of health (with lower PCD rates) against PCD.
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Affiliation(s)
- Yinzi Jin
- Department of Global HealthSchool of Public HealthPeking UniversityBeijingChina
- Institute for Global HealthPeking UniversityBeijingChina
| | - Suhang Song
- China Center for Health Development StudiesPeking UniversityBeijingChina
| | - Lin Zhang
- School of Public HealthShanghai Jiao Tong UniversityShanghaiChina
| | | | | | - Sidney C. Smith
- Division of CardiologySchool of MedicineUniversity of North Carolina at Chapel HillNC
| | - Zhi‐Jie Zheng
- Department of Global HealthSchool of Public HealthPeking UniversityBeijingChina
- Institute for Global HealthPeking UniversityBeijingChina
- RTI InternationalResearch Triangle ParkNC
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11
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Skjelbred T, Lynge TH, Nielsen J, Winkel BG, Tfelt-Hansen J. Symptoms and healthcare contact preceding sudden cardiac death in persons aged 1-49 years. Trends Cardiovasc Med 2020; 31:119-124. [PMID: 31987774 DOI: 10.1016/j.tcm.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 01/17/2023]
Abstract
Sudden Cardiac Death (SCD) is a leading cause of death among persons in their youth and early middle-age. To prevent SCD it is crucial to identify persons at high-risk of SCD. Knowledge of symptoms and medical contact prior to SCD could potentially aid in the identification of high-risk persons in the general population who would benefit from further investigation. This review aims to summarize the current knowledge of symptoms and healthcare contact preceding SCD in persons aged 1-49 years, and to explore how the symptoms differ according to SCD cause and age of the deceased. There was a high frequency of both cardiac and non-specific symptoms prior to SCD. Additionally, many SCD victims contacted the healthcare system prior to death on the basis of their symptoms and only a few were diagnosed with cardiovascular disease. This information underlines that young persons reporting potential cardiac symptoms should also be thoroughly examined. Furthermore, such symptoms could be used in combination with other easily accessible information in non-invasive prediction models aiming at identifying persons at high risk of SCD that would benefit from further investigation and possibly treatment.
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Affiliation(s)
- Tobias Skjelbred
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jakob Nielsen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark
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12
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Larsen MK, Christiansen SL, Hertz CL, Frank-Hansen R, Jensen HK, Banner J, Morling N. Targeted molecular genetic testing in young sudden cardiac death victims from Western Denmark. Int J Legal Med 2019; 134:111-121. [DOI: 10.1007/s00414-019-02179-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
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13
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Hata Y, Hirono K, Yamaguchi Y, Ichida F, Oku Y, Nishida N. Minimal inflammatory foci of unknown etiology may be a tentative sign of early stage inherited cardiomyopathy. Mod Pathol 2019; 32:1281-1290. [PMID: 31024045 DOI: 10.1038/s41379-019-0274-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 01/18/2023]
Abstract
Although relatively uncommon, pathologists may encounter minimal inflammatory foci in the absence of typical structural heart disease; however, the clinicopathological significance of minimal inflammatory foci, including correlation with sudden unexpected death, is unexplored. From 1072 serial autopsy subjects, cases with unexplained minimal inflammatory foci, the extent of which was under 1% of the whole examined ventricle, were extracted to exclude cases with borderline/focal myocarditis resulting from local, systemic infection, or autoimmune mechanisms. Immunohistochemistry and genetic analysis targeting viral genomes and heart disease-related genes using next generation sequencing were performed. We detected 10 cases with unexplained minimal inflammatory foci (five males, five females, aged 15-68 years). The cause and/or manner of death were sudden unexpected death (6 cases, 60%), sudden unexpected death with epilepsy (1 case, 10%), drowning in a hot bath (1 case, 10%), and suicide (2 cases, 20%). In none of these cases was pathogen-derived DNA or RNA detected. In 8 of the 10 cases (80%), 17 possible pathogenic genetic variants causative for arrhythmogenic right ventricular cardiomyopathy or dilated cardiomyopathy; DSP was the most frequently involved gene (three cases with two different variants), followed by LAMA4 and MYBPC3 (two cases, two variants for each gene), LDB3 (two cases, one variant), and the remaining 10 variants occurred in seven cases (DSC2, RYR2, SOS1, SCN5A, SGCD, LPL, PKP2, MYH11, GATA6, and DSG2). All mutations were missense mutations. DSP_Lys1581Glu and DSC2_p.Thr275Met were classified according to American College of Medical Genetics and Genomics consensus statement guidelines as pathogenic or likely pathogenic for arrhythmogenic cardiomyopathy in three patients (30%). The remaining 15 variants were classified as potentially pathogenic variants. Unexplained minimal inflammatory foci may be an early sign of inherited cardiomyopathy, and such cases might already have arrhythmogenic potential that can lead to sudden unexpected death. Detection of minimal inflammatory foci by careful pathological examination may indicate the value of conducting comprehensive genetic analysis, even if significant structural abnormalities are not evident.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yoshiaki Yamaguchi
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yuko Oku
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
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14
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Mirzaei M, Joodi G, Bogle B, Chen S, Simpson RJ. Years of Life and Productivity Loss Because of Adult Sudden Unexpected Death in the United States. Med Care 2019; 57:498-502. [PMID: 31107395 PMCID: PMC6565486 DOI: 10.1097/mlr.0000000000001129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have evaluated the years of life lost (YLL) and productivity loss due to sudden unexpected death (SUD). The burden of SUD on society is undetermined because of lack of population-based studies and comprehensive adjudication methods. OBJECTIVE We estimated YLL and productivity loss from SUD in working-age adults and compared it with the leading causes of death in the United States. METHODS We screened all out of hospital deaths among people aged 20-64 in Wake County, NC from 2013 to 2015 to adjudicate SUDs. We extrapolated Wake County incidence to estimate the age-standardized and sex-standardized rate of SUD in the United States. YLL was calculated based on the remaining life expectancy of the victims. Incorporating market and housekeeping value estimated the present value of lifetime productivity loss because of SUD. RESULTS SUD incidence rates in the US adults aged 20-64 were 49.3 (95% confidence interval, 41.2-58.3) and 21.7 (95% confidence interval, 16.5-27.8) per 100,000 among men and women, respectively. SUD resulted in the loss of 2 million years of life, accounting for 10.0% of YLL from all causes of death. Among natural causes of death, YLL from SUD was only lower than that from all cancers combined and heart disease. Lifetime productivity loss because of SUD was ~$51 billion, exceeding productivity loss from any individual cancer. CONCLUSION SUD is an important source of YLL and productivity loss among adults aged 20-64. Such a high burden on society justifies prioritizing health policies and interventions toward preventing SUD.
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Affiliation(s)
- Mojtaba Mirzaei
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
| | - Golsa Joodi
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
| | - Brittany Bogle
- Department of Epidemiology, Gillings School of Public
Health, University of North Carolina at Chapel Hill
| | - Sarah Chen
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
| | - Ross J Simpson
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
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15
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Kiuchi MG, Nolde JM, Villacorta H, Carnagarin R, Chan JJSY, Lugo-Gavidia LM, Ho JK, Matthews VB, Dwivedi G, Schlaich MP. New Approaches in the Management of Sudden Cardiac Death in Patients with Heart Failure-Targeting the Sympathetic Nervous System. Int J Mol Sci 2019; 20:E2430. [PMID: 31100908 PMCID: PMC6567277 DOI: 10.3390/ijms20102430] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVDs) have been considered the most predominant cause of death and one of the most critical public health issues worldwide. In the past two decades, cardiovascular (CV) mortality has declined in high-income countries owing to preventive measures that resulted in the reduced burden of coronary artery disease (CAD) and heart failure (HF). In spite of these promising results, CVDs are responsible for ~17 million deaths per year globally with ~25% of these attributable to sudden cardiac death (SCD). Pre-clinical data demonstrated that renal denervation (RDN) decreases sympathetic activation as evaluated by decreased renal catecholamine concentrations. RDN is successful in reducing ventricular arrhythmias (VAs) triggering and its outcome was not found inferior to metoprolol in rat myocardial infarction model. Registry clinical data also suggest an advantageous effect of RDN to prevent VAs in HF patients and electrical storm. An in-depth investigation of how RDN, a minimally invasive and safe method, reduces the burden of HF is urgently needed. Myocardial systolic dysfunction is correlated to neuro-hormonal overactivity as a compensatory mechanism to keep cardiac output in the face of declining cardiac function. Sympathetic nervous system (SNS) overactivity is supported by a rise in plasma noradrenaline (NA) and adrenaline levels, raised central sympathetic outflow, and increased organ-specific spillover of NA into plasma. Cardiac NA spillover in untreated HF individuals can reach ~50-fold higher levels compared to those of healthy individuals under maximal exercise conditions. Increased sympathetic outflow to the renal vascular bed can contribute to the anomalies of renal function commonly associated with HF and feed into a vicious cycle of elevated BP, the progression of renal disease and worsening HF. Increased sympathetic activity, amongst other factors, contribute to the progress of cardiac arrhythmias, which can lead to SCD due to sustained ventricular tachycardia. Targeted therapies to avoid these detrimental consequences comprise antiarrhythmic drugs, surgical resection, endocardial catheter ablation and use of the implantable electronic cardiac devices. Analogous NA agents have been reported for single photon-emission-computed-tomography (SPECT) scans usage, specially the 123I-metaiodobenzylguanidine (123I-MIBG). Currently, HF prognosis assessment has been improved by this tool. Nevertheless, this radiotracer is costly, which makes the use of this diagnostic method limited. Comparatively, positron-emission-tomography (PET) overshadows SPECT imaging, because of its increased spatial definition and broader reckonable methodologies. Numerous ANS radiotracers have been created for cardiac PET imaging. However, so far, [11C]-meta-hydroxyephedrine (HED) has been the most significant PET radiotracer used in the clinical scenario. Growing data has shown the usefulness of [11C]-HED in important clinical situations, such as predicting lethal arrhythmias, SCD, and all-cause of mortality in reduced ejection fraction HF patients. In this article, we discussed the role and relevance of novel tools targeting the SNS, such as the [11C]-HED PET cardiac imaging and RDN to manage patients under of SCD risk.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Janis Marc Nolde
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Humberto Villacorta
- Cardiology Division, Department of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro 24033-900, Brazil.
| | - Revathy Carnagarin
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Justine Joy Su-Yin Chan
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Jan K Ho
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Vance B Matthews
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, The University of Western Australia, Perth 6150, Australia.
| | - Markus P Schlaich
- Dobney Hypertension Cenre, School of Medicine-Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia Level 3, MRF Building, Rear 50 Murray St, Perth 6000, MDBP: M570, Australia.
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth 6000, Australia.
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Australia.
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16
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Lynge TH, Nielsen JL, Blanche P, Gislason G, Torp-Pedersen C, Winkel BG, Risgaard B, Tfelt-Hansen J. Decline in incidence of sudden cardiac death in the young: a 10-year nationwide study of 8756 deaths in Denmark. Europace 2019; 21:909-917. [DOI: 10.1093/europace/euz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Jakob Lund Nielsen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Paul Blanche
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
- Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark
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17
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Abstract
Sudden cardiac death in the young (SCDY) is always a devastating event. The death is sudden and unexpected and often in a person who was thought to be healthy. In recent years our understanding of these tragic events have drastically improved; 10-20years ago we did not know how often SCD occurred in the young, and we had sparse knowledge on the role of inheritance. We have found that SCD corresponds to 7% of all deaths with an overall (highest possible) incidence rate of 2.8 per 100,000 person-years (autopsy rate of sudden death cases of 75%). This incidence rate is higher than in the Veneto region (1.0), in the Netherlands (1.6), and in the UK (1.8), but can be explained by differences in definition and methodological factors. Cause of death in SCDY also differs to some extent between countries. Recent data suggest that there are identifiable risk factors for SCDY such as symptoms, comorbidities and polypharmacy. SCDY is to some extent preventable and this can be achieved through several initiatives: 1. better OCHA treatment including readily available AEDs, 2. family screening on the families left behind, and 3. better diagnostics and treatment for patients at risk for SCDY.
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18
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El-Assaad I, Al-Kindi SG, Aziz PF. Trends of Out-of-Hospital Sudden Cardiac Death Among Children and Young Adults. Pediatrics 2017; 140:peds.2017-1438. [PMID: 29180463 DOI: 10.1542/peds.2017-1438] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous estimates of sudden cardiac death in children and young adults vary significantly, and population-based studies in the United States are lacking. We sought to estimate the incidence, causes, and mortality trends of sudden cardiac death in children and young adults (1-34 years). METHODS Demographic and mortality data based on death certificates for US residents (1-34 years) were obtained (1999-2015). Cases of sudden death and sudden cardiac death were retrieved by using the International Classification of Diseases, 10th Revision codes. RESULTS A total of 1 452 808 subjects aged 1 to 34 years died in the United States, of which 31 492 (2%) were due to sudden cardiac death. The estimated incidence of sudden cardiac death is 1.32 per 100 000 individuals and increased with age from 0.49 (1-10 years) to 2.76 (26-34 years). During the study period, incidence of sudden cardiac death declined from 1.48 to 1.13 per 100 000 (P < .001). Mortality reduction was observed across all racial and ethnic groups with a varying magnitude and was highest in children aged 11 to 18 years. Significant disparities were found, with non-Hispanic African American individuals and individuals aged 26 to 34 years having the highest mortality rates. The majority of young children (1-10 years) died of congenital heart disease (n = 1525, 46%), whereas young adults died most commonly from ischemic heart disease (n = 5075, 29%). CONCLUSIONS Out-of-hospital sudden cardiac death rates declined 24% from 1999 to 2015. Disparities in mortality exist across age groups and racial and ethnic groups, with non-Hispanic African American individuals having the highest mortality rates.
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Affiliation(s)
- Iqbal El-Assaad
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio; and
| | - Sadeer G Al-Kindi
- Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio
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19
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Kiuchi MG, Lobato GM, Chen S. Extraction of a dual-chamber pacemaker and inserting of a new automatic implantable cardioverter defibrillator: The easy procedure almost became catastrophic: a case report. Medicine (Baltimore) 2017; 96:e7919. [PMID: 28858113 PMCID: PMC5585507 DOI: 10.1097/md.0000000000007919] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The cardiovascular illnesses are in the middle of the foremost reasons of death around the world. Deaths in Europe, from sudden cardiac death (SCD), reach nearby 700,000 individuals every year. In the United States, statistics point to the existence of nearly 1 million yearly deaths from cardiovascular sickness, of which 330,000 are the consequence of abrupt. The significance of automatic implantable cardioverter-defibrillator (ICD) has been proven in subjects with preceding myocardial infarction and stark systolic left ventricular dysfunction (secondary prevention). CASE PRESENTATION In this case, we describe a female patient, 94 years old, with a dual-chamber pacemaker since 2014, normal functioning, and controlled hypertension. The patient was in use of bisoprolol 10 mg daily, hydrochlorothiazide 25 mg daily, and candesartan cilexetil 16 mg daily. She presented 2 episodes of syncope associated with the high ventricular rate (HVR), which characterizes sustained ventricular tachycardia (SVT) due to its instability, besides 1 episode of cardiorespiratory arrest. During an attempt to position the active monocoil shock lead in the right ventricle, there was perforation of the upper posterolateral wall of the right atrium, transfixing the pericardium and constituting a pericardial-pleural fistula with hemothorax formation in the right hemithorax. We chose to remove the electrodes and suture the left pocket. There was no cardiac tamponade or pericardial effusion, verified by a pericardial puncture. Thoracic drainage was introduced into the right hemithorax, and 3 L of blood were drained acutely with volume replacement and hemotransfusion. We maintained thoracic drainage in water seal. The ICD was implanted on the right side. CONCLUSION So, in this case, we reported a rare complication during pacemakers or ICD implantation that is the pericardial-pleural fistula with hemothorax formation in the contralateral hemithorax. Despite the patient's advanced age, we had the dexterity and luck to save her life.
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Affiliation(s)
| | - Guilherme Miglioli Lobato
- Anesthesiology Division, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil
| | - Shaojie Chen
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Zachariasardóttir S, Risgaard B, Ågesen FN, Jabbari R, Glinge C, Ingemann-Hansen O, Ottesen GL, Thomsen JL, Haunsø S, Banner J, Winkel BG, Tfelt-Hansen J. Sudden cardiac death and coronary disease in the young: A nationwide cohort study in Denmark. Int J Cardiol 2017; 236:16-22. [DOI: 10.1016/j.ijcard.2017.01.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
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Hata Y, Kinoshita K, Nishida N. An Autopsy Case of Sudden Unexpected Death of a Young Adult in a Hot Bath: Molecular Analysis Using Next-Generation DNA Sequencing. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2017; 10:1179547617702884. [PMID: 28469501 PMCID: PMC5398417 DOI: 10.1177/1179547617702884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/11/2017] [Indexed: 11/17/2022]
Abstract
We report a case of sudden unexpected death of a young woman who was found in a bathtub of hot water. The autopsy concluded that all possible causes of sudden loss of consciousness, except cardiac origin, could be excluded. However, the heart did not show any obvious pathological changes. We used next-generation DNA sequencing (NGS) to examine 73 genes and detected 3 rare, potentially pathogenic variants with minor allele frequencies ⩽1.0%. The pathogenicity of these variants was evaluated using 8 in silico predictive algorithms, and SCN5A_p.Gly289Ser, CACNB2_p.Ser502Leu, and MYH11_p.Lys1573Glu were detected as possible pathogenic variants. Inherited heart disease is a likely cause of sudden unexpected deaths of young people in hot baths, even before the clinical manifestation of the disease. In the future, molecular analysis by NGS may help to predict young to early middle-aged people who could be at risk of sudden arrhythmogenic fatality in hot baths.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Koshi Kinoshita
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Winkel BG, Risgaard B, Bjune T, Jabbari R, Lynge TH, Glinge C, Bundgaard H, Haunsø S, Tfelt-Hansen J. Gender differences in sudden cardiac death in the young-a nationwide study. BMC Cardiovasc Disord 2017; 17:19. [PMID: 28061807 PMCID: PMC5219679 DOI: 10.1186/s12872-016-0446-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/16/2016] [Indexed: 11/28/2022] Open
Abstract
Background Hitherto, sudden cardiac death (SCD) in the young has been described with no distinction between genders. SCD occurs more often in men (SCDm) than women (SCDw), but this disparity is not understood and has not been investigated systematically in a nationwide setting. Our objective was to report gender differences in SCD in the young in a nationwide (Denmark) setting. Methods All deaths in persons aged 1–35 years nationwide in Denmark between 2000 and 2009 were included. Death certificates and autopsy reports were obtained. The extensive health care registries in Denmark were used to investigate any known disease prior to death. SCDw were compared to SCDm. Results During the 10-year study period there were a total of 8756 deaths in 23.7 million person-years. In total, 635 deaths were SCD. SCDw constituted 205 deaths (32%). Women had a higher proportion of witnessed deaths (51 vs. 41%, p = 0.02) and died less often in a public place (16 vs. 26%, p = 0.01). Age at death, ratios of autopsies and sudden unexplained deaths, and comorbidities, did not differ. Causes of SCD were largely comparable between genders. The incidence rate of SCDw was half of that of SCDm (1.8 vs. 3.6 per 100,000 person-years, incidence rate ratio 2.0 (95% CI 1.7–2.4), p < 0.01). Conclusions Incidence rate ratio of SCDm vs SCDw is 2. Young SCDw and SCDm are equally investigated, have comparable comorbidity, and causes of SCD. SCD due to potentially inherited cardiac diseases is less often in young women and could reflect a protection of female gender.
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Affiliation(s)
- Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
| | - Bjarke Risgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Thea Bjune
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Reza Jabbari
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Charlotte Glinge
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Stig Haunsø
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
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Incidence of ventricular arrhythmic events in CKD patients with ICD. Int J Cardiol 2017; 227:312-317. [DOI: 10.1016/j.ijcard.2016.11.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022]
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Sosa I, Grubesic A. How could analyzing the activity of two matrix metalloproteinases unveil the cause of sudden cardiac death. Int J Immunopathol Pharmacol 2016; 29:712-714. [PMID: 27271976 DOI: 10.1177/0394632016651878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/05/2016] [Indexed: 01/25/2023] Open
Abstract
Sudden cardiac death is natural, unexpected death, related to cardiovascular disease. Its postmortem elucidation is significant, as the family of the deceased aspires to prevent other sudden deaths. Irrespective of the proper etiological entity, the myocardial collagen matrix remodels, associated with the progression of cardiovascular diseases. It has become evident that many mediators such as humoral factors, transforming growth factor (TGF)-β1 among them, are involved in the remodeling process. Cardiac remodeling is the balance of regenerative and eliminatory processes that include enzymes involved in the degradation of extracellular matrix (ECM) components. Enzymes capable of degrading native fibrillar collagen are interstitial collagenases, specifically matrix metalloproteinases (MMP)-1 and MMP-8. Here, we suggest a technique of visualizing turnover of collagen in cardiac tissue.
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Affiliation(s)
- Ivan Sosa
- Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Aron Grubesic
- Department of Internal Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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Vassalini M, Verzeletti A, Restori M, De Ferrari F. An autopsy study of sudden cardiac death in persons aged 1–40 years in Brescia (Italy). J Cardiovasc Med (Hagerstown) 2016; 17:446-53. [DOI: 10.2459/jcm.0000000000000234] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Clinical evaluation of unselected cardiac arrest survivors in a tertiary center over a 1-year period (the LAZARUZ study). J Electrocardiol 2016; 49:707-13. [PMID: 27237785 DOI: 10.1016/j.jelectrocard.2016.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES When the cause of an aborted cardiac arrest is unclear the initiation of therapy, counseling and family screening is challenging. METHODS We included 43 unselected, prospectively identified cardiac arrest survivors with or without a diagnosis. Family history for cardiac disease and supplemental electrocardiograms were evaluated for additional diagnostic information. RESULTS 43 cardiac arrest survivors were included, 34 (79%) were male and the average age was 48years (range 23-64, SD 13.0). The most common etiologies identified in cardiac arrest survivors were ischemic heart disease (33%), cardiomyopathies (14%), miscellaneous (e.g. drug induced arrhythmias, coronary spasms) (12%) and channelopathies (5%). Family history of cardiac disease - even inheritable conditions - was not indicative of etiology in cardiac arrest survivors. Supplemental ECGs were abnormal in 10 of 43 patients; in the majority of these patients (7) no conclusive diagnosis was reached. CONCLUSIONS In this study 16/43 (37%) of unselected, prospectively included cardiac arrest survivors remained without a diagnosis despite exhaustive investigations. We may extract additional diagnostic information from simple maneuvers during the recording of the electrocardiogram. We suggest that these ECG derived clues be investigated in future studies including genetic test results and data from relatives.
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Lewis ME, Lin FC, Nanavati P, Mehta N, Mounsey L, Nwosu A, Pursell I, Chung EH, Mounsey JP, Simpson RJ. Estimated incidence and risk factors of sudden unexpected death. Open Heart 2016; 3:e000321. [PMID: 27042316 PMCID: PMC4809187 DOI: 10.1136/openhrt-2015-000321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/06/2015] [Accepted: 12/21/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In this manuscript, we estimate the incidence and identify risk factors for sudden unexpected death in a socioeconomically and racially diverse population in one county in North Carolina. Estimates of the incidence and risk factors contributing to sudden death vary widely. The Sudden Unexpected Death in North Carolina (SUDDEN) project is a population-based investigation of the incidence and potential causes of sudden death. METHODS From 3 March 2013 to 2 March 2014, all out-of-hospital deaths in Wake County, North Carolina, were screened to identify presumed sudden unexpected death among free-living residents between the ages of 18 and 64 years. Death certificate, public and medical records were reviewed and adjudicated to confirm sudden unexpected death cases. RESULTS Following adjudication, 190 sudden unexpected deaths including 122 men and 68 women were identified. Estimated incidence was 32.1 per 100 000 person-years overall: 42.7 among men and 22.4 among women. The majority of victims were white, unmarried men over age 55 years, with unwitnessed deaths at home. Hypertension and dyslipidaemia were common in men and women. African-American women dying from sudden unexpected death were over-represented. Women who were under age 55 years with coronary disease accounted for over half of female participants with coronary artery disease. CONCLUSIONS The overall estimated incidence of sudden unexpected death may account for approximately 10% of all deaths classified as 'natural'. Women have a lower estimated incidence of sudden unexpected death than men. However, we found no major differences in age or comorbidities between men and women. African-Americans and young women with coronary disease are at risk for sudden unexpected death.
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Affiliation(s)
- Mary Elizabeth Lewis
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Feng-Chang Lin
- NC TraCS, University of North Carolina, North Carolina, USA
| | - Parin Nanavati
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Neil Mehta
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Louisa Mounsey
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Anthony Nwosu
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Irion Pursell
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Eugene H Chung
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - J Paul Mounsey
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
| | - Ross J Simpson
- Department of Medicine, The University of North Carolina, Cardiac Electrophysiology, North Carolina, USA
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Hata Y, Kinoshita K, Mizumaki K, Yamaguchi Y, Hirono K, Ichida F, Takasaki A, Mori H, Nishida N. Postmortem genetic analysis of sudden unexplained death syndrome under 50 years of age: A next-generation sequencing study. Heart Rhythm 2016; 13:1544-51. [PMID: 27005929 DOI: 10.1016/j.hrthm.2016.03.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies on the genetic analysis of victims of sudden unexplained death syndrome (SUDS) have shown diagnostic potential. Previously, such analyses mainly targeted the major channelopathy-associated genes. OBJECTIVE The purpose of this study was to evaluate the utility of next-generation sequencing (NGS) in the postmortem diagnosis of SUDS. METHODS Our data are derived from 25 cases of SUDS (21 men and 4 women; age 19-50 years). A total of 70 genes were examined by NGS, and the pathogenicity of any detected rare variants with minor allele frequencies of <0.5% was evaluated using a widely used database and eight in silico algorithms. RESULTS Five known and 15 potentially pathogenic variants with a high in silico score were identified in 14 cases. In all, 6 channelopathy-related variants were identified in 5 cases, including 2 cases with history of arrhythmia; 11 cases had cardiomyopathy- or cardiac transcription factor-related variants. Three cases with desmosomal gene- or other cardiomyopathy-related variants showed possibly related pathologic changes. Three cases with RYR2 or TBX5 variants showed possible pathogenic fibrosis of the cardiac conduction system. Only 12 variants showed moderate or strong possible pathogenicity in SUDS cases compared with qualifying controls. CONCLUSION Hereditary heart diseases other than channelopathy may also be a significant cause of SUDS, even if clinical and pathologic findings do not show advanced disease. A combination of gene analysis using NGS and some predictive methods for detecting variants and careful pathologic evaluation may provide a reliable diagnosis of hereditary heart disease for potential SUDS cases.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Koshi Kinoshita
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Koichi Mizumaki
- Clinical Research and Ethics Center, University of Toyama, Toyoma, Japan
| | - Yoshiaki Yamaguchi
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyoma, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyoma, Japan
| | - Asami Takasaki
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyoma, Japan
| | - Hisashi Mori
- Department of Molecular Neuroscience, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyoma, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
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Marstrand P, Axelsson A, Thune JJ, Vejlstrup N, Bundgaard H, Theilade J. Cardiac magnetic resonance imaging after ventricular tachyarrhythmias increases diagnostic precision and reduces the need for family screening for inherited cardiac disease. Europace 2016; 18:1860-1865. [PMID: 26838692 DOI: 10.1093/europace/euv446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/16/2015] [Indexed: 01/20/2023] Open
Abstract
AIMS Guidelines recommend evaluation of family members of sudden cardiac death victims. However, initiation of cascade screening in families with uncertain diagnoses is not cost-effective and may cause unnecessary concern. For these reasons, we set out to assess to what extent cardiac magnetic resonance imaging (CMR) would increase the diagnostic precision and thereby possibly change the indication for family screening in patients with ventricular tachyarrhythmias. METHODS AND RESULTS We retrospectively collected data from 79 patients hospitalized with aborted cardiac arrest (resuscitated from a cardiac arrest), ventricular tachycardia (VT), or syncope who underwent a CMR at the Copenhagen University Hospital, Rigshospitalet, Denmark. Besides CMR, the patients were evaluated with an electrocardiogram, echocardiogram (both 100%), coronary angiogram (CAG)/coronary computed tomography scan (CT-CAG) (81%), exercise stress test (47%), late potentials (54%), electrophysiological study (44%), pharmacological provocation (44%), and/or myocardial biopsy (16%). Family screening was indicated for 53 probands (67%) prior to CMR. After full workup, only 43 cases (54%) warranted evaluation of relatives (19% decrease, P = 0.034). The full evaluation changed whether family screening was indicated in 18 probands (14/18 moved to no indication for family screening). In the 18 where recommendations on family screening changed, CMR findings were the major driver for re-classification in 17 cases. CONCLUSION Cardiac magnetic resonance imaging re-defines the cardiac diagnoses in a significant proportion of cases and reduces the number of patients in whom family screening is warranted. Cardiac magnetic resonance imaging is highly relevant for optimal care and resource allocation when an inherited heart disease is the presumed cause of life-threatening arrhythmias.
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Affiliation(s)
- Peter Marstrand
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Anna Axelsson
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Juliane Theilade
- Department of Cardiology, Herlev Hospital, University Hospital Copenhagen, Denmark
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Smallman DP, Webber BJ, Mazuchowski EL, Scher AI, Jones SO, Cantrell JA. Sudden cardiac death associated with physical exertion in the US military, 2005–2010. Br J Sports Med 2015; 50:118-23. [DOI: 10.1136/bjsports-2015-094900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 12/19/2022]
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Bernotiene G, Radisauskas R, Tamosiunas A, Milasauskiene Z. Trends in out-of-hospital ischemic heart disease mortality for the 25-64 year old population of Kaunas, Lithuania, based on data from the 1988-2012 Ischemic Heart Disease Registry. Scand J Public Health 2015; 43:648-56. [PMID: 25969167 DOI: 10.1177/1403494815586294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/17/2022]
Abstract
AIM The aim of the study was to evaluate trends in out-of-hospital ischemic heart disease (IHD) mortality in the Kaunas, Lithuania population aged 25-64, from 1988 to 2012. METHODS The registry was maintained according to the World Health Organisation (WHO) recommendations for the multinational MONICA (MONItoring of trends and determinants in CArdiovascular disease) project. We analysed out-of-hospital deaths from IHD, by sex and age groups, using the linear logistic regression model for identifying trends. RESULTS In 1988-2012, the out-of-hospital IHD deaths in Kaunas accounted for 78.4% and 68.4%, on average, of all IHD deaths in men and women aged 25-64, respectively. During the study period, the out-of-hospital IHD mortality for the Kaunas population aged 25-64 was 134.5 per 100,000 men and 18.2 per 100,000 women. From 1988 to 2012, the out-of-hospital IHD mortality for men and women aged 25-64 tended to decline by, on average, 8.3% per year (p = 0.269) and 16.2% per year (p = 0.101), respectively; whereas the corresponding rates for men aged 25-44 were declining significantly, by 22.5% per year (p = 0.047). The most significant changes in out-of-hospital IHD mortality were among men aged 25-44 with no previous history of acute myocardial infarction (AMI), in whom the out-of-hospital IHD mortality was significantly declining, by 21.3% per year (p = 0.015); whereas the corresponding rates for men aged 45-54 with a previous history of AMI tended to decline by 20.4% per year (p = 0.114). CONCLUSIONS In 1988-2012, the out-of-hospital IHD deaths of younger men and middle-aged women accounted for the highest percentage of all IHD deaths; and a higher proportion of both men and women with no previous history of AMI, as compared to the proportion of those with a previous history of AMI.
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Affiliation(s)
- Gailute Bernotiene
- Department of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Department of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Department of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Zemyna Milasauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Gullach AJ, Risgaard B, Lynge TH, Jabbari R, Glinge C, Haunsø S, Backer V, Winkel BG, Tfelt-Hansen J. Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark. BMC Pulm Med 2015; 15:35. [PMID: 25887740 PMCID: PMC4404085 DOI: 10.1186/s12890-015-0033-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled asthma as a previous hospital admittance because of asthma (of any severity) or when asthma was considered to have influenced the death according to the death certificate. The purpose of this study is to increase the medical focus on young persons with uncontrolled asthma and thereby hopefully aid in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young persons with uncontrolled asthma. METHODS Through the review of death certificates, we found 625 sudden unexpected death cases in individuals aged 1-35 years in Denmark from 2000 to 2006. Of those, 49 persons with uncontrolled asthma were identified. Previous contacts with the healthcare system were identified, and available records from general practitioners were retrieved. RESULTS We identified 49 individuals who suffered from uncontrolled asthma. This corresponds to an incidence rate of 0.32 per 100,000 person-years. The cause of death in 31 cases (63%) was sudden cardiac death, and in 13 cases (27%), it was a fatal asthma attack. Symptoms (chest pain, dyspnea, seizures, general malaise, syncope, and palpitations) prior to death were reported in 41 (84%) of the cases. In 34 (69%) of the cases, antecedent symptoms (symptoms >24 hours before death) were present, and 28 (57%) patients had prodromal symptoms (symptoms <24 hours before death). The most common antecedent symptoms were dyspnea and chest pain, whereas the most common prodromal symptoms were dyspnea, general malaise, and/or fatigue. Twenty-eight patients (57%) sought medical advice from a general practitioner and/or emergency department due to these symptoms. CONCLUSION The cause of death was predominantly sudden cardiac death followed by fatal asthma attack. We found that 41 (84%) of patients suffered from symptoms prior to death and that 28 (57%) sought medical advice from the emergency department and/or general practitioners.
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Affiliation(s)
- Anders Juul Gullach
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Bjarke Risgaard
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Thomas Hadberg Lynge
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Reza Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Charlotte Glinge
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Stig Haunsø
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. .,Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark.
| | - Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - Bo Gregers Winkel
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Jacob Tfelt-Hansen
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. .,Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark.
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Longmuir PE, Colley RC, Wherley VA, Tremblay MS. Canadian Society for Exercise Physiology position stand: Benefit and risk for promoting childhood physical activity. Appl Physiol Nutr Metab 2014; 39:1271-9. [DOI: 10.1139/apnm-2014-0074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current guidelines recommend children accumulate 60 min of daily physical activity; however, highly publicized sudden-death events among young athletes raise questions regarding activity safety. An expert group convened (June 2012) to consider the safety of promoting increased physical activity for children, and recommended the publication of an evidence-based statement of current knowledge regarding the benefits and risks of physical activity for children. Recommendations for encouraging physical activity while maximizing the opportunity to identify children who have been prescribed a physical activity restriction include (1) professionals and (or) researchers that encourage children to change the type of physical activity or to increase the frequency, intensity, or duration of their activity should inquire whether a child has primary healthcare provider-prescribed activity limitations before the child’s activity participation changes; (2) physical activity researchers should prioritize the development of evidence regarding the benefits and risks of childhood physical activity and inactivity, particularly data on the risks of sedentary lifestyles and physical activity-associated injury risks that accounts for the amount of activity performed, and the effectiveness of current risk-management strategies and screening approaches; (3) professionals and researchers should prioritize the dissemination of information regarding the benefits of physical activity and the risks of sedentary behaviour in children; and (4) parents and professionals should encourage all children to accumulate at least 60 min of physical activity daily. The recommendations are established as a minimum acceptable standard that is applicable to all physical activity opportunities organized for children, whether those opportunities occur in a community, school, or research setting.
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Affiliation(s)
- Patricia E. Longmuir
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa Faculty of Medicine, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Rachel C. Colley
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa Faculty of Medicine, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Valerie A. Wherley
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT 06825, USA
| | - Mark S. Tremblay
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa Faculty of Medicine, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
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Hertz CL, Ferrero-Miliani L, Frank-Hansen R, Morling N, Bundgaard H. A comparison of genetic findings in sudden cardiac death victims and cardiac patients: the importance of phenotypic classification. Europace 2014; 17:350-7. [PMID: 25345827 DOI: 10.1093/europace/euu210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sudden cardiac death (SCD) is responsible for a large proportion of non-traumatic, sudden and unexpected deaths in young individuals. Sudden cardiac death is a known manifestation of several inherited cardiac diseases. In post-mortem examinations, about two-thirds of the SCD cases show structural abnormalities at autopsy. The remaining cases stay unexplained after thorough investigations and are referred to as sudden unexplained deaths. A routine forensic investigation of the SCD victims in combination with genetic testing makes it possible to establish a likely diagnosis in some of the deaths previously characterized as unexplained. Additionally, a genetic diagnose in a SCD victim with a structural disease may not only add to the differential diagnosis, but also be of importance for pre-symptomatic family screening. In the case of SCD, the optimal establishment of the cause of death and management of the family call for standardized post-mortem procedures, genetic screening, and family screening. Studies of genetic testing in patients with primary arrhythmia disorders or cardiomyopathies and of victims of SCD presumed to be due to primary arrhythmia disorders or cardiomyopathies, were systematically identified and reviewed. The frequencies of disease-causing mutation were on average between 16 and 48% in the cardiac patient studies, compared with ∼10% in the post-mortem studies. The frequency of pathogenic mutations in heart genes in cardiac patients is up to four-fold higher than that in SCD victims in a forensic setting. Still, genetic investigation of SCD victims is important for the diagnosis and the possible investigation of relatives at risk.
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Affiliation(s)
- Christin L Hertz
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Rune Frank-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Niels Morling
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Henning Bundgaard
- Rigshospitalets Unit for Inherited Heart Diseases, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
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Post-mortem genetic analysis in juvenile cases of sudden cardiac death. Forensic Sci Int 2014; 245:30-7. [PMID: 25447171 DOI: 10.1016/j.forsciint.2014.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/18/2014] [Accepted: 10/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The reason behind a sudden death of a young individual remains unknown in up to 50% of postmortem cases. Pathogenic mutations in genes encoding heart proteins are known to cause sudden cardiac death. OBJECTIVE The aim of our study was to ascertain whether genetic alterations could provide an explanation for sudden cardiac death in a juvenile cohort with no-conclusive cause of death after comprehensive autopsy. METHODS Twenty-nine cases <15 years showing no-conclusive cause of death after a complete autopsy were studied. Genetic analysis of 7 main genes associated with sudden cardiac death was performed using Sanger technology in low quality DNA cases, while in good quality cases the analysis of 55 genes associated with sudden cardiac death was performed using Next Generation Sequencing technology. RESULTS Thirty-five genetic variants were identified in 12 cases (41.37%). Ten genetic/variants in genes encoding cardiac ion channels were identified in 8 cases (27.58%). We also identified 9 cases (31.03%) carrying 25 genetic variants in genes encoding structural cardiac proteins. Nine cases carried more than one genetic variation, 5 of them combining structural and non-structural genes. CONCLUSIONS Our study supports the inclusion of molecular autopsy in forensic routine protocols when no conclusive cause of death is identified. Around 40% of sudden cardiac death young cases carry a genetic variant that could provide an explanation for the cause of death. Because relatives could be at risk of sudden cardiac death, our data reinforce their need of clinical assessment and, if indicated, of genetic analysis.
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Hofer F, Fellmann F, Schläpfer J, Michaud K. Sudden cardiac death in the young (5-39 years) in the canton of Vaud, Switzerland. BMC Cardiovasc Disord 2014; 14:140. [PMID: 25291980 PMCID: PMC4198689 DOI: 10.1186/1471-2261-14-140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/03/2014] [Indexed: 12/24/2022] Open
Abstract
Background Sudden cardiac death (SCD) among the young is a rare and devastating event, but its exact incidence in many countries remains unknown. An autopsy is recommended in every case because some of the cardiac pathologies may have a genetic origin, which can have an impact on the living family members. The aims of this retrospective study completed in the canton of Vaud, Switzerland were to determine both the incidence of SCD and the autopsy rate for individuals from 5 to 39 years of age. Methods The study was conducted from 2000 to 2007 on the basis of official statistics and analysis of the International Classification of Diseases codes for potential SCDs and other deaths that might have been due to cardiac disease. Results During the 8 year study period there was an average of 292′546 persons aged 5-39 and there were a total of 1122 deaths, certified as potential SCDs in 3.6% of cases. The calculated incidence is 1.71/100′000 person-years (2.73 for men and 0.69 for women). If all possible cases of SCD (unexplained deaths, drowning, traffic accidents, etc.) are included, the incidence increases to 13.67/100′000 person-years. However, the quality of the officially available data was insufficient to provide an accurate incidence of SCD as well as autopsy rates. The presumed autopsy rate of sudden deaths classified as diseases of the circulatory system is 47.5%. For deaths of unknown cause (11.1% of the deaths), the autopsy was conducted in 13.7% of the cases according to codified data. Conclusions The incidence of presumed SCD in the canton of Vaud, Switzerland, is comparable to the data published in the literature for other geographic regions but may be underestimated as it does not take into account other potential SCDs, as unexplained deaths. Increasing the autopsy rate of SCD in the young, better management of information obtained from autopsies as well developing of structured registry could improve the reliability of the statistical data, optimize the diagnostic procedures, and the preventive measures for the family members.
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Affiliation(s)
| | | | | | - Katarzyna Michaud
- University Center of Legal Medicine, Lausanne and Geneva, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
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Risgaard B, Winkel BG, Jabbari R, Behr ER, Ingemann-Hansen O, Thomsen JL, Ottesen GL, Gislason GH, Bundgaard H, Haunsø S, Holst AG, Tfelt-Hansen J. Burden of Sudden Cardiac Death in Persons Aged 1 to 49 Years. Circ Arrhythm Electrophysiol 2014; 7:205-11. [DOI: 10.1161/circep.113.001421] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Knowledge of the burden and causes of sudden cardiac death (SCD) is sparse in persons aged <50 years; better understanding is needed to lower the risk of SCD. The aim of this study was to report SCD incidence rates and autopsy findings in persons aged 1 to 49 years.
Methods and Results—
All deaths in persons aged 1 to 49 years were included in 2007 to 2009. Death certificates were reviewed by 2 physicians. History of previous admissions to hospital was assessed, and discharge summaries were read. Sudden unexpected death cases were identified and autopsy reports were collected. In the 3-year study period, there were 7849 deaths of which we identified 893 (11%) SCD cases. The annual incidence rate per 100 000 persons increased from 2.3 (95% confidence interval, 2.0–2.7) to 21.7 (95% confidence interval, 20.2–23.4) in persons aged 1 to 35 and 36 to 49 years, respectively. Coronary artery disease was the most common cause of death and was found in 158 (36%) autopsied cases, followed by 135 (31%) cases of sudden unexplained death.
Conclusions—
In a nationwide cohort of persons aged <50 years, the annual incidence rate of SCD was ≈10× higher in persons aged 36 to 49 years than in persons aged 1 to 35 years. Notably, coronary artery disease was the most common cause of SCD, followed by unexplained deaths. These findings may help in developing strategies to prevent SCD in the future.
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Affiliation(s)
- Bjarke Risgaard
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Bo Gregers Winkel
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Reza Jabbari
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Elijah R. Behr
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Ole Ingemann-Hansen
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Jørgen Lange Thomsen
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Gyda Lolk Ottesen
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Gunnar H. Gislason
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Henning Bundgaard
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Stig Haunsø
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Anders Gaarsdal Holst
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
| | - Jacob Tfelt-Hansen
- From the Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC) (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), Laboratory of Molecular Cardiology (B.R., B.G.W., R.J., S.H., A.G.H., J.T.-H.), and Unit for Inherited Cardiac Diseases, Department of Cardiology (H.B.), The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Cardiovascular Sciences Research Centre, St George’s University of London, London, United Kingdom (E.R.B.); Department of Forensic
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Wong LCH, Behr ER. Sudden unexplained death in infants and children: the role of undiagnosed inherited cardiac conditions. Europace 2014; 16:1706-13. [PMID: 24585884 DOI: 10.1093/europace/euu037] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Sudden unexplained death in childhood is a traumatic event for both the immediate family and medical professionals. This is termed sudden unexplained or arrhythmic death syndrome (SUDS/SADS) for children over 1 year of age while sudden unexplained death in infancy or sudden infant death syndrome (SUDI/SIDS) refers to unexplained deaths in the first year of life. There is increasing evidence for the role of undiagnosed inherited cardiac conditions, particularly channelopathies, as the cause of these deaths. This has far-reaching implications for the family regarding the potential risk to other family members and future pregnancies, providing a challenge not only in the counselling but also in the structured assessment and management of immediate relatives. This review will discuss the cardiac risk involved in sudden unexplained deaths of infants and children, the role of molecular autopsy, family cardiological screening, current management strategies, and future directions in this area.
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Affiliation(s)
- Leonie C H Wong
- Cardiovascular Sciences Research Centre, Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Elijah R Behr
- Cardiovascular Sciences Research Centre, Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
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Capone G, Kanduc D. Peptide sharing between Bordetella pertussis proteome and human sudden death proteins: a hypothesis for a causal link. Future Microbiol 2014; 8:1039-48. [PMID: 23902149 DOI: 10.2217/fmb.13.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIM To explore the molecular basis of the relationship between Bordetella pertussis infection and sudden death. METHODS B. pertussis proteins were analyzed for amino acid sequence identity to a set of 67 human proteins that, when altered, have been associated with sudden death. RESULTS More than 82,000 pentapeptides are shared between B. pertussis proteins and sudden death-associated antigens. CONCLUSION Results suggest that a possible link between B. pertussis infection and sudden death might be represented by potential immunological cross-reactions occurring between B. pertussis proteins and human proteins associated to sudden death.
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Affiliation(s)
- Giovanni Capone
- Department of Biosciences, Biotechnologies & Biopharmaceutics, University of Bari, Bari, Italy
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Sudden cardiac death in children and adolescents between 1 and 19 years of age. Heart Rhythm 2014; 11:239-45. [DOI: 10.1016/j.hrthm.2013.11.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Indexed: 01/01/2023]
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Winkel BG, Risgaard B, Sadjadieh G, Bundgaard H, Haunsø S, Tfelt-Hansen J. Sudden cardiac death in children (1-18 years): symptoms and causes of death in a nationwide setting. Eur Heart J 2013; 35:868-75. [PMID: 24344190 DOI: 10.1093/eurheartj/eht509] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS Hitherto, sudden cardiac death in children (SCDc)-defined as sudden cardiac death (SCD) in the 1-18 years old-has been incompletely described in the general population. Knowledge on incidence rates, causes of death and symptoms prior to death is sparse and has been affected by reporting and referral bias. METHODS AND RESULTS In a nationwide setting all deaths in children aged 1-18 years in Denmark in 2000-06 were included. To chart causes of death and incidence rates, death certificates and autopsy reports were collected and read. By additional use of the extensive healthcare registries in Denmark, we were also able to investigate prior disease and symptoms. During the 7-year study period there was an average of 1.11 million persons aged 1-18 years. There were a total of 1504 deaths (214 deaths per year) from 7.78 million person-years. A total of 114 (7.5%) were sudden and unexpected. A cardiac disease was known prior to death in 18% of all sudden unexpected death cases. In two-thirds of all sudden unexpected death cases no previous medical history was registered. Causes of death in autopsied cases were cardiac or unknown in 70%. Unexplained deaths, presumed to be a primary cardiac arrhythmia, accounted for 28% of autopsied sudden unexpected death cases. Autopsy rate was 77%. There were a total of 87 cases of SCDc (5.8% of all deaths). Prodromal symptoms were noted in 26% and antecedent symptoms in 45% of SCDc cases. The most frequent antecedent symptoms were seizures, dyspnoea, and syncope. In total, 61% of SCDc were not known with any prior disease; 23% were known with congenital or other heart disease prior to death. In total, 43 (49%) of all sudden unexpected deaths died of a potential inherited cardiac disease. The incidence rate of sudden unexpected death was 1.5 per 100 000 person-years. The highest possible incidence rate of SCDc was 1.1 per 100 000 person-years. CONCLUSION From a nationwide study of all deaths in a 7-year period more than half of all victims of SCDc experienced antecedent and/or prodromal symptoms prior to death. The incidence rate of sudden death and SCDc was 1.5 and 1.1 per 100 000 person-years, respectively. Cardiac symptoms in young persons should warrant clinical work-up and an autopsy should be performed in all cases of sudden unexpected death in which the deceased was not known with congenital heart disease prior to death. This is pivotal, in the subsequent familial cascade screening, to diagnose and treat potential inherited cardiac diseases in family members.
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Affiliation(s)
- Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet and Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
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Berdowski J, de Beus MF, Blom M, Bardai A, Bots ML, Doevendans PA, Grobbee DE, Tan HL, Tijssen JGP, Koster RW, Mosterd A. Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis. Eur Heart J 2013; 34:3616-23. [DOI: 10.1093/eurheartj/eht401] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Spradley FT, Kang KT, Pollock JS. Short-term hypercaloric diet induces blunted aortic vasoconstriction and enhanced vasorelaxation via increased nitric oxide synthase 3 activity and expression in Dahl salt-sensitive rats. Acta Physiol (Oxf) 2013; 207:358-68. [PMID: 23176108 DOI: 10.1111/apha.12025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 09/02/2012] [Accepted: 09/27/2012] [Indexed: 02/03/2023]
Abstract
AIM To elucidate the role of the O(2)(-), H(2)O(2) or NO pathways in aortic angiotensin (Ang)II-induced vasoconstriction in Dahl salt-sensitive (SS) rats compared with control SS-13(BN) rats on a normal or hypercaloric diet. METHODS Aortic function was assessed using wire myography in 16-week-old rats maintained on a normal diet or a 4-week hypercaloric diet. Nitric oxide synthase (NOS) activity and expression was determined by the conversion of radio-labelled arginine to citrulline and Western blot analysis respectively. RESULTS On normal diet, AngII-induced vasoconstriction was greater in SS than SS-13(BN) rats. Polyethylene glycol superoxide dismutase (PEG-SOD) reduced the aortic AngII response similarly in both strains on normal diet. Catalase blunted, whereas N(ω)-Nitro-L-arginine methyl ester (L-NAME) did not affect the AngII response in SS rats. In SS-13(BN) rats, catalase had no effect and L-NAME enhanced AngII response. On hypercaloric diet, aortic AngII responsiveness was reduced in SS but unaltered in SS-13(BN) rats compared with their normal diet counterparts. PEG-SOD reduced the AngII response in both rats on hypercaloric diet. Catalase treatment did not alter aortic AngII response, while L-NAME increased the response in SS rats on hypercaloric diet. In SS-13(BN) rats on hypercaloric diet, catalase reduced and L-NAME did not alter the AngII response. Furthermore, aortic endothelial-dependent vasorelaxation was increased in SS rats on hypercaloric diet compared with normal diet and aortic NOS3 activity and expression was increased. CONCLUSION A short-term hypercaloric diet induces a blunted vasoconstrictive and enhanced vasodilatory phenotype in SS rats, but not in SS-13(BN) rats, via reduced H(2)O(2) and increased NOS3 function.
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Affiliation(s)
| | - K.-T. Kang
- Vascular Biology Center; Medical College of Georgia; Georgia Health Sciences University; Augusta; GA; USA
| | - J. S. Pollock
- Section of Experimental Medicine; Department of Medicine; Medical College of Georgia; Georgia Health Sciences University; Augusta; GA; USA
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Huisma FF, Potts JE, Gibbs KA, Sanatani S. Assessing the knowledge of sudden unexpected death in the young among Canadian medical students and recent graduates: a cross-sectional study. BMJ Open 2012; 2:e001798. [PMID: 23242483 PMCID: PMC3533023 DOI: 10.1136/bmjopen-2012-001798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 08/04/2012] [Accepted: 11/22/2012] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the level of knowledge concerning Sudden Unexpected Death in the Young (SUDY) among Canadian medical students and recent graduates (≤5 years after graduating). DESIGN A cross-sectional study was conducted by distributing a standardised, multiple choice, online questionnaire which assessed basic knowledge of SUDY. SETTING Canadian medical schools and residency training programmes. PARTICIPANTS 614 Canadian medical students (in either their penultimate or final year) and recent graduates (≤5 years after graduating) completed an anonymous online questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES The level of knowledge regarding molecular aetiology, clinical presentation, pharmacological management and modes of inheritance of six of the commonest conditions causing SUDY, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQT) and Wolff-Parkinson White syndrome (WPW), were compared between medical students and recent graduates. Questions were broken down into basic knowledge and advanced categories and analysed as a secondary outcome measure. RESULTS Of 614 responses, approximately two-thirds were answered by recent graduates, who generally scored 10% higher on all subject categories than medical students. Overall, questions regarding HCM were best answered (40%), followed by WPW syndrome (32%), CPVT (30%), ARVC (23%), Brugada syndrome (21%) and LQT syndrome (17%). Questions categorised as basic knowledge were answered 30% and 39% correctly in medical student and recent graduate groups, respectively, and those in the advanced category were answered 20% and 25% correctly. CONCLUSIONS Survey respondents fared poorly when answering questions regarding SUDY, which may be a reflection of inadequate medical education regarding these disorders. Standardised teaching regarding SUDY needs to occupy a stronger focus in Canadian medical curricula in order to prevent more unnecessary deaths by these syndromes in the future.
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Affiliation(s)
- Felicity F Huisma
- Division of Pediatric Cardiology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
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van der Linde D, Takkenberg JJM, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk APJ, Witsenburg M, Yap SC, Bogers AJJC, Silversides CK, Oechslin EN, Roos-Hesselink JW. Natural history of discrete subaortic stenosisin adults: a multicentre study. Eur Heart J 2012; 34:1548-56. [DOI: 10.1093/eurheartj/ehs421] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morentin B, Aguilera B, Suárez-Mier MP, Molina P, Lucena J. A forensic pathology approach to sudden death in children and young adults in Biscay and Seville (Spain). Medwave 2012. [DOI: 10.5867/medwave.2012.09.5529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Risgaard B, Nielsen JB, Jabbari R, Haunsø S, Holst AG, Winkel BG, Tfelt-Hansen J. Prior myocardial infarction in the young: predisposes to a high relative risk but low absolute risk of a sudden cardiac death. ACTA ACUST UNITED AC 2012; 15:48-54. [DOI: 10.1093/europace/eus190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smith T, Theuns DAMJ, Muskens-Heemskerk A, Deckers JW, Jordaens L. Survivors of ventricular fibrillation have persistent cardiovascular risk factors late in follow-up. Eur J Prev Cardiol 2011; 20:161-7. [PMID: 22157513 DOI: 10.1177/1741826711432031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Implantable cardioverter-defibrillators (ICDs) prevent arrhythmic death, but do not modify disease progression. The prevalence of persistent cardiovascular risk factors in patients receiving an ICD and their adherence to optimal pharmacological therapy at late follow-up is unknown. The aim of this study was to assess the prevalence of cardiovascular and specific sudden cardiac arrest (SCA) risk factors, and the pharmacological treatment in ICD recipients who survived SCA caused by ventricular fibrillation (VF). DESIGN Cross-sectional study. A total of 100 consecutive ICD patients who survived SCA due to documented VF, not due to a transient or reversible cause or an arrhythmogenic disease, were interviewed and examined at the routine outpatient clinic. RESULTS The mean age of the patients was 60 ± 11 years, and they were analysed at a median interval of 1092 days after SCA. The majority of patients had coronary artery disease. The New York Heart Association class at the time of implantation was ≥ II in 62%. A single chamber device was used in 49% and a resynchronization device in 12%. At the routine control, the most prevalent risk factors were overweight or obesity (63%), hypertension (41%), and smoking (16%). Pharmacological therapy was suboptimal in 18-32% of the patients. Eight per cent of the patients had known diabetes and 29% had elevated HbA1c levels. While only 7% had pre-existing overt heart failure, 43% had N-terminal pro-brain natriuretic peptide levels ≥ 100 pmol/l. High sensitivity C-reactive protein was ≥ 3 mg/l in 52% of the patients. Family history was positive for sudden cardiac death (SCD) in 46% of the patients. CONCLUSIONS Despite regular medical consultation, a large proportion of the patients had persistent cardiovascular risk factors and were often suboptimally treated. Unexpectedly, latent heart failure and unrecognized diabetes are observed in a large proportion of the patients, as well as elevated inflammatory markers. Genetic analysis may be rewarding, as 46% of the patients had a family history of SCD. Full medical attention, optimizing drug therapy, and counselling of these patients is necessary.
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Affiliation(s)
- Tim Smith
- Erasmus MC, Rotterdam, The Netherlands
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Mortality Risk of Untreated Myosin-Binding Protein C–Related Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2011; 58:2406-14. [DOI: 10.1016/j.jacc.2011.07.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/13/2011] [Accepted: 07/27/2011] [Indexed: 11/24/2022]
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